This information is intended only to provide general guidance. It does not provide definitive medical advice. It is important that you consult your doctor about your specific condition.
What is nausea and vomiting?
Nausea is the unpleasant feeling that there may be a need to vomit. Vomiting is actually “throwing up”, forcibly ejecting the stomach contents through the mouth. Retching, or "dry heaving", is vomiting when there is no material to eject. Regurgitation differs from vomiting in that small amounts of food, liquid, or acid gently enter the throat and mouth but are not forcibly ejected. All of these are symptoms, not diseases in themselves.
What causes nausea and vomiting?
Common causes of nausea and vomiting include:
- Medications (medications that are particularly likely to cause nausea and vomiting include cancer chemotherapy, anesthetic agents, and narcotics).
- Infections of the gastrointestinal tract, especially viral gastroenteritis ("intestinal virus").
- Other infections, such as hepatitis, diverticulitis, appendicitis, and cholecystitis (gallbladder infection) can also cause nausea and vomiting.
- Bacterial toxins and food (food poisoning)
- Motion sickness or vertigo (inner ear/balance organ)
- Psychological disorders such as anxiety, depression, anorexia nervosa, and bulimia.
- Physical or emotional pain
- Migraine headaches
- Ulcers and gastritis, including alcohol intoxication.
Less common causes of nausea and vomiting include:
- Infections outside the gastrointestinal tract, such as pneumonia, bladder and kidney infection, meningitis, and ear infections.
- Inflammation of the abdominal organs such as pancreatitis, Crohn's disease, or ulcerative colitis.
- Delayed emptying of the stomach (gastroparesis).
- Slow transit through the intestine (ileus or pseudo-obstruction).
- Disorders of the brain (brain tumors, concussions, head trauma, multiple sclerosis).
- Hormone disorders including thyroid disease, diabetes, and underactive adrenal glands
- Radiation therapy
- Kidney failure
- Cyclic vomiting syndrome
- Heart attack (myocardial infarction)
- Chemical toxins
- Gastroesophageal reflux disease
- A reaction to certain smells or odors.
When should you contact your doctor for nausea and vomiting?
You should seek emergency medical care if you have any of the following (this applies to adults but not children):
- Abdominal or chest pain
- Bloody or coffee-grounds appearance to your vomit
- Fever over 101°F
- Severe headache
- A recent head injury
- Stiff neck
- Confusion and decreased responsiveness
- Inability to stand up
- Rapid breathing or a rapid pulse
- Muscle cramps
- Feeling very thirsty or having a dry tongue
- Inability to hold down any liquids for over 12-16 hours.
If the nausea or vomiting persists for more than a few days, you should see your doctor. Elderly patients or very young children can become dangerously dehydrated quickly and require earlier attention from their doctors.
How is the cause of nausea or vomiting evaluated?
Your doctor can usually determine the cause of the nausea by taking a detailed history and performing a physical examination. Brief episodes of nausea or vomiting do not require special evaluation. If the cause is not clear, your doctor may obtain blood tests (blood count, levels of chemicals electrolytes, liver enzymes, and pancreatic enzymes). Your doctor may order a urine pregnancy test, an electrocardiogram, x-ray tests such as a plain x-rays of the abdomen, a CT scan of the abdomen or head, or an upper GI series (in which barium is swallowed to outline the inside surface of the stomach and intestine). EGD, or upper GI endoscopy is a test in which a long thin tube with a camera on the end is passed through the mouth into the esophagus, stomach, and upper intestine. If the nausea and vomiting persist and a cause is not found, a psychiatric evaluation may be useful.
What can you do to help the nausea or vomiting?
- Drink cold liquids, flavored ices or popsicles are easier to tolerate.
- When you try to eat, take foods with a lot of liquid, such as Jell-O, soup, and plain yogurt, and starchy foods such as toast or crackers. Ginger can help nausea.
- You should avoid foods that are fried or contain a lot of fat.
- Avoid strong smells, such as perfume or foods with strong aromas.
How are nausea and vomiting treated?
- If there are signs of dehydration because of prolonged or severe nausea and vomiting, you may need to be given fluids through a tube that goes into vein (an "IV").
- Prescription medications for nausea and vomiting include:
- Ondansetron (brand name Zofran)
- Prochlorperazine (brand name Compazine)
- Promethazine (brand name Phenergan)
- Metoclopramide (brand name Reglan)
Specific causes of the nausea such as inflammation of the stomach, stress or anxiety, migraine headaches, or motion sickness can be treated by the appropriate medications, or, if there is intestinal obstruction, by surgery. You can read more in the conditions we treat web pages.