Nausea Vomiting: Symptoms, Causes and Treatment

Nausea and vomiting are distressing symptoms that can significantly impact daily life, wellbeing, and even medical outcomes. They may appear as standalone complaints or as part of a broader illness, and their occurrence ranges from brief, self-limited episodes to persistent, chronic conditions. Understanding the symptoms, causes, and available treatments is crucial for both patients and healthcare providers. This article synthesizes the latest research to provide a comprehensive overview of these common but complex symptoms.

Symptoms of Nausea Vomiting

Nausea and vomiting are not diseases themselves but symptoms that signal underlying issues in the body. While everyone has likely experienced them, the way they manifest and their associated features can be quite varied. Recognizing the key symptoms and their patterns is the first step toward proper care and relief.

Symptom	Description	Associated Features	Sources
Nausea	Uneasy, queasy stomach sensation	Sweating, salivation, anxiety	5 4
Vomiting	Forceful expulsion of stomach contents	Retching, abdominal pain	5 4
Retching	Spasmodic, dry heaves without expulsion	Precedes or follows vomiting	4
Chronicity	Symptoms lasting ≥4 weeks	Weight loss, dehydration	5

Table 1: Key Symptoms

What Does Nausea Feel Like?

Nausea is described as an unpleasant sensation of the urge to vomit, typically felt in the upper stomach or throat. It's often accompanied by other bodily changes such as increased salivation, sweating, and a general sense of discomfort or anxiety. Unlike vomiting, nausea does not always lead to expulsion of stomach contents but can be just as distressing 5 4.

Vomiting and Retching

Vomiting is the physical act of forcefully ejecting stomach contents through the mouth. Before this occurs, individuals may experience retching—repetitive, spasmodic movements of the diaphragm and abdominal muscles that do not result in actual vomiting. Retching can sometimes accompany or follow vomiting episodes and is itself uncomfortable 4.

Acute vs. Chronic Symptoms

• Acute symptoms are sudden in onset and usually resolve within a short period, often linked to infections, medications, or food poisoning 4.
• Chronic symptoms persist for weeks or longer, suggesting more complex or ongoing issues such as gastrointestinal disorders or side effects from long-term medication use 5.

Associated Features

• Dehydration: Frequent vomiting can lead to loss of fluids and electrolytes, resulting in dry mouth, weakness, and even confusion.
• Weight loss and malnutrition: Especially in chronic cases, ongoing nausea and vomiting can cause people to eat less, risking nutritional deficiencies 5.

Causes of Nausea Vomiting

Nausea and vomiting can originate from a wide array of causes, ranging from simple and reversible to complex or life-threatening. Identifying the root cause is essential for effective management and treatment.

Cause Type	Examples	Key Features	Sources
Gastrointestinal	Gastroparesis, obstruction, infections	Abdominal pain, altered bowels	4 5 2
Central Nervous	Migraine, increased intracranial pressure	Headache, neurological changes	4 3
Medications	Opioids, chemotherapy, anesthesia	Dose-dependent, timing with meds	1 4 2
Metabolic	Pregnancy, uremia, diabetic ketoacidosis	Systemic symptoms	4 6

Table 2: Main Causes of Nausea and Vomiting

Gastrointestinal Causes

A significant proportion of nausea and vomiting cases stem from the gut. These include:

• Gastroparesis: Delayed stomach emptying, often seen in diabetes or after certain surgeries 5.
• Obstructions: Blockages in the intestines can cause severe, persistent vomiting 4.
• Infections: Viral gastroenteritis and foodborne illnesses are common culprits in acute cases 4 5.
• Functional Disorders: Such as cyclic vomiting syndrome, which is characterized by recurring episodes 5.

Central Nervous System and Vestibular Causes

Disorders of the brain and inner ear can also provoke these symptoms:

• Migraine: Nausea is a hallmark symptom of migraine headaches 4.
• Vestibular Disorders: Balance problems, such as those seen in motion sickness, directly stimulate the vomiting center in the brain 2 3.
• Increased Intracranial Pressure: Tumors, bleeding, or swelling in the brain can trigger vomiting, often alongside other neurological signs 4.

Medication and Chemical-Induced

Many medications are known to cause nausea and vomiting:

• Opioids and Anesthesia: Commonly cause postoperative nausea and vomiting (PONV), especially in those with specific risk factors such as female sex or history of motion sickness 1.
• Chemotherapeutic Agents: Highly associated with nausea and vomiting, often requiring preemptive antiemetic treatment 8 10.
• Other Medications: Antibiotics, anti-inflammatory drugs, and many others can also trigger symptoms 4.

Metabolic and Hormonal Causes

• Pregnancy: Up to 80% of women experience some degree of nausea in early pregnancy, often referred to as "morning sickness" 6.
• Endocrine and Metabolic Disorders: Conditions like uremia, diabetic ketoacidosis, and adrenal insufficiency can all present with nausea and vomiting 4 5.

Multifactorial and Unknown Causes

Sometimes, no single cause can be identified. Especially in advanced illnesses, the etiology is often multifactorial, involving a combination of gastrointestinal, metabolic, chemical, and psychological factors 2 5.

Treatment of Nausea Vomiting

Managing nausea and vomiting is centered around identifying and addressing the underlying cause. However, symptomatic relief is often necessary to maintain hydration, nutrition, and quality of life. Treatments range from lifestyle changes and dietary interventions to medications and alternative therapies.

Treatment	Indication/Use	Key Points	Sources
Antiemetics	Symptom relief (varied causes)	Multiple drug classes	1 5 9
Non-drug Therapies	Pregnancy, mild cases	Ginger, acupressure	6 7 8 10
Supportive Care	Severe/prolonged symptoms	Hydration, nutrition	4 5 2
Address Cause	Specific disorders	Surgery, medication change	4 5 2

Table 3: Approaches to Treatment

Medications

Antiemetics

Several medications are used to control nausea and vomiting:

• 5-HT3 Antagonists (e.g., Ondansetron): Effective in postoperative and chemotherapy-induced cases 1.
• Dopamine Antagonists (e.g., Metoclopramide): Useful for a range of causes, including gastroparesis 1 5.
• Olanzapine: Shown to significantly reduce chronic nausea and vomiting in advanced cancer patients, improving appetite and overall well-being 9.
• Others: Antihistamines and anticholinergics may be helpful, especially in motion sickness 1 5.

Treatment Selection

The choice of medication depends on the presumed cause, patient profile, and side effect considerations. In palliative care, the approach may be empirical, starting with broad-spectrum antiemetics and adjusting as necessary 5 2.

Non-Pharmacological and Alternative Therapies

Ginger

• Pregnancy: Ginger has been found to be safe and somewhat effective for pregnancy-related nausea, though evidence is mixed and not robust 6 10.
• Chemotherapy and PONV: Some studies support ginger's role in reducing the severity of nausea and vomiting related to chemotherapy and surgery, though effects may be modest 7 8 10.
• Preparation and Dosage: Most benefits are seen with doses up to 1g per day, but standardization and further research are needed 8 10.

Acupressure and Acupuncture

• Acupressure (P6 point): May provide some relief in pregnancy and postoperative settings, though evidence is limited 6.
• Acupuncture: No consistent benefit has been demonstrated in rigorous studies 6.

Supportive and General Care

• Hydration: Oral or intravenous fluids are crucial, especially if vomiting is severe or prolonged 4 5.
• Nutritional Support: Small, frequent meals and easily digestible foods can help maintain nutrition during episodes 5.
• Hospitalization: Indicated for severe dehydration, persistent vomiting, or if serious underlying pathology is suspected 4.

Addressing the Underlying Cause

• Medication Changes: Discontinuing or replacing offending drugs can resolve symptoms 4.
• Surgical Intervention: Needed in cases of intestinal obstruction or certain anatomical problems 4 5.
• Treating Infections or Metabolic Disorders: Appropriate therapy based on specific diagnosis 4.

Chronic Nausea and Vomiting

Long-term cases require a careful, stepwise approach:

• Rule out mechanical, metabolic, and infectious causes first.
• Empirical therapy may be used when no cause is found, with close monitoring of response and side effects 5.

Conclusion

Nausea and vomiting are complex symptoms with a broad spectrum of causes and treatments. While often self-limited, they can also signal serious underlying disease or significantly impair quality of life. A thoughtful, patient-centered approach that combines thorough assessment with evidence-based interventions is key to effective care.

Key Takeaways:

• Nausea and vomiting are common and distressing, with symptoms ranging from mild discomfort to severe dehydration and nutritional compromise.
• Causes are varied, including gastrointestinal, neurological, metabolic, medication-related, and multifactorial origins.
• Treatment should focus on the underlying cause where possible, but symptomatic relief is crucial for patient comfort and well-being.
• Evidence supports the use of antiemetic drugs, with ginger and acupressure offering potential non-drug options in certain situations.
• Chronic or unexplained cases require careful evaluation and a tailored, stepwise management plan.

Understanding these symptoms and their management empowers patients and healthcare providers to work collaboratively toward relief and improved health outcomes.