Nausea and vomiting

Nausea and vomiting

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: M.Umer Tariq [2]

Synonyms and Keywords: emesis

Overview

Nausea (Latin: Nausea, Greek: Template:Polytonic, "sea-sickness") is the sensation of unease and discomfort in the stomach with an urge to vomit.

Nausea is not a sickness, but rather a symptom of several conditions, many of which are not related to the stomach. Nausea is often indicative of an underlying condition elsewhere in the body. Travel sickness, which is due to confusion between perceived movement and actual movement, is an example. The sense of equilibrium lies in the ear and works together with eyesight. When these two don't "agree" to what extent the body is actually moving the symptom is presented as nausea even though the stomach itself has nothing to do with the situation. Nausea is also an adverse effect of many drugs. Nausea may also be an effect of a large intake of sugary foods.

In medicine, nausea can be a problem during some chemotherapy regimens and following general anaesthesia. Nausea is also a common symptom of pregnancy. Mild nausea experienced during pregnancy can be normal, and should not be considered an immediate cause for alarm.

• Vomiting (also throwing up or emesis) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting may result from many causes, ranging from gastritis or poisoning to brain tumors, or elevated intracranial pressure (ICP). The feeling that one is about to vomit is called nausea. It usually precedes, but does not always lead to vomiting. Antiemetics are sometimes necessary to suppress nausea and vomiting, and in severe cases where dehydration develops, intravenous fluid may need to be administered to replace fluid volume.

The medical branch investigating vomiting, emetics and antiemetics is called emetology.

Causes

Complete Differential Diagnosis of the Causes of Nausea and Vomiting (alphabetical)

1,2-Dichloroethene 1,3-Dichloropropene 2C-E 2C-I 2C-T-7 2-Ethylhexanol 5-Hydroxytryptophan 5-MeO-AMT Abrin ABVD Accessory pancreas Acetaminophen (patient information) Acetoxyketobemidone Acetylcysteine Achalasia Aciclovir Aconitine Acoustic neuroma Acromegaly Acute Coronary Syndromes Acute fatty liver of pregnancy Acute HIV infection Acute high altitude sickness Acute pancreatitis Acute prostatitis Acute viral nasopharyngitis (common cold) Adamsite Addison's Disease Adjustable gastric band Adrenal failure Afferent Loop Syndrome Airsickness Alatrofloxacin Injection (patient information) Albuterol Inhalation (patient information) Alcohol Withdrawal Alcoholism Aldesleukin (patient information) Allylprodine Alpha-Methyltryptamine Alprazolam Altitude sickness Altretamine Alvarado score Amifostine Amineptine Aminocaproic acid Aminopterin Aminosalicylic acid Amitriptyline (patient information) Ammonium chloride Amnesic shellfish poisoning Amoxicillin Amphotericin B Amrinone Amyl nitrite Amyloidosis Anadenanthera peregrina Anastomosis stenosis Anastrozole (patient information) Anesthesia Angina pectoris Anorexia nervosa Antihistamine Antiretroviral drug Anxiety Aortic Arch Anomalies Appendicitis Arachnoid cyst Aripiprazole (patient information) Arsenic Poisoning Asceptic Meningitis Asparaginase (patient information) Aspirin Astrovirus Atomoxetine Auranofin Autonomic neuropathy Azithromycin Aztreonam Bacillus cereus Balance disorder Barbiturate Barcoo Fever Barium oxalate Barium Sulfate (patient information) Beef tapeworm Beleric Belladonna Alkaloid Combinations Benign intracranial hypertension Benzodiazepine Benzylpiperazine Beta-lactam antibiotic Bevacizumab Injection (patient information) Bezafibrate (patient information) Bicalutamide (patient information) Biliary colic Blastocystosis Bleomycin Bortezomib Bowel obstruction Brain Stem Gliomas Brain tumor Breastfeeding complications Bromelain Bromomethane Bronchodilator Brucella Bulimia nervosa Buprenorphine Bupropion Busulfan (patient information) Butanethiol Butorphanol Cabergoline Caecitis Calcitonin Calcitriol Calcium carbamide Cancer Capecitabine (patient information) Capsaicin Carbon monoxide poisoning Carboplatin (patient information) Cardiac arrhythmia Carmustine (patient information) Carprofen Carvedilol (patient information) Caspofungin Cefaclor Cefoperazone Sodium Injection (patient information) Cefuroxime Cephalosporin Cerebral aneurysm Cerebral arteriovenous malformation Cerebral hemorrhage Cerebral shunt (blocked) Cerebrovascular disease Cetuximab Injection (patient information) Cevimeline Chelation therapy Chemotherapy Childbirth Chloral hydrate Chlordiazepoxide Chloromethane Chlorothiazide Chlorpropamide Cholecystitis Cholecystolithiasis CHOP Chronic fatigue syndrome Cicuta Ciguatera Cimicifuga racemosa Cinchonism Cisplatin Citalopram Cladribine (patient information) Clarithromycin Clindamycin Clofarabine Clofibrate Clomifene Clorazepate Co-codamol Codeine Colorado tick fever Combat stress reaction Community-acquired pneumonia Concussion Contraceptive patch Coprinopsis atramentaria Craniopharyngioma Crohn's disease Croup Cryptosporidium parvum Cyanogen Cyclic vomiting syndrome Cyclophosphamide Cyclospora cayetanensis Cytarabine (patient information) Cytisine Dacarbazine (patient information) Dactinomycin (patient information)

Dantrolene Daptomycin Darbepoetin Alfa Injection (patient information) Darunavir (patient information) Daunorubicin (patient information) Decompression sickness Deferasirox (patient information) Defibrotide Dehydration Dengue fever Depression Dextroamphetamine and Amphetamine (patient information) Dextromethorphan Dextropropoxyphene Diabetes mellitus Diabetic gastroparesis Diabetic Ketoacidosis Diarrheal shellfish poisoning Diazepam Diazinon Dicofol Dientamoebiasis Diethyl ether Diethylcathinone Diflunisal Digitalis purpurea Digitoxin Digoxin Dioxathion Dioxin Diphtheria Disagreeable sights, smells or thoughts (such as decayed matter, others' vomit, thinking of vomiting), etc. Disulfiram Diuretic Diverticulitis Docetaxel (patient information) Dofetilide (patient information) Dolasetron (patient information) Donepezil (patient information) Dosulepin hydrochloride Doxorubicin DTPA Duke's disease Duloxetine Dumping syndrome Ear infection Ebola Emergency contraception Emetine Encephalitis Endometriosis Endosulfan Enfuvirtide Entecavir (patient information) Enteric Neuropathy Eosinophilic gastroenteritis Ependymoma Epiploic appendagitis Epirubicin Injection (patient information) Episodic ataxia Epistaxis Epoetin Alfa Injection (patient information) Ergotism Erlotinib (patient information) Erotic vomiting Erythromycin Esophageal cancer Esophageal diverticulum Esophageal stenosis Esophagitis Essure Estradiol Estrogen and Progestin (Oral Contraceptives) (patient information) Ethcathinone Ethchlorvynol Ethosuximide Ethyl carbamate Ethylmorphine Etidronate (patient information) Etoposide Exenatide Exercise induced nausea Exercise urticaria Extreme pain Familial hemiplegic migraine Felbamate (patient information) Fentanyl Oral Transmucosal (patient information) Fexofenadine Filgrastim (patient information) Fioricet Floxuridine (patient information) Flu Fluconazole Flucytosine Fludarabine Phosphate (patient information) Fluorescein Fluoride poisoning Fluorouracil (patient information) Flurazepam Flutamide (patient information) Food allergies Food poisoning Foreign bodies Fructose intolerance hypoglycemia Fulvestrant Injection (patient information) Fundic gland polyposis Gabapentin (patient information) Gamma-Hydroxybutyric acid Gastric carcinoma Gastric outlet obstruction Gastritis Gastrocolic fistula Gastroenteritis Gastroesophageal reflux disease Gastrointestinal perforation Gastroparesis Gatifloxacin (patient information) Gefitinib (patient information) Gemcitabine Hydrochloride (patient information) Gemeprost General anaesthesia Gestational diabetes Giardia lamblia Ginger Ginkgo Glaucoma Glioblastoma multiforme Glioma Glycylcycline Goserelin (patient information) Graft-versus-host disease Granisetron (patient information) Green Tobacco Sickness Grifulvin V Guaifenesin Hangover Hantavirus pulmonary syndrome Head trauma Heat stroke Heavy metal ingestion Helicobacter pylori infection HELLP syndrome Hemicrania continua Hemorrhage Henipavirus Hepatic coma Hepatic porphyria Hepatitis B Hepatitis D Hepatitis E Herkinorin Hernia Heroin HIV Hookworm Hormone replacement therapy (trans) Human ehrlichiosis Hydralazine Hydrocephalus Hydrochlorothiazide Hydrocodone Hydromorphone Hydroxychloroquine Hydroxyurea (patient information) Hydroxyzine (patient information) Hypercalcemia Hyperemesis gravidarum Hypermagnesemia Hyperparathyroidism Hypertension Hyperthermia Hyperthyroidism Hypervitaminosis A Hypocalcemia Hypocholermia Hypoglycemia Hypokalemia Hyponatremia Hysterical contagion Iatrogenesis Ibogaine

Ibuprofen Idarubicin (patient information) Idiopathic Ifosfamide (patient information) Ileus Imatinib (patient information) Imipenem Inappetence Indometacin Inflammation in the area of the vestibular organ Influenza Instillation abortion Interstitial nephritis Intestinal parasite Intussusception (medical disorder) Iodomethane Iron(II) sulfate Irritable bowel syndrome Irukandji syndrome Ischemic bowel Isoniazid Isopropyl alcohol Isosorbide mononitrate Itraconazole Kaopectate Kaposi's sarcoma Ketogenic diet Ketorolac Ketotic hypoglycemia La Crosse encephalitis Labyrinthitis Lactose intolerance Lanreotide Lassa fever Lead poisoning Letrozole (patient information) Leuprolide (patient information) Levodopa and Carbidopa (patient information) Lewisite Lindane Listeria monocytogenes Lithium nitrate Lobelia Lomotil Lopinavir Loprazolam Lorazepam Lower respiratory tract infection Malaria Malaria prophylaxis Marine toxins Mastocytosis Mazindol Mechlorethamine (patient information) Medazepam Medical cannabis Megestrol (patient information) Melarsoprol Melphalan (patient information) Ménière's disease Meningitis Meningococcemia Meningoencephalitis Mercaptopurine Meropenem Mesalamine (patient information) Mescaline Mesenteric infarction Mesna (patient information) Metabolic acidosis Metal fume fever Metformin Methadone Methotrexate Methylergonovine Methylketobemidone Methylphenidate Methyprylon Metronidazole Mifepristone Migraine Milk of Magnesia Miltefosine Minimally Invasive Thorasic Spinal Fusion Mirtazapine Misoprostol Mitomycin (patient information) Mitotane Mitoxantrone Moclobemide Monocrotophos Mood stabilizer MOPP (medicine) Morning sickness Morphine Motion sickness Motofen Moxifloxacin Multiple chemical sensitivity Murray Valley encephalitis virus Mushroom poisoning Mycophenolic acid Myocardial infarction Nabilone Naegleria fowleri Nafcillin Nalbuphine Nalmefene Naloxone Naphthalene Natamycin Nerve agent Nervousness N-Ethyl-3-piperidyl benzilate Nicorandil Nicotine poisoning Nilutamide (patient information) Nitrazepam N-Nitroso-N-Methylurea Non-Hodgkin lymphoma Nootropic Norovirus Norplant Nortriptyline (patient information) Norwalk Virus Nutcracker syndrome Obidoxime Olanzapine (patient information) Omeprazole (patient information) Ondansetron Opioid Orellanine Orthostatic reaction Oseltamivir (patient information) Osteosarcoma Otitis interna Ovarian cyst Ovarian hyperstimulation syndrome Ovarian torsion Oxaliplatin Oxamniquine Oxazepam Oxcarbazepine Oxybutynin (patient information) Oxycodone and aspirin (patient information) Paclitaxel Paliperidone (patient information) Palonosetron Panic attack Pegaspargase (patient information) Pemetrexed injection (patient information) Penicillin Pentamidine Pentavalent antimonial Pentetic acid Pentostatin (patient information) Peptic ulcer Pergolide (patient information) Perhexiline Peritonitis Pesticide Pfiesteria piscicida PFPP Phenelzine (patient information) Phentermine Pholcodine Phytohaemagglutinin Pioglitazone (patient information) Piribedil Plicamycin (patient information) PMA Pneumonia Polio Poliomyelitis Porphyria Posaconazole (patient information) Post-concussion syndrome Post-exposure prophylaxis Postoperative nausea and vomiting Postoperative pain Post-tussive emesis Potassium bromide Potassium chloride Praziquantel Pregabalin (patient information)

Pregnancy Primaquine (patient information) Procainamide (patient information) Procarbazine (patient information) Prochlorperazine Prolactinoma Propiram Propylketobemidone Prosidol Protriptyline (patient information) Pseudo-obstruction Psychogenic vomiting Pulmonary embolism Pyelonephritis Pyloric stenosis Pyrazinamide Pyridoxine deficiency Q fever Quetiapine (patient information) Quinupristin/dalfopristin Radiation poisoning Ranolazine (patient information) Rasagiline (patient information) Refractive error Renal colic Renal failure Reserpine Reye's syndrome Risedronate (patient information) Rituximab injection (patient information) Rivastigmine (patient information) Rizatriptan (patient information) Rocky Mountain spotted fever Ropinirole (patient information) Rotigotine Roxithromycin Rubbing alcohol Salpingitis Salsalate (patient information) Sarin Sativex Scarlet fever Scleroderma Seasickness Secobarbital Selective serotonin reuptake inhibitor Selegiline (patient information) Seliciclib Sexual fetish (emetophilia) Shigella Sibutramine (patient information) Ski sickness Sleep deprivation Slone's Disease Small bowel bacterial overgrowth syndrome Small intestine cancer Smoke inhalation Snakebites Soapwort Sodium polystyrene sulfonate (patient information) Sodium stibogluconate Solanine Sorafenib (patient information) Spider bite Spironolactone (patient information) Splenic infarction Spoiled foods Sporotrichosis Spotted fever SSRI discontinuation syndrome Staphylococcal enteritis Stiripentol Strep throat Streptozocin (patient information) Subdural hematoma Sufentanil Sultiame Sumatriptan injection (patient information) Sunitinib (patient information) Suramin Syndrome of inappropriate antidiuretic hormone (SIADH) Tabes dorsalis Tacrine Tapentadol Telbivudine (patient information) Telithromycin (patient information) Temik Temozolomide Teniposide (patient information) Testicular rupture Testicular torsion Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine (patient information) Tetrahydrocannabinol Tetrahydrozoline Tetramethylsuccinonitrile Tetrodotoxin Theobromine Thiabendazole Thiethylperazine Thioguanine (patient information) Thiotepa (patient information) Thrombotic thrombocytopenic purpura Thyroid Medication (patient information) Thyrotoxicosis Tigecycline Tobacco smoking and second-hand smoke Tocopherol Tolmetin Topiramate Topotecan Hydrochloride (patient information) Toxidrome Tralomethrin Tramadol Trandolapril Trastuzumab Traumatic brain injury Traveler's diarrhea Trazodone Triamterene Triazolam Triclofos Tricyclic antidepressant Trifluoperazine Trifluoromethylphenylpiperazine Trimeperidine Trimethobenzamide (patient information) Trimetrexate Glucuronate (patient information) Tropisetron Trovafloxacin (patient information) Tularemia Twisted ovarian cyst Typhoid Vaccine (patient information) Typhus Ulcers Uremia Urofollitropin Urolithiasis Vagotomy Valaciclovir Valproic Acid (patient information) Varenicline Vasovagal syncope Venlafaxine Vertebro-basilar syndrome Vertigo Vestibular balance disorder Vestibular neuronitis Vibrio parahaemolyticus Vicodin Vidarabine Vigabatrin Viloxazine Vinblastine (patient information) Vinorelbine Tartrate (patient information) Violent emotions (including laughing) Violent fits of coughing or hiccups Vitamin A Vitamin C Vitamin D Volvulus Voriconazole Vorinostat (patient information) Water intoxication Waterborne diseases West Nile virus Yellow fever Zanamivir Inhalation (patient information) Ziprasidone (patient information) Zollinger-Ellison Syndrome Zolpidem (patient information) Zopiclone

Complete Differential Diagnosis of the Causes of Nausea and Vomiting (by organ system)

Cardiovascular	Acute Coronary Syndromes, Amyloidosis, Anastomosis stenosis, Angina pectoris, Aortic Arch Anomalies, Cardiac arrhythmia, Cerebral aneurysm, Cerebral arteriovenous malformation, Cerebrovascular disease,Myocardial infarction,
Chemical / poisoning	1,2-Dichloroethene, 1,3-Dichloropropene ,Abrin,Aconitine , Adamsite, Bromomethane, Butanethiol, Capsaicin, Carbon monoxide poisoning, Chloromethane, Ciguatera, Cinchonism, Cyanogen, Digitalis purpurea,Ginkgo,Heavy metal ingestion,Iodomethane,Iron poisoning,Iron(II) sulfate,Lewisite,Lindane,Lobelia,N-Ethyl-3-piperidyl benzilate,Nicotine poisoning,N-Nitroso-N-Methylurea,PFPP,Potassium bromide,Smoke inhalation,Snakebites,Temik,Green Tobacco Sickness,Lead poisoning,Metal fume fever,Naegleria fowleri,Nerve agent,Phytohaemagglutinin,
Dermatologic	No underlying causes
Drug Side Effect	2C-E, 2C-I, 2C-T-7, 5-Hydroxytryptophan, 5-MeO-AMT, ABVD, Acetoxyketobemidone, Acetylcysteine, Acetylsalicylic acid, Aciclovir, Alatrofloxacin, Albuterol, Aldesleukin , Allylprodine, Alpha-Methyltryptamine, Alprazolam, Altretamine, Amifostine, Amineptine, Aminocaproic acid, Aminopterin, Aminosalicylic acid, Amitriptyline, Amoxicillin, Amphotericin B, Amrinone, Amyl nitrite, Anadenanthera peregrina, Analgesic, Anastrozole, Anesthesia, Antihistamine, Antiretroviral drug, Aripiprazole, Asparaginase, Atomoxetine, Auranofin, Azithromycin, Aztreonam, Barbiturate, Barium sulfate, Belladonna alkaloid combinations and phenobarbital, Benzodiazepine, Benzylpiperazine, Beta-lactam antibiotic, Bevacizumab, Bezafibrate, Bicalutamide, Bleomycin, Bortezomib, Bromelain, Bronchodilator, Buprenorphine, Busulfan, Butorphanol, Cabergoline, Calcitriol, Calcium carbamide, Capecitabine, Carboplatin, Carmustine, Carprofen, Carvedilol, Caspofungin, Cefaclor, Cefoperazone sodium, Cefuroxime, Cephalosporin, Cetuximab, Cevimeline, Chelation therapy, Chemotherapy, Chlordiazepoxide, Chlorothiazide, Chlorpropamide, CHOP, Cimicifuga racemosa, Cisplatin, Cladribine (patient information), Clarithromycin, Clindamycin, Clofarabine, Clofibrate, Clomifene, Clorazepate, Co-codamol, Codeine, Combined oral contraceptive pill, Contraceptive patch, Cyclophosphamide, Cytisine, Cytarabine, Dacarbazine , Dactinomycin , Dantrolene, Daptomycin, Darbepoetin Alfa Injection , Darunavir , Daunorubicin , Deferasirox , Defibrotide, Dextroamphetamine and Amphetamine , Dextromethorphan, Dextropropoxyphene, Diazepam, Diazinon, Dicofol, Diethyl ether, Diethylcathinone, Diflunisal, Digitoxin, Digoxin, Diethylcathinone, Diethyl ether, Disulfiram , Diuretic, Docetaxel , Dofetilide , Dolasetron , Donepezil , Dosulepin hydrochloride, Doxorubicin, DTPA, Duloxetine, Emetine, Endosulfan, Enfuvirtide, Entecavir , Epirubicin , Epoetin Alfa , Erlotinib , Erythromycin, Estradiol, Estrogen and Progestin (Oral Contraceptives) , Ethcathinone, Ethchlorvynol, Ethosuximide, Ethyl carbamate, Ethylmorphine, Etidronate , Etoposide, Exenatide, Felbamate , Fentanyl Oral Transmucosal , Fexofenadine, Filgrastim , Fioricet, Floxuridine , Fluconazole, Flucytosine, Fludarabine Phosphate , Fluorescein, Fluorouracil , Flurazepam, Flutamide , Fulvestrant , Gabapentin , Gamma-Hydroxybutyric acid, Gatifloxacin , Gefitinib , Gemcitabine Hydrochloride , Gemeprost, Glycylcycline, Goserelin , Granisetron , Grifulvin V, Guaifenesin, H1 antihistamine, Herkinorin, Heroin, Hydralazine, Hydrochlorothiazide, Hydrocodone, Hydromorphone, Hydroxychloroquine, Hydroxyurea , Hydroxyzine , Ibogaine, Ibuprofen, Idarubicin , Ifosfamide , Imatinib , Imipenem, Iodomethane, Isoniazid, Isopropyl alcohol, Isosorbide mononitrate, Itraconazole, Kaopectate, Ketorolac, Lanreotide, Letrozole , Leuprolide , Levodopa and Carbidopa , Lithium nitrate, Lopinavir, Loprazolam, Lorazepam, Malaria prophylaxis, Mechlorethamine , Medazepam, Megestrol , Melarsoprol, Melphalan , Mercaptopurine, Meropenem, Mesalamine , Mescaline, Mesna, Metformin, Methadone, Methotrexate, Methylergonovine, Methylketobemidone, Methylphenidate, Methyprylon, Metronidazole, Mifepristone, Milk of Magnesia, Miltefosine, Mirtazapine, Misoprostol, Mitomycin , Mitotane, Mitoxantrone, Moclobemide, Monocrotophos, Morphine, Motofen, Moxifloxacin, Mycophenolic acid, Nabilone, Nafcillin, Nalbuphine, Nalmefene, Naloxone, Naphthalene, Natamycin, Nicorandil, Nilutamide , Nitrazepam, Nortriptyline , Obidoxime, Olanzapine , Omeprazole , Ondansetron, Opioid, Oseltamivir , Oxaliplatin, Oxamniquine, Oxazepam, Oxcarbazepine, Oxybutynin , Oxycodone and aspirin , Paclitaxel, Paliperidone , Palonosetron, Paracetamol, Pegaspargase , Pemetrexed , Penicillin, Pentamidine, Pentavalent antimonial, Pentetic acid, Pentostatin , Pergolide , Perhexiline, Phenelzine , Phentermine, Pholcodine, Pioglitazone , Piribedil, Plicamycin , Posaconazole , Potassium chloride, Praziquantel, Pregabalin , Primaquine , Procainamide , Procarbazine , Prochlorperazine, Propiram, Propylketobemidone, Prosidol, Protriptyline , Pyrazinamide, Quetiapine , Quinupristin/dalfopristin, Ranolazine , Rasagiline , Reserpine, Risedronate , Rituximab , Rivastigmine , Rizatriptan , Ropinirole , Rotigotine, Roxithromycin, Rubbing alcohol, Salsalate , Sarin, Sativex, Secobarbital, Selegiline , Seliciclib, Serotonin, Sibutramine , Sodium polystyrene sulfonate , Sodium stibogluconate, Solanine, Sorafenib , Spironolactone , Stiripentol, Streptozocin , Sufentanil, Sultiame, Sumatriptan , Sunitinib , Suramin, Tapentadol, Telbivudine , Telithromycin , Temozolomide, Teniposide , Tetrahydrocannabinol, Tetrahydrozoline, Tetramethylsuccinonitrile, Tetrodotoxin, Thiabendazole, Thiethylperazine, Thioguanine , Thiotepa , Thyroid Medication , Tigecycline, Tocopherol, Tolcapone , Tolmetin, Topiramate, Topotecan Hydrochloride , Tralomethrin, Tramadol, Trandolapril, Trastuzumab, Trazodone, Triamterene, Triazolam, Triclofos, Tricyclic antidepressant, Trifluoperazine, Trifluoromethylphenylpiperazine, Trimeperidine, Trimethobenzamide , Trimetrexate Glucuronate , Tropisetron, Trovafloxacin , Valaciclovir, Valproic Acid , Varenicline, Venlafaxine, Vicodin, Vidarabine, Vigabatrin, Viloxazine, Vinblastine , Vinorelbine Tartrate , Voriconazole, Vorinostat , Zolpidem , Zopiclone,
Ear Nose Throat	Ear infection,Epistaxis,Labyrinthitis,Ménière's disease,Otitis interna
Endocrine	Acromegaly, Addison's Disease, Adrenal failure, Diabetes mellitus,Hyperparathyroidism,Hyperthyroidism,Prolactinoma,Syndrome of inappropriate antidiuretic hormone (SIADH),Thyrotoxicosis,
Environmental	Bothrops bite, Bromomethane, Carbon monoxide poisoning,Heat stroke,Dioxin,
Gastroenterologic	Achalasia, Acute abdomen , Accessory pancreas , Acute fatty liver of pregnancy, Acute pancreatitis, Adjustable gastric band, Afferent loop syndrome, Alcoholic Hepatitis, Alcoholism, Anastomosis stenosis, Appendicitis, Bacterial gastroenteritis, Beef tapeworm, Biliary colic, Blastocystosis, Bowel obstruction, Brucella, Bulimia nervosa, Caecitis, Cholecystitis, Cholecystolithiasis, Crohn's disease, Cyclic vomiting syndrome,Diabetic gastroparesis,Diverticulitis,Enteric Neuropathy,Epiploic appendagitis,Esophageal cancer,Esophageal diverticulum,Esophageal stenosis,Esophagitis,Food allergies,Food poisoning,Fundic gland polyposis,Gastric carcinoma,Gastric outlet obstruction,Gastritis,Gastrocolic fistula,Gastroenteritis,Gastroesophageal reflux disease,Gastrointestinal perforation,Gastroparesis,Hepatic coma,Hepatic porphyria,Hepatitis,Hernia,Ileus,Intussusception (medical disorder),Irritable bowel syndrome, Ischemic bowel,Mesenteric ischemia,Peptic ulcer,Peritonitis,Pyloric stenosis,Small bowel bacterial overgrowth syndrome, Small intestine cancer,Traveler's diarrhea,
Genetic	Slone's Disease,
Hematologic	Mastocytosis,Porphyria,Splenic infarction,Thrombotic thrombocytopenic purpura,
Iatrogenic	Essure,Dumping syndrome,High doses of ionizing radiation,Instillation abortion,Minimally Invasive Thorasic Spinal Fusion,
Infectious Disease	Acute infections,Acute viral nasopharyngitis (common cold), AIDS, Asceptic Meningitis, Astrovirus, Bacillus cereus infection, Beef tapeworm,Bacterial gastroenteritis, Bacillus cereus infection, Barcoo Fever, Blastocystosis, Brucella, Colorado tick fever, Community-acquired pneumonia, Croup, Cryptosporidium parvum infection, Cyclospora cayetanensis infection,Dengue fever,Diarrheal shellfish poisoning,Dientamoebiasis,Diphtheria,Duke's disease,Ebola,Giardia lamblia,Hantavirus pulmonary syndrome,Helicobacter pylori infection,Henipavirus,Hepatitis B,Hepatitis D,Hepatitis E,Hookworm,Human ehrlichiosis,Influenza,Intestinal parasite,Lassa fever,Listeria monocytogenes,Malaria,Meningococcemia,Naegleria fowleri,Norovirus,Norwalk Virus,Pfiesteria piscicida,Poliomyelitis,Q fever,Rocky Mountain spotted fever,Scarlet fever,Shigella,Sporotrichosis,Staphylococcal enteritis,Tularemia,Vibrio parahaemolyticus,West Nile virus, Yellow fever,
Musculoskeletal / Ortho	No underlying causes
Neurologic	Acoustic neuroma , Arachnoid cyst, Asceptic Meningitis, Autonomic neuropathy, Balance disorder, Benign intracranial hypertension ,Brain Stem Gliomas, Brain tumor, Cerebral aneurysm, Cerebral arteriovenous malformation, Cerebral hemorrhage,Cerebrovascular disease,Concussion, Craniopharyngioma, Cyclic vomiting syndrome,Encephalitis,Ependymoma,Episodic ataxia,Familial hemiplegic migraine,Glioblastoma multiforme,Glioma,Hemicrania continua,Hydrocephalus,La Crosse encephalitis,Subdural hematoma,Tabes dorsalis,Vagal episode,Vertebrobasilar insufficiency,Vestibular neuritis
Nutritional / Metabolic	Amnesic shellfish poisoning, , Cicuta, Coprinopsis atramentaria,Pyridoxine deficiency,Ginger,Lactose intolerance / Hypercalcemia,Hypermagnesemia,Hypocalcemia,Hypocholermia,Hypoglycemia,Hypokalemia,Hyponatremia,Ketogenic diet,Metabolic acidosis,
Obstetric/Gynecologic	Acute fatty liver of pregnancy, Breastfeeding complications, Childbirth,Endometriosis,Gestational diabetes,HELLP syndrome,Hyperemesis gravidarum,Ovarian cyst,Ovarian hyperstimulation syndrome,Ovarian torsion,Pregnancy,Salpingitis,Twisted ovarian cyst,
Oncologic	Acoustic neuroma, Brain Stem Gliomas, Brain tumor, Craniopharyngioma,Ependymoma,Kaposi's sarcoma,Non-Hodgkin lymphoma,Osteosarcoma,Prolactinoma,Zollinger-Ellison Syndrome,
Opthalmologic	Glaucoma,Refractive error,
Overdose / Toxicity	1,2-Dichloroethene, 1,3-Dichloropropene, 2C-E, 2C-I, 2C-T-7, Abrin, ABVD, Acetaminophen (patient information), Acetoxyketobemidone, Acetylsalicylic acid, Aconitine, Aminopterin, Antihistamine, Arsenic Poisoning, Aspirin, Barium oxalate, Beleric, Bupropion, Chloral hydrate, CHOP, Cinchonism, Dioxathion,Ergotism, Fluoride poisoning,Indometacin,Lomotil,Mazindol,Orellanine, Vitamin C,Vitamin A,Vitamin D,Marine toxins,Pesticide,PMA,Soapwort,Theobromine,
Psychiatric	Alcohol Withdrawal, Anorexia nervosa, Anxiety, Bulimia nervosa, Combat stress reaction,Depression,Disagreeable sights, smells or thoughts (such as decayed matter, others' vomit, thinking of vomiting), etc.,Hangover,Psychogenic vomiting,Sexual fetish (emetophilia),
Pulmonary	Community-acquired pneumonia,Hantavirus pulmonary syndrome,Lower respiratory tract infection,Pulmonary embolism,
Renal / Electrolyte	Dehydration,Diabetic Ketoacidosis,Interstitial nephritis,Nutcracker syndrome,Pyelonephritis,Renal colic, Renal failure,Renal stones,
Rheum / Immune / Allergy	Amyloidosis, Chronic fatigue syndrome, Crohn's disease,Graft-versus-host disease,Scleroderma,Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine ,Typhoid Vaccine ,
Sexual	AIDS
Trauma	Post-concussion syndrome,Head trauma,Hemorrhage,
Urologic	Acute prostatitis, Testicular rupture,Testicular torsion,Urolithiasis,
Miscellaneous	Acute high altitude sickness, Airsickness,Decompression sickness,Exercise induced nausea,Extreme pain,Foreign bodies,Hyperthermia,Mushroom poisoning,Post-tussive emesis,Reye's syndrome,Seasickness,Sleep deprivation,SSRI discontinuation syndrome,Ulcers,Water intoxication,Waterborne diseases,

Pathophysiology of nausea and vomiting

Vomiting center

Vomiting is coordinated in the vomiting center in the lateral medullary reticular formation in the pons. Receptors on the floor of the fourth ventricle of the brain represent a chemoreceptor trigger zone, stimulation of which can lead to vomiting. The chemoreceptor zone lies outside the blood-brain barrier, and can therefore be stimulated by blood-borne drugs that can stimulate vomiting, or inhibit it.

There are various sources of input to the vomiting center:

• The chemoreceptor trigger zone at the base of the fourth ventricle has numerous dopamine D₂ receptors, serotonin 5-HT₃ receptors, opioid receptors, Acetylcholine receptors, and receptors for substance P. Stimulation of different receptors are involved in different pathways leading to emesis, in the final common pathway substance P appears to be involved.
• The vestibular system which sends information to the brain via cranial nerve VIII (vestibulocochlear nerve). It plays a major role in motion sickness and is rich in muscarinic receptors and histamine H₁ receptors.
• Cranial nerve X (vagus nerve), which is activated when the pharynx is irritated, leading to a gag reflex.
• Vagal and enteric nervous system inputs that transmit information regarding the state of the gastrointestinal system. Irritation of the GI mucosa by chemotherapy, radiation, distention or acute infectious gastroenteritis activates the 5-HT₃ receptors of these inputs.
• The CNS mediates vomiting arising from psychiatric disorders and stress.

Vomiting Act

The vomiting act encompasses three types of outputs initiated by the medulla: Motor, parasympathetic nervous system (PNS) and sympathetic nervous system (SNS). Collectively, they are as follows:

• Increased salivation to protect the enamel of teeth from stomach acids (excessive vomiting leads to caries). This is part of the PNS output.
• Retroperistalsis, starting from the middle of the small intestine, sweeping up the contents of the digestive tract into the stomach, through the relaxed pyloric sphincter.
• A lowering of intrathoracic pressure (by inspiration against a closed glottis), coupled with an increase in abdominal pressure as the abdominal muscles contract, propels stomach contents into the esophagus without involvement of retroperistalsis. The lower esophageal sphincter relaxes. This is part of the motor output, and it is also important to note that the stomach itself does not contract in the process of vomiting.
• Vomiting is ordinarily preceded by retching.
• Vomiting also initiates a SNS response causing both sweating and increased heart rate.

The neurotransmitters that regulate vomiting are poorly understood, but inhibitors of dopamine, histamine and serotonin are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. Vasopressin and neurokinin may also participate.

Content

Since the stomach secretes acid, vomit contains a high concentration of hydronium ions and is thus strongly acidic. Recent food intake will be reflected in the gastric vomit.

The content of the vomitus (vomit) may be of medical interest. Fresh blood in the vomit is termed hematemesis ("blood vomiting"). Old blood bears resemblance to coffee grounds (as the iron in the blood is oxidized), and when this matter is identified the term "coffee ground vomiting" is used. Bile can enter the vomit during subsequent heaves due to duodenal contraction if the vomiting is severe. Fecal vomiting is often a consequence of intestinal obstruction, and is treated as a warning sign of this potentially serious problem ("signum mali ominis"); such vomiting is sometimes called "miserere". If food has recently been consumed, then partly digested food may show up in the vomit.

If the vomiting reflex continues for an extended period of time with no appreciable vomitus, the condition is known as non-productive emesis or dry heaves, which can become both extremely painful and debilitating.

Diagnosis

Physical Examination

• Exams should include:

  • Neurologic
  • Ear
  • Ophthalmagic
  • Abdominal

Laboratory Findings

• Complete blood count (CBC)
• Electrolytes
• Liver function tests (LFTs)
• Amylase
• Lipase
• Calcium
• Magnesium
• Salicylate level
• Hepatitis serologies
• Cerebrospinal fluid (CSF) analysis
• Toxicology screen

Electrolyte and Biomarker Studies

• Electrolytes

Electrocardiogram

• ECG to rule out an inferior MI or arrhythmia

X Ray

• Plain kidney, ureter, bladder (KUB) X-rays

MRI and CT

• Abdominal CT scan (with oral and IV contrast)
• Head CT scan

Echocardiography or Ultrasound

• Abdominal/pelvic ultrasound

Other Diagnostic Studies

• Endoscopy
• Colonoscopy

Treatment

• Fluid resuscitation (due to vomiting-induced dehydration)
• Treat underlying disease etiologies

Treatment of Nausea

While short-term nausea and vomiting are generally harmless, they may sometimes indicate a more serious condition, such as Coeliac disease. When associated with prolonged vomiting, it may lead to dehydration and/or dangerous electrolyte imbalances.

Symptomatic treatment for nausea and vomiting may include short-term avoidance of solid food. This is usually easy as nausea is nearly always associated with loss of appetite. Dehydration may require rehydration with oral or intravenous electrolyte solutions. If the cause is by motion sickness, sitting down in a still environment may also help.

There are several types of antiemetics, and researchers continue to look for more effective treatments. The main types used post operatively for surgical patients are ondansetron, dexamethasone, promethazine, diphenhydramine, and in small doses droperidol. Doxylamine is the drug of choice in pregnancy-related nausea. Anecdotally, another remedy used by recovery room nurses is to place an isopropyl alcohol swab under the patient's nose while he or she breathes through the nose. This may abate the nausea until the antiemetic medication takes effect. When ingested or inhaled, the chemical compound tetrahydrocannabinol has been shown to reduce nausea in some users. Also available are a variety of non-invasive (often untested) mechanical devices used to suppress nausea due to motion sickness.

The spice ginger is also used for centuries as a folk remedy to treat nausea, and recent research has supported this use.

Treatment of Vomiting

Acute Pharmacotherapies

• Antiemetics: An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of some opioid analgesics and chemotherapy directed against cancer. Antiemetics act by inhibiting the receptor sites associated with emesis. Hence, anticholinergics, antihistamines, dopamine antagonists, serotonin antagonists and cannabinoids are used as anti-emetics.
• Anticholinergics

Surgery and Device Based Therapy

• Colonoscopy/endoscopy may also be used as therapy

Complications of vomiting

Aspiration of vomit

Vomiting can be very dangerous if the gastric content gets into the respiratory tract. Under normal circumstances the gag reflex and coughing will prevent this from occurring, however these protective reflexes are compromised in persons under narcotic influences such as alcohol or anesthesia. The individual may choke and asphyxiate or suffer an aspiration pneumonia.

Dehydration and electrolyte imbalance

Prolonged and excessive vomiting will deplete the body of water (dehydration) and may alter the electrolyte status. The loss of acids leads to metabolic alkalosis (increased blood pH), and the electrolyte imbalance shows hypokalemia (potassium depletion) and hypochloremia (chlorine depletion). The hypokalemia is an indirect result of the kidney compensating for the loss of acid. With the loss of intake of food the individual will become cachectic.

References