Nausea-and-vomiting-treatments

Nausea And Vomiting Treatment

Nausea and vomiting treatment is based upon the cause of the nausea and vomiting. The treatment varies according to the cause and based on the physical condition of the patient. So history taking and physical examination is very important to diagnose the possible cause of nausea and vomiting to provide appropriate treatment. In this article we are going to discuss about the treatment options in case of nausea and vomiting. Lets check.

History Checking For Nausea And Vomiting Treatment

Accurate medical history checking of the patient for nausea and vomiting treatment is highly important to diagnose the cause of vomiting and to provide appropriate treatment.

History Taking

The history helps to know the cause of nausea and vomiting. Drugs, toxins, and infections often cause acute symptoms. It means that the symptoms appear within a short period of time after exposure with the nausea and vomiting triggering factors.

But prolonged illnesses evoke chronic complaints of nausea and vomiting. In chronic nausea and vomiting cases, either the patient is already diagnosed with the medical condition or unaware about any underlying disease, but gives history of chronic nausea and vomiting. So, proper medical history evaluation is a vital part.

Diagnosis of the cause of the vomiting based on the history

Usually the time of vomiting, number of vomiting episodes, any triggering factors, other associated symptoms, etc. give an indication about the cause of vomiting. Though in many cases, further evaluation and laboratory tests are needed to confirm the diagnosis, especially in cases of chronic nausea and vomiting. The appearance of symptoms or timing of vomiting differs according to the cause such as

  • Gastroparesis and pyloric obstruction results in vomiting within an hour of eating.
  • Vomiting from intestinal blockage occurs later.
  • Vomiting that occur minutes after meal consumption usually due to rumination syndrome.
  • With severe gastric emptying delays, the vomitus may contain food residue ingested days before.
  • Hematemesis (vomiting of blood) raises suspicion of an ulcer, malignancy, or Mallory-Weiss tear.
  • Feculent emesis (Fecal vomiting that is when the vomiting material contains fecal material) is noted with distal intestinal or colonic obstruction.
  • Bilious vomiting excludes gastric obstruction, whereas vomiting of undigested food is consistent with a Zenker’s diverticulum or achalasia.
  • When vomiting can relieve abdominal pain, then vomiting can be due to a bowel obstruction. Vomiting does not relieve abdominal pain in pancreatitis or cholecystitis.
  • When there is profound weight loss then malignancy or obstruction is highly suspected.
  • If vomiting is present along with fever, then it suggests inflammation.
  • The cause of vomiting is suspected to be from intracranial source if there are headaches or vision problems.
  • If vomiting is present along with vertigo or tinnitus, the cause of vomiting is due to labyrinthine disease (inner ear disease).

Physical Examination For Nausea And Vomiting Treatment

The physical examination of the patient for nausea and vomiting treatment should be thoroughly done. History should be correlated with the physical examination in the nausea and vomiting treatment.

  • Orthostatic hypotension and reduced skin turgor indicate intravascular fluid loss or hypovolemia.
  • Lung (Pulmonary) abnormalities raise concern for aspiration of vomitus.
  • Tenderness or involuntary guarding raises suspicion of inflammation.
  • Blood in the stool (fecal blood) suggests mucosal injury from ulcer, ischemia, or tumor.
  • Nerve (Neurologic) disease presents with papilledema, visual field loss, or focal neural abnormalities.
  • Neoplasm is suspected when there is palpable masses or adenopathy.

Nausea And Vomiting Treatment

Nausea and vomiting treatment depends upon the cause of nausea and vomiting. Two types of treatment are given. One is general management and the other is medications or drugs.

The General Management

The general management is an important part of nausea and vomiting treatment. The general management is especially needed in case of vomiting. These are the following

  1. To correct remediable abnormalities if possible. This also corrects the cause of vomiting.
  2. If dehydration is present due to vomiting, replacement of the fluid either by oral intake or through intravenously (I.V fluid is given when patient is unable to take fluid by mouth).
  3. If there is electrolyte (sodium, potassium, etc.) imbalance due to vomiting, correction of those electrolyte abnormalities is done.
  4. If patient can take food or liquid by mouth, then nutrients are restarted with low fat liquid.

If vomiting causes severe dehydration, then immediate hospitalization is required to replenish the lost fluid and electrolytes. This is vital to save the life.

Medications

The medicines for nausea and vomiting treatment are given based upon the cause or condition that are causing nausea or vomiting. The medicines that are prescribed for nausea and vomiting treatment are the following

Antiemetic Agents

1. Antihistaminergic drugs (such as dimenhydrinate, meclizine)- It is used in motion sickness, inner ear disease

2. Anticholinergic drugs (such as scopolamine)- It is used in motion sickness, inner ear disease

3. Antidopaminergic drugs (such as prochlorperazine, thiethylperazine)- It is used in medication-, toxin-, or metabolic-induced vomiting

4. 5-HT3 antagonist (such as ondansetron, granisetron)- It is used in chemotherapy- and radiation-induced vomiting, postoperative vomiting

5. NK1 antagonist (such as aprepitant)- It is used in chemotherapy-induced nausea and vomiting

6. Tricyclic antidepressant (such as amitriptyline, nortriptyline)- It is used in chronic nausea vomiting syndrome, cyclic vomiting syndrome

7. Other antidepressant (such as mirtazapine, olanzapine)- Possible uses are chronic nausea vomiting syndrome, gastroparesis

Prokinetic Agents

1. 5-HT4 agonist and antidopaminergic (Metoclopramide)- It is used in gastroparesis

2. Motilin agonist (Erythromycin)- It is used in gastroparesis. Possible use in intestinal pseudoobstruction.

3. Peripheral antidopaminergic (Domperidone)- It is used in gastroparesis.

4. Somatostatin analogue (Octreotide)- It is used in intestinal pseudoobstruction.

5. Acetylcholinesterase inhibitor (Pyridostigmine)- Possible use in small-intestinal dysmotility/pseudoobstruction.

Special Settings

1. Benzodiazepines (Lorazepam) are used in anticipatory nausea and vomiting with chemotherapy.

2. Glucocorticoids (Methylprednisolone, dexamethasone) are used in chemotherapy-induced vomiting.

3. Cannabinoids (Tetrahydrocannabinol) are used in chemotherapy-induced vomiting.

All the above mentioned medicines are used in nausea and vomiting treatment. Based upon the clinical condition of the patient, the dose of the medicine is determined. In nausea and vomiting treatment, the severity of the condition determines that how long patient needs to continue the medicine.

As the nausea and vomiting treatment depends upon several factors such as age of the patient, severity of the condition, presence of any underlying medical conditions, number of medicine intake for other underlying medical conditions, cause of the nausea and vomiting, etc. – so nausea and vomiting treatment varies person to person.

It is highly important to give proper history to the doctor and follow the doctor’s instructions. Stay healthy and happy.

Sources

  1. Lishman’s Organic PsychiatryA Textbook of Neuropsychiatry
  2. Goldman-Cecil Medicine
  3. Harrison’s Principles of Internal Medicine 20th edition
  4. Davidson’s Principles and Practice of Medicine 23rd edition

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