Nausea

Nausea is not a disease in itself. It occurs as a symptom of various diseases. Disturbances in the gastrointestinal tract, inner ear, or chemoreceptors (which are cells sensitive to chemicals) generate signals of being sick in the brain. The feeling of nausea is then produced as a response to these disturbances.

Some of the common causes of nausea include:

• Gastrointestinal conditions: Any issue that interferes with the normal functioning of the stomach and the gastrointestinal tract can lead to nausea. These issues are:
• Stomach infection or gastroenteritis
• Food poisoning
• Gastric ulcers
• Appendicitis
• Hyperacidity
• Intestinal obstruction
• Cholecystitis
• Crohn’s disease
• Gallstones
• Gastroesophageal Reflux Disease (GERD)
• Irritable bowel syndrome
• Allergy to certain foods, like milk
• Indigestion (or excessive food intake)
• Ear and balance disorders:
• Motion sickness
• Meniere’s disease
• Ear infection or otitis media
• Vestibular neuritis
• Pregnancy: Morning sickness or the feeling of nausea is a common occurrence in pregnancy, especially during the first trimester.
• Side effects of medications or therapies: Nausea can occur as a side effect of certain medications, such as chemotherapy drugs, NSAID painkillers, anesthetic drugs, and radiation therapy.
• Self-inflicted: Sometimes, nausea and vomiting can be self-inflicted in severe eating disorders like anorexia or bulimia.
• Other illnesses: The feeling of nausea is also seen with other health conditions, such as:
• Allergy or anaphylaxis
• Hyperthyroidism
• Meningitis
• Encephalitis
• Hydrocephalus
• Hepatitis
• Migraine
• Anxiety and depression
• Claustrophobia
• Excessive alcohol consumption
• Heart attack
• Cancer
• Acute severe trauma

Nausea and vomiting in children: Vomiting in infants in the first few months can occur after feeding, known as spitting up. If the vomiting is projectile, meaning it occurs with force and travels across a distance, it may suggest an abnormality in the stomach. Often, gastrointestinal infections are also responsible for nausea and vomiting in children.

A single episode of nausea does not require immediate diagnosis, as it is often self-limiting and can be easily managed at home. However, a thorough evaluation of nausea is necessary when symptoms are recurring or chronic. A detailed history and clinical examination, including an assessment of the eyes and ears, along with specific investigations, can help identify the underlying cause of nausea:

Lab Tests

• Complete Blood Count (CBC): Checks for causes like anemia or active infections.
• Serum Electrolyte: Evaluates the balance of electrolytes, such as sodium and potassium in the body.
• Protein Total, Serum: Assesses levels of human proteins, including albumin and globulin, and the overall nutritional status.
• Pregnancy Urine Test: Conducted in females of reproductive age to check for suspected pregnancy.
• Liver Function Test: Evaluates the health of the liver and identifies possible causes of liver dysfunction.
• Tuning Fork Test: A screening test that uses a tuning fork to assess hearing loss, which could be a cause of nausea.
• Nystagmus: A condition characterized by uncontrolled eye movements, which can lead to dizziness, nausea, and vision problems.
• Uremia Test: Identifies high levels of urea in the blood; nausea and vomiting may be caused by encephalopathic or neurologic disorders associated with uremia.
• Kidney Function Test (KFT): As kidney health declines, non-specific symptoms such as vomiting, nausea, weakness, and tiredness may develop.

These tests are performed to evaluate the overall health of a patient and diagnose the cause of nausea.

Imaging Studies

If the cause of nausea is not established through physical evaluation and laboratory testing, certain imaging studies may be helpful in diagnosing gastrointestinal causes. These include:

• X-Ray abdomen
• Dual phase CT abdomen
• USG abdomen
• Endoscopy

If nausea is suspected to result from problems in the central nervous system, an MRI of the brain or CT scan of the head may be performed.

Not all types of nausea can be prevented, especially those originating from causes related to the central nervous system. However, certain types of nausea, particularly those stemming from gastrointestinal causes, can be mitigated by:

• Eating fresh food that is not spicy or oily.
• Consuming smaller portions throughout the day instead of larger meals.
• Drinking liquids between meals.
• Avoiding activities that trigger motion sickness, such as joyrides or long-distance travel by road.
• Resting in a sitting or elevated position after meals.
• Avoiding painkillers like NSAIDs above the prescribed dosage.
• Avoiding strong smells, such as deodorants, perfumes, or cooking odors, if they trigger nausea during pregnancy.

Mild episodes of nausea and vomiting do not require medical treatments as they often resolve on their own. For chronic or severe nausea, the following treatment options are available:

1. Symptomatic Relief for Nausea

Antiemetic medicines help to control nausea and prevent vomiting. These are the first choice of treatment suggested to provide relief from the symptoms of nausea. They work by blocking the action of the neurotransmitter receptors involved in causing vomiting. Some common examples of antiemetic medicines include:

• Domperidone
• Ondansetron
• Prochlorperazine
• Aprepitant

Antiemetics for morning sickness: To treat morning sickness, which is a common symptom seen in the early stages of pregnancy, a combination of anti-nausea medicines is recommended. For example, doxylamine + Vitamin B6 (Pyridoxine), a combination drug used to treat and prevent nausea and vomiting during pregnancy. Doxylamine is an antihistamine that blocks the action of certain natural substances in the body that may contribute to nausea and vomiting. Vitamin B6 is also known to have anti-nausea action. Your doctor may recommend the dose based on the severity of your symptoms.

Antihistamines: This class of medicines reduces or blocks the chemical histamine associated with allergies. These are helpful in treating nausea caused by motion sickness or vertigo. Examples include:

• Promethazine
• Meclizine

Anticholinergic medications: This class of medicines acts by blocking the action of the neurotransmitter acetylcholine, which plays a key role in managing numerous body functions. It also helps to control nausea and vomiting.

Prokinetic drugs: This class of medicines falls under prescription medications. They promote normal contraction of the intestine and help in the emptying of the stomach. These are commonly recommended for people with GERD and are usually given in combination with medications that lower acid production in the body, such as PPIs and H2 receptor blockers. Examples include:

• Metoclopramide
• Itopride

2. Treatment of Underlying Cause

This includes treating the underlying cause of nausea such as:

• Stomach infections with antibiotics
• Vertigo with antivertigo drugs
• Hyperacidity with antacids
• Migraine with triptans
• Chemotherapy side effects with anti-nausea drugs

3. Supportive Care

This includes supportive care with fluids and Oral Rehydrating Solutions (ORS) to replenish the loss of electrolytes in the body. These help in cases where the patient has lost excessive fluids due to vomiting and shows signs of dehydration.

Homecare for nausea depends on whether it is a one-time episode or a chronic occurrence.

Home Remedies for Acute Nausea

The following care can be taken when a person starts feeling nauseous:

• Sucking on ice chips or candies may help suppress nausea.
• Ensuring appropriate hydration by consuming fluids and electrolytes to prevent dehydration.
• Lying down in a propped-up position to settle the feeling of retching.
• Avoiding heavy or spicy foods for at least 24 hours following an episode of nausea.
• When vomiting cannot be averted, do not vomit while lying down. Vomit with your head positioned forward to prevent the risk of possible aspiration of vomit. Vomit aspiration in the lungs can cause serious health complications such as pneumonia.

Homecare for Chronic Nausea

The following care measures can be taken if a person suffers from chronic nausea in pregnancy, post-chemotherapy, vertigo, or other brain-related conditions:

• Pregnant women should avoid strong smells or foods that trigger nausea.
• For procedures like chemotherapy or radiation, take prescribed antiemetic medications on time as advised.
• Patients with vertigo and motion sickness must avoid activities that worsen the symptoms, like joy rides or road travel.
• Individuals suffering from gastrointestinal conditions that cause nausea should avoid consuming spicy, oily, or processed food.

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Worsening of acute episodes of nausea can lead to excessive vomiting, which may cause dehydration. In severe cases, it can result in hypotension, shock, or loss of consciousness. It may also lead to poor nutrition, as patients are unable to consume or retain solid food.

Another serious complication of nausea is vomit aspiration into the lungs. The aspirated fluid can accumulate in the lungs and lead to pneumonia, which may be severe in some cases.

Malnutrition and weight loss are additional complications observed in patients with chronic nausea, as they often avoid consuming full meals due to fear.

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• Relaxation techniques and breathing exercises: Exercises that promote overall body relaxation, such as breathing exercises, can help alleviate feelings of nausea. Taking slow, deep breaths and holding the breath for a short time after each inhalation can help you feel calm and may ease nausea.
• Aromatherapy: Aromatherapy can help reduce feelings of nausea by inhaling pleasant fragrances, such as peppermint oil or citrus scents, which can calm the sensation of nausea.
• Acupressure and acupuncture: These techniques can help block the noxious stimuli that cause nausea by applying pressure to specific trigger points. Applying pressure to the Neiguan or P-6 pressure point, located on the inner arm near the wrist, can help reduce nausea.
• Natural remedies: Sucking on small portions of certain natural foods, such as ginger candy, a piece of ginger with rock salt, cumin seeds or powder, a piece of lemon, cinnamon sticks, or fennel seeds, can help alleviate feelings of nausea. These herbs and spices are known for their digestive properties and can improve taste sensation in the mouth, thereby helping to suppress nausea.

Nausea can be exhausting for people who experience chronic nausea, such as cancer patients undergoing chemotherapy. With constant nausea, individuals may lose interest in eating meals regularly, contributing to malnutrition and other health problems. Nausea in the first trimester of pregnancy is particularly troublesome for some women, and if left untreated, may cause health concerns for both the mother and the baby. In such cases, it is important to take precautions and use medications to prevent the condition.

Chemotherapy and Nausea: Antiemetics are usually advised prior to chemotherapy, as nausea is one of the common side effects of cancer treatments such as chemotherapy or radiation therapy. In addition to taking these medications, it is wise to control your diet and maintain a stress-free lifestyle to improve your condition.

Migraine and Nausea: In some cases, individuals suffering from migraines may experience symptoms like nausea and vomiting. However, if you experience this regularly or if nausea worsens during a migraine attack, consult a doctor to receive appropriate treatment.

Acidity and Nausea: Several gastrointestinal problems are associated with nausea and vomiting. It is advisable to take medications such as prokinetic drugs and follow dietary modifications to help alleviate the symptoms.

Medications and Nausea: Nausea can occur as a side effect of many nonprescription and prescription medications. These include antibiotics, NSAIDs such as aspirin and ibuprofen, antidepressants, chemotherapy drugs, opioid pain relievers, and vitamins and mineral supplements such as iron. If you suspect that your nausea or vomiting may be caused by a medication, contact your doctor to determine if you should stop taking it or if you need an alternative treatment.