Nausea

Causes Of 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:

1. Stomach infection or gastroenteritis

2. Food poisoning

3. Gastric ulcers

4. Appendicitis

5. Hyperacidity

6. Intestinal obstruction

7. Cholecystitis

8. Crohn’s disease

9. Gallstones

10. Gastroesophageal Reflux Disease (GERD)

11. Irritable bowel syndrome

12. Allergy to certain foods, like milk

13. Indigestion (or excessive food intake)
    
    

Ear and balance disorders:

1. Motion sickness

2. Meniere’s disease

3. Ear infection or otitis media

4. 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:

1. Allergy or anaphylaxis

2. Hyperthyroidism

3. Meningitis

4. Encephalitis

5. Hydrocephalus

6. Hepatitis

7. Migraine

8. Anxiety and depression

9. Claustrophobia

10. Excessive alcohol consumption

11. Heart attack

12. Cancer

13. 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 a 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.

Here’s more on things to keep in mind if your child experiences vomiting. 
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Diagnosis Of Nausea

A single episode of nausea does not require any immediate diagnosis, as it is often self-limiting and can be easily cared for at home. A detailed evaluation of nausea is necessary when symptoms of nausea are recurring or chronic. A detailed history and clinical examination (including the eye and/ ear) with some specific investigations listed below help in identifying  the underlying cause of nausea: 

Lab Tests: Laboratory tests include-

• Complete Blood Count (CBC) to check for causes like anemia or active infections. 

• Serum Electrolyte to evaluate the balance of electrolytes, such as sodium and potassium in the body. 

• Protein Total, Serum checks the levels of human proteins, such as albumin, globulin, and the overall nutritional status.

• Pregnancy Urine Test in females of reproductive age to check for suspected pregnancy.

• Liver Function Test to check for the health of the liver and other possible causes of dysfunction of the liver. 

• Tuning fork test: It is a screening test that uses a tuning fork to assess hearing loss which could be the cause of nausea.

• Nystagmus: It is a condition where a person cannot control eye movement.This can lead to dizziness or nausea, and also vision problems, as the person is unable to hold a steady gaze.

• Uremia test: It is a clinical condition which is characterised by high levels of urea in the blood. Nausea and vomiting may be caused by encephalopathic (damage or disease that affects the brain) or neurologic disorders (diseases of the brain, spine and the nerves that connect them) associated with uremia.

• Kidney function test (KFT): As the kidney health declines, some non-specific symptoms develop such as vomiting, nausea, weakness and tiredness. 

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 with physical evaluation and laboratory testing, certain imaging studies such as X-Ray abdomen, Dual phase CT abdomen, USG abdomen, and endoscopy, may be helpful in diagnosing gastrointestinal causes.

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

Prevention Of Nausea

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

• Eating fresh food, which is not spicy and oily.

• Eating smaller portions throughout the day instead of larger meals.

• Drinking liquids between two meals.

• Avoiding activities that trigger motion sickness, such as joyrides, traveling long distances via road, etc.

• Resting in a sitting position or elevated position after meals.

• Avoiding pain killers like NSAIDs above the prescribed dosage.

• Avoiding strong smells, such as deodorants, perfumes, or cooking odors, if they trigger nausea during pregnancy.

Specialist To Visit

A mild or occasional episode of nausea and vomiting can safely be treated at home and does not require medical attention. However, if nausea is a chronic occurrence and/or multiple episodes of nausea and vomiting occur within a short span, it is essential to seek medical care. If your nausea lasts for more than 24 hours straight and is accompanied with severe pain in the abdomen, blood in the vomit, fever, and diarrhea, immediately consult your physician. Also, it is advisable to consult a doctor if you feel confused, lethargic, and dehydrated.

 

The doctors who diagnose and treat nausea are:

• General physician

• Gastroenterologist

• Neurologist

• Obstetrician and Gynecologist

Vomiting is also a common symptom that should not be ignored. Read about what causes vomiting and when to go to a doctor.
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Treatment Of Nausea

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: 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 of the 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 early stages of pregnancy, a combination of anti-nausea medicines are recommended. For example, doxylamine + Vitamin B6 (Pyridoxine), a combination drug which is 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 symptom.


Antihistamines: This class of medicines reduces or blocks the chemical histamine which is associated with allergy. These are helpful in treating nausea caused due to motion sickness or vertigo. Examples include: 

• Promethazine 
• Meclizine

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

Prokinetic drugs: This class of medicines comes under prescription medicines. They promote normal contraction of the intestine and help in the emptying of the stomach. These are commonly recommended for people with GERD and given mostly 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. 

Home Care For Nausea

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: 

1. Sucking on ice chips or candies may help suppress nausea.

2. Ensuring appropriate hydration by consuming fluids and electrolytes to prevent dehydration.

3. Lying down in a propped-up position to settle the feeling of retching.

4. Avoiding heavy or spicy foods for at least 24 hours following an episode of nausea.

5. 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: 

1. Pregnant women should avoid strong smells or foods that trigger nausea.

2. For procedures like chemotherapy or radiation, take prescribed antiemetic medications on time as advised.

3. Patients with vertigo and motion sickness must avoid activities that worsen the symptoms, like joy rides or road travel.

4. Individuals suffering from gastrointestinal conditions that cause nausea should avoid consuming spicy, oily, or processed food.

Feeling nauseated? 6 foods that you can try for instant relief!
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Alternative Therapies For Nausea

Relaxation techniques and breathing exercises: Exercises that promote overall body relaxation, such as breathing exercises, can help overcome feelings of nausea. Taking slow and deep breaths and holding breath for a short time after each breath is a simple breathing exercise to help you feel calm and may help ease nausea.

Aromatherapy: Aromatherapy can help reduce the feelings of nausea. It involves inhaling pleasant fragrances, such as peppermint oil fragrances or citrus fragrances which calm the sensation of nausea.

Acupressure and acupuncture: Acupressure and acupuncture techniques can help block the noxious stimuli that cause nausea by applying intense pressure to the peripheral trigger points. Applying pressure on the pressure point called Neiguan or P-6, which is on the inner arm, near the wrist helps reduce nausea.

Natural remedies: Sucking on small portions of certain natural foods, such as ginger candy or a piece of ginger with rock salt sprinkled on it, cumin seeds or powder, a piece of lemon, cinnamon stick, fennel seeds, etc., help overcome the feeling of nausea. These herbs and spices are known for their digestive properties, they help improve the taste sensation in the mouth and thus help suppress the sensation of nausea.

Complications Of Nausea

Worsening of acute episodes of nausea can lead to excessive vomiting, which can cause dehydration. In severe cases, it can lead to hypotension, shock, or loss of consciousness. It may result in poor nutrition as patients cannot consume or keep down solid food.

Vomit aspiration in the lungs is another serious complication of nausea. The aspirated fluid may collect in the lungs and cause pneumonia, which may be severe in some cases.

Malnutrition and weight loss is another complication seen in patients with chronic nausea, as they often avoid consuming full meals out of fear.

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Living With Nausea

Nausea can be exhausting for people who experience chronic nausea, such as cancer patients undergoing chemotherapy. With constant nausea, the person 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 the mother and the baby. In such cases, do take precautions and medicines 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 medicines, it is wise to keep a control on your diet and lead a stress-free lifestyle to improve your condition.

 

Migraine and Nausea: In some cases, people suffering from migraine can cause symptoms like nausea and vomiting. However, if you experience it on a regular basis or if nausea is worsened during a migraine attack, do consult a doctor and get the right treatment.

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

Medications and Nausea: Nausea can occur as a side effect of many nonprescription and prescription medicines. 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 think that your nausea or vomiting may be caused by a medicine, call your doctor to know if you should stop taking the medication or need to take a different medication.