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[[Dimenhydrinate]] (Gravol) is an inexpensive and effective over the counter medication for preventing postoperative nausea and vomiting.<ref>{{Cite journal|author=Kranke P, Morin AM, Roewer N, Eberhart LH |title=Dimenhydrinate for prophylaxis of postoperative nausea and vomiting: a meta-analysis of randomized controlled trials |journal=Acta Anaesthesiol Scand |volume=46 |issue=3 |pages=238–44 |year=2002 |month=March |pmid=11939912 |doi= 10.1034/j.1399-6576.2002.t01-1-460303.x|url=}}</ref> [[Meclozine]] is another [[antihistamine]] [[antiemetic]]. In certain people, [[cannabinoids]] may be effective in reducing chemotherapy associated nausea and vomiting.<ref>{{Cite journal|author=Tramèr MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ |title=Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review |journal=BMJ |volume=323 |issue=7303 |pages=16–21 |year=2001 |month=July |pmid=11440936 |pmc=34325 |doi= 10.1136/bmj.323.7303.16|url=}}</ref><ref>{{Cite web| url = http://www.drugpolicy.org/marijuana/medical/challenges/litigators/medical/conditions/nausea.cfm | title = Medicinal Uses of Marijuana: Nausea, Emesis and Appetite Stimulation | accessdate = 2007-08-02 | year = 2001 | author = Drug Policy Alliance}}</ref> [[Ondansetron]] (Zofran) is effective for nausea and vomiting.<ref name=USA07/> [[Pyridoxine]] or [[metoclopramide]] are the first line treatments for pregnancy related nausea and vomiting.<ref name=preg07/>
[[Dimenhydrinate]] (Gravol) is an inexpensive and effective over the counter medication for preventing postoperative nausea and vomiting.<ref>{{Cite journal|author=Kranke P, Morin AM, Roewer N, Eberhart LH |title=Dimenhydrinate for prophylaxis of postoperative nausea and vomiting: a meta-analysis of randomized controlled trials |journal=Acta Anaesthesiol Scand |volume=46 |issue=3 |pages=238–44 |year=2002 |month=March |pmid=11939912 |doi= 10.1034/j.1399-6576.2002.t01-1-460303.x|url=}}</ref> [[Meclozine]] is another [[antihistamine]] [[antiemetic]]. In certain people, [[cannabinoids]] may be effective in reducing chemotherapy associated nausea and vomiting.<ref>{{Cite journal|author=Tramèr MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ |title=Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review |journal=BMJ |volume=323 |issue=7303 |pages=16–21 |year=2001 |month=July |pmid=11440936 |pmc=34325 |doi= 10.1136/bmj.323.7303.16|url=}}</ref><ref>{{Cite web| url = http://www.drugpolicy.org/marijuana/medical/challenges/litigators/medical/conditions/nausea.cfm | title = Medicinal Uses of Marijuana: Nausea, Emesis and Appetite Stimulation | accessdate = 2007-08-02 | year = 2001 | author = Drug Policy Alliance}}</ref> [[Ondansetron]] (Zofran) is effective for nausea and vomiting.<ref name=USA07/> [[Pyridoxine]] or [[metoclopramide]] are the first line treatments for pregnancy related nausea and vomiting.<ref name=preg07/>
Many consider [[Medical marijuana]] to be an effective herbal remedy for nausea, where legal.<ref>http://www.cannabissearch.com/medical_benefits/nausea/</ref>
Many consider [[Medical marijuana]] to be an effective herbal remedy for nausea, where legal.<ref>http://www.cannabissearch.com/medical_benefits/nausea/</ref>

In hospital settings topical anti-nausea gels are not indicated because of lack of research backing their efficacy.<ref name="AAHPMfive">{{Citation |author1 = American Academy of Hospice and Palliative Medicine |author1-link = American Academy of Hospice and Palliative Medicine |date = |title = Five Things Physicians and Patients Should Question |publisher = [[American Academy of Hospice and Palliative Medicine]] |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |page = |url = http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-hospice-palliative-medicine/ |accessdate = August 1, 2013}}, which cites
*{{cite PMID|22560361}}
*{{cite PMID|16351526}}</ref> Topical gels containing [[lorazepam]], [[diphenhydramine]], and [[haloperidol]] are sometimes used for nausea but are not equivalent to more established therapies.<ref name="AAHPMfive"/>


==Prognosis==
==Prognosis==

Revision as of 15:03, 1 November 2013

"Wamble" redirects here. For the American guitarist, see Doug Wamble.
For other uses, see Nausea (disambiguation).
Nausea
SpecialtyGastroenterology, emetology Edit this on Wikidata

Nausea (Latin nausea, from Greek ναυσία - nausia,[1] "ναυτία" - nautia, motion sickness", "feeling sick," "queasy" or "wamble"[2][3]) is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit.[4] It often, but not always, precedes vomiting. A person can suffer nausea without vomiting. (Greek ναῦς - naus, "ship"; ναυσία started as meaning "seasickness".)

Nausea is a non-specific symptom, which means that it has many possible causes. Some common causes of nausea are motion sickness, dizziness, migraine, fainting, gastroenteritis (stomach infection) or food poisoning. Side effects of many medications including cancer chemotherapy, nauseants or morning sickness in early pregnancy. Nausea may also be caused by anxiety, disgust and depression.[5][6][7]

Medications taken to prevent and treat nausea are called antiemetics. The most commonly prescribed antiemetics in the US are promethazine, metoclopramide and ondansetron.

Differential diagnosis

There are many causes of nausea. One organization listed 700 in 2009.[8] Gastrointestinal infections (37%) and food poisoning are the two most common causes.[4][9] While side effects from medications (3%) and pregnancy are also relatively frequent.[4][9] In 10% of people the cause remains unknown.[9]

Food poisoning

Food poisoning usually causes an abrupt onset of nausea and vomiting one to six hours after ingestion of contaminated food and lasts for one to two days.[10] It is due to toxins produced by bacteria in food.[10]

Medications

Many medications can potentially cause nausea.[10] Some of the most frequently associated include cancer and systemic chemotherapy regimens and general anaesthetic agents.

Pregnancy

Nausea or "morning sickness" is common during early pregnancy but may occasionally continue into the second and third trimesters. In the first trimester nearly 80% of women have some degree of nausea.[11] Pregnancy should therefore be considered as a possible cause of nausea in any women of child bearing age.[10] While usually it is mild and self-limiting severe cases known as hyperemesis gravidarum may require treatment.[12]

Disequilibrium

A number of conditions involving balance such as motion sickness and vertigo can lead to nausea and vomiting.

Stress and depression

Nausea may be caused by stress and depression.

Potentially serious

While most causes of nausea are not serious, some serious causes do occur. These include: diabetic ketoacidosis, brain tumor, surgical problems, heart attack,[13] pancreatitis, small bowel obstruction, meningitis, appendicitis, cholecystitis, Addisonian crisis, Choledocholithiasis (from gallstones) and hepatitis, as a sign of carbon monoxide poison and many others.[4]

Diagnostic approach

Often no investigations are needed, however basic lab tests may be appropriate.[4] If a bowel obstruction is possible, abdominal x-rays may be useful.[4]

Treatment

If dehydration is present due to loss of fluids from severe vomiting, rehydration with oral electrolyte solutions is preferred.[4] If this is not effective or possible, intravenous rehydration may be required.[4] NIH Medline recommends drinking clear fluids, sitting quietly and eating bland foods. [14] Medline recommends you call a doctor if you:

  • Cannot keep any food or liquid down
  • Vomit 3 or more times in 1 day
  • Are nauseated for more than 48 hours
  • Feel weakness
  • Have fever
  • Have stomach pain
  • Do not have to urinate for 8 hours or more [15]

Medications

Main article: Antiemetic

Dimenhydrinate (Gravol) is an inexpensive and effective over the counter medication for preventing postoperative nausea and vomiting.[16] Meclozine is another antihistamine antiemetic. In certain people, cannabinoids may be effective in reducing chemotherapy associated nausea and vomiting.[17][18] Ondansetron (Zofran) is effective for nausea and vomiting.[10] Pyridoxine or metoclopramide are the first line treatments for pregnancy related nausea and vomiting.[12] Many consider Medical marijuana to be an effective herbal remedy for nausea, where legal.[19]

In hospital settings topical anti-nausea gels are not indicated because of lack of research backing their efficacy.[20] Topical gels containing lorazepam, diphenhydramine, and haloperidol are sometimes used for nausea but are not equivalent to more established therapies.[20]

Prognosis

While short-term nausea and vomiting are generally harmless, they may sometimes indicate a more serious condition. When associated with prolonged vomiting, it may lead to dehydration and/or dangerous electrolyte imbalances. Repeated intentional vomiting, characteristic of bulimia, can cause stomach acid to wear away at the enamel in teeth.[21]

Epidemiology

Nausea and or vomiting is the main complaint in 1.6% of visits to family physicians in Australia.[9] However only 25% of people with nausea visit their family physician.[4] It is most common in those 15–24 years old and less common in other ages.[9]

See also

References

  1. ^ ναυσία, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus
  2. ^ ναυτία, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus
  3. ^ "Wamble definition". MedTerms Medical Dictionary.
  4. ^ a b c d e f g h i Metz A, Hebbard G (2007). "Nausea and vomiting in adults--a diagnostic approach". Aust Fam Physician. 36 (9): 688–92. PMID 17885699. {{cite journal}}: Unknown parameter |month= ignored (help)
  5. ^ "Stress symptoms: Effects on your body, feelings and behavior". Mayo Clinic.
  6. ^ "Diagnostic Criteria: Clinical Guidelines for the Management of Anxiety". PubMed.
  7. ^ "Disease Information for Stress/Emotional/Physical: Clinical Manifestations".
  8. ^ "Differential Diagnosis for Nausea".
  9. ^ a b c d e Helena Britt; Fahridin, S (2007). "Presentations of nausea and vomiting" (PDF). Aust Fam Physician. 36 (9): 673–784. PMID 17885697. {{cite journal}}: Unknown parameter |month= ignored (help)
  10. ^ a b c d e Scorza K, Williams A, Phillips JD, Shaw J (2007). "Evaluation of nausea and vomiting". Am Fam Physician. 76 (1): 76–84. PMID 17668843. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  11. ^ Koch KL, Frissora CL (2003). "Nausea and vomiting during pregnancy". Gastroenterol. Clin. North Am. 32 (1): 201–34, vi. doi:10.1016/S0889-8553(02)00070-5. PMID 12635417. {{cite journal}}: Unknown parameter |month= ignored (help)
  12. ^ a b Sheehan P (2007). "Hyperemesis gravidarum--assessment and management". Aust Fam Physician. 36 (9): 698–701. PMID 17885701. {{cite journal}}: Unknown parameter |month= ignored (help)
  13. ^ O’Connor RE, Brady W, Brooks SC, Diercks D, Egan J, Ghaemmaghami C, Menon V, O’Neil BJ, Travers AH, Yannopoulos D. Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S788.
  14. ^ http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000122.htm
  15. ^ http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000122.htm
  16. ^ Kranke P, Morin AM, Roewer N, Eberhart LH (2002). "Dimenhydrinate for prophylaxis of postoperative nausea and vomiting: a meta-analysis of randomized controlled trials". Acta Anaesthesiol Scand. 46 (3): 238–44. doi:10.1034/j.1399-6576.2002.t01-1-460303.x. PMID 11939912. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  17. ^ Tramèr MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ (2001). "Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review". BMJ. 323 (7303): 16–21. doi:10.1136/bmj.323.7303.16. PMC 34325. PMID 11440936. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  18. ^ Drug Policy Alliance (2001). "Medicinal Uses of Marijuana: Nausea, Emesis and Appetite Stimulation". Retrieved 2007-08-02. {{cite web}}: |author= has generic name (help)
  19. ^ http://www.cannabissearch.com/medical_benefits/nausea/
  20. ^ a b American Academy of Hospice and Palliative Medicine, "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Hospice and Palliative Medicine, retrieved August 1, 2013, which cites
  21. ^ "Bulimia Nervosa-Topic Overview". WebMD. Retrieved 26 July 2012.
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