Nausea and vomiting

Vomiting is an involuntary expulsion of the stomach contents. Nausea is the feeling or urge to vomit but may not lead to vomiting. Both are symptoms of many conditions and diseases, including pregnancy, malaria, migraine headaches, overeating, food poisoning, brain injury, motion sickness, kidney disease and medical treatments, like chemotherapy and antimalarials.

Nausea and vomiting are not diseases but are symptoms of many conditions like:

• Early pregnancy.
• Painful menstruation and premenstrual syndrome.
• Overeating.
• Response to strong odours or smells.
• Peptic ulcer disease.
• Motion sickness.
• Infections or viruses.
• Brain tumours or brain injuries.
• Psychological conditions like anorexia nervosa and bulimia.
• Certain medications such as opioids and some antibiotics can cause you to become nauseous or to vomit.
• It is common to become nauseous and to vomit during chemotherapy.

See your healthcare provider as soon as possible, if you:

• Have been vomiting for over 12 hours.
• Have associated inability to breathe or have chest pain.
• Are weak and unable to stand or do your daily activities.
• Are confused or unconscious.
• Have bloody or greenish vomit.
• Have a deviation of the eyes or pain in the eyes.
• Have a severe headache.

You can't prevent nausea, but you can prevent vomiting by using medicines that stop it or that treat an underlying disease. You can also reduce the severity or frequency by following the self-care tips.

For patients taking anti-cancer medicines, your healthcare provider will usually provide medicines that you can take to prevent vomiting.

Self-Care Tips

• Take little sips of water at intervals to stay hydrated.
• Use oral rehydration salts mixed with water to replenish lost fluids.
• Avoid oily or spicy foods. Eat light, bland foods in moderation.
• Choose various kinds of foods that you tolerate well to continue getting adequate nutrition.
• Avoid drinks like Coke, Fanta or other bubbly drinks (containing gas).
• Avoid lying down or sudden movements after eating as this can trigger nausea or vomiting.
• Aromatherapy may help in the case of nausea during pregnancy.
• Taking ginger and peppermint may help in the case of chemotherapy-induced nausea. In patients taking chemotherapy whose vomiting is triggered by anticipation, only medicines can help.
• You may also use over the counter medicines that reduce vomiting, like bismuth subsalicylate (Pepto-Bismol) and alginate (Gaviscon).
• Pyridoxine, a vitamin B type supplement, may also help with vomiting during pregnancy.

Treatment Options

The treatment for nausea and vomiting is dependent on the cause.

• Most prescription medicines for vomiting act in the brain and may cause drowsiness as a side effect. Do not operate machines or drive when using these pills.
• Some of the medicines used include sedatives (like promethazine), antihistamines (cyclizine), and serotonin inhibitors (ondansetron).
• For motion sickness you can use promethazine or Dramamine. Your healthcare provider may advise you to take this an hour before travelling. You can also use scopolamine, a patch you wear behind the ear, and apply it four hours before travelling.
• For pregnancy your healthcare provider may recommend meclizine and pyridoxine in small doses.
• For premenstrual syndrome and menstruation: you may use vitamin B6 supplements and calcium with vitamin D.
• Your healthcare provider may recommend metoclopramide or ondansetron for nausea or vomiting caused by chemotherapy, infection or medicines.

Nausea and vomiting usually resolve when the underlying cause is managed. Self-care helps relieve nausea and reduce the severity of symptoms.

Avoiding the risk factors like overeating, long road trips, and strong odours can also go a long way in treatment. Most people will experience nausea and vomiting at least once in their lifetime, in most cases, this will not be cause for alarm.

In people with motion sickness and other long-term illnesses, self-care and treatment may bring a cure. The goal is to reduce the severity of symptoms and improve function. Patience, open communication and collaboration with your healthcare provider will result in the best mix of self-care and treatment possible.