Nausea

Nausea is an uneasiness and/or discomfort of the stomach that causes an involuntary urge to vomit. Nausea does not always lead to vomiting. It is a nonspecific symptom and therefore can occur in many conditions.

Nausea is a symptom that can be associated with many conditions. These conditions include, but are not limited to:

• motion sickness or sea sickness
• medications such as chemotherapy used to treat cancer and anesthetics as seen following surgery
• pregnancy
• stress
• infections such as viral or bacterial infections of that affect the gastrointestinal tract as well as those that may affect other organs such as bladder and kidney infections and pneumonia
• gall bladder disease
• inflammation of the pancreas or liver
• viral infection of the liver (viral hepatitis)
• food poisoning
• overeating or after eating a large meal
• eating greasy foods
• gastroesophageal reflux disease
• constipation
• peptic ulcers in the stomach or small intestine
• gastroparesis (a condition that causes slow emptying of stomach contents)
• reaction to certain smells or odors, concussion, ingestion of toxins or excessive amounts of alcohol.

There are no specific investigations that are recommended for nausea. A thorough history and a physical exam are of utmost importance in determine if laboratory and/or radiologic testing should be done based on the chronicity of nausea and presence of other symptoms.

Initially, treatment involves avoiding possible triggers including certain foods and/or medications. If symptoms are not improving, medications may be used. Commonly used medications include:

• anti-emetic medications to decrease associated nausea and vomiting such as diphenhydrinate or ondansetron
• histamine-2-blockers or proton pump inhibitors which are antacids that decrease the production or release of acid made into the stomach
• prokinetic medications such as erythromycin or metoclopramide, to improve the emptying of the stomach.

If dehydration is present due to poor appetite, rehydration with oral electrolyte solutions are recommended. If this is not effective or possible, intravenous rehydration may be required. Nutrition support may also be needed, especially if the nausea is persistent. This includes drinking clear liquids and eating bland foods. If drinking or eating by mouth is not tolerated, a nasogastric or nasojejunal tube can be placed through the nose into the stomach or small intestines, respectively. Feedings can be administered through these tubes to ensure adequate growth, hydration and nutrition status. In some cases, when tube feeds are not tolerated, parenteral nutrition through an intravenous line can supply essential nutrients and vitamins directly into the bloodstream.

Short term causes of nausea, such as those seen with infections and pregnancy, are self-limited and do not recur. However, with persistent nausea, a further evaluation should be done to identify the cause and help to tailor the correct treatment.