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Vomiting
| Definition |
| Nausea is the sensation leading to the
urge to vomit. To vomit is to force the contents of the stomach up
through the esophagus and out of the mouth. |
| Alternative names |
| emesis; vomiting; stomach upset; upset
stomach |
| Considerations |
Dehydration is the biggest concern in
most vomiting episodes. The rate with which dehydration takes place
depends on the size of the person, the frequency of the vomiting, and
whether or not there is also diarrhea.
Infants with frequent vomiting and diarrhea are at the greatest risk for
dehydration and need immediate medical attention.
Signs of dehydration are increased thirst, infrequent urination or dark
yellow urine, dry mouth, eyes that appear sunken, and skin that has lost
its normal elasticity. |
| Common causes |
- medications
- viral infections
- seasickness or motion sickness
- migraine headaches
- morning sickness during pregnancy
- food poisoning
- food allergies
- chemotherapy in cancer patients
- bulimia
- alcoholism
Possible causes of vomiting in infants
(0 to 6 months):
- congenital pyloric stenosis, a
constriction in the outlet from the stomach (With this disorder, the
infant--usually male, less than 4 months old--vomits forcefully
after each feeding but otherwise appears to be healthy.)
- disturbed equilibrium from bouncing
the baby immediately after feeding
- food allergies or milk intolerance
- gastroenteritis (infection of the
digestive tract that usually causes vomiting with diarrhea)
- gastroesophageal reflux
- hole in bottle nipple may be wrong
size
- infection, often accompanied by a
fever or runny nose
- intestinal obstruction, evidenced
by recurring attacks of vomiting, and crying or screaming as if in
great pain
- accidental ingestion of a drug or
poison--Call the doctor IMMEDIATELY or take the child to an
emergency care facility!
Note: There may be other causes of
nausea and vomiting. This list is not all inclusive, and the causes are
not presented in order of likelihood. The causes of this symptom can
include unlikely diseases and medications. Furthermore, the causes may
vary based on age and gender of the affected person, as well as on the
specific characteristics of the symptom such as quality, time course,
aggravating factors, relieving factors, and associated complaints. Use
the Symptom Analysis option to explore the possible explanations for
nausea and vomiting, occurring alone or in combination with other
problems.
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| Home care |
When the cause of nausea and vomiting
is known, it is important to treat the underlying disorder.
Whatever the cause, it is important for the person who has vomited a
great deal to take in as much fluid as possible without upsetting the
stomach any further. Sip clear fluids such as water, ginger ale, fruit
juices, or Gatorade. Don't drink much at any one time, and work slowly
back to a normal diet.
There is currently no treatment that has been approved by the FDA for
morning sickness in pregnant women.
Treatment for motion sickness:
- Lying down can often help.
- Antihistamines (such as cyclizine,
meclizine, or Marezine), which are available over the counter, may
help.
- Scopolamine skin patches (such as
Transderm Scop) require a prescription and are useful for extended
trips (such as an ocean voyage). In order to prevent the onset of
motion sickness, the scopolamine patch should be put on 4 to 12
hours before setting sail. Although scopolamine is effective, it may
produce dry mouth, blurred vision, and some drowsiness. Scopolamine
is for adults only. It should not be given to children.
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| Call your health care provider if |
- there is bleeding (bloody or black
vomitus) or severe abdominal pain (call immediately)! Some abdominal
discomfort accompanies almost every case of vomiting, but severe
pain is not common.
- a headache and stiff neck are also
present.
- there is lethargy or marked
irritability in a young child.
- there are signs of dehydration.
- a child is unable to retain any
fluids for eight hours or more, or the vomiting is recurrent.
- an adult is unable to retain any
fluids for twelve hours or more.
- nausea persists for a prolonged
period of time (in a person who is not pregnant).
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| What to expect at your health care
provider's office |
A history will be obtained and a
physical examination performed.
Medical history questions documenting nausea and vomiting in detail may
include:
- quality
- Are you vomiting fresh blood
(hematemesis)?
- Do you have repeated episodes
of vomiting blood?
- Are you vomiting coffee ground
material?
- Are you vomiting undigested
food?
- Are you vomiting greenish
(bilious) material?
- Does the vomit contain round
worms?
- Is it mild?
- Is it severe enough to cause
unintentional weight loss?
- aggravating factors
- Is the vomiting self-induced?
- Have you been traveling? Where?
- What medication do you take?
- Have you had chemotherapy?
- Did other people that ate at
the same location as you experience the same symptoms?
- Are you pregnant?
- time pattern
- When did the vomiting begin?
- How long has it lasted?
- Do you have morning nausea or
vomiting?
- Did it begin recently?
- Is it recurrent?
- Does it occur several hours
after meals (postprandial)?
- other
- What other symptoms are also
present?
- Is there abdominal pain?
- Is there a fever?
- Is there diarrhea?
- Is there poor skin turgor or
other signs of dehydration?
- Is there abdominal swelling?
- Are there headaches?
The physical examination will include
examination for signs of dehydration.
Diagnostic tests that may be performed include:
- blood tests (such as CBC or blood
differential)
- urinalysis
- X-rays of the abdomen
Intervention:
If dehydration is severe, intravenous fluids may be given. This may
require hospitalization, although it can often be done in the doctor's
office. The use of antivomiting drugs is controversial, and they should
be used only in severe cases.
After seeing your health care provider:
If a diagnosis was made by your health care provider related to nausea
and vomiting, you may want to note that diagnosis in your personal
medical record.
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