Vomiting

Symptoms Of Vomiting

Vomiting is a common gastrointestinal complaint that can be triggered by a lot of stimuli and it is considered a defense mechanism against toxins, drugs, bacteria, viruses, and fungi that enter the body. Symptoms associated with vomiting include:

• Nausea

• Abdomen distension

• Diarrhea

• Fever

• Lightheadedness

• Vertigo

• Increased heart rate

• Excessive sweating

• Dryness of the mouth

• Decreased urination

• Chest pain

• Fainting

• Confusion

• Excessive sleepiness

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Causes Of Vomiting

During vomiting, the major muscles in between the neck and stomach contract at the same time. This puts pressure on the stomach, expelling the contents in the stomach up the throat and through your mouth. The most common causes of vomiting include:

Gastroenteritis

Acute viral gastroenteritis is an intestinal infection caused by various viruses. It is a major cause of vomiting. Other signs and symptoms include diarrhea, stomach cramps, nausea, and sometimes fever.

Food poisoning

If you eat food that is contaminated or stale, it can lead to food poisoning. It is caused due to multiplication of bacteria in the food which produces toxins in the body. 

Food poisoning commonly causes vomiting. Other symptoms include nausea, and stomach cramping, with or without diarrhea.

Inner ear infections

Also known as labyrinthitis, it can cause vomiting that is commonly accompanied by dizziness and a feeling of spinning (vertigo).

Motion sickness

Motion sickness is a sensation of throwing up while traveling by road, air, or sea. The movement of the vehicle causes turbulence as a result of which the inner ear loses its balance and causes nausea and vomiting.

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Pregnancy

Pregnant women typically endure repeated episodes of nausea and vomiting, particularly during the first trimester of pregnancy called "morning sickness". 

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Appendicitis

Appendicitis is an inflammation of the appendix (a thin pouch that connects to the large intestine). This can cause pain that tends to move to the right or lower right side of the stomach. Nausea and vomiting are often associated with appendicitis.

Gallstones

Gallstones are hardened deposits of digestive fluid that can form in gallbladder (a small, pear-shaped organ on the right side of the abdomen that holds a digestive fluid called bile). Gallstones can lead to severe abdominal pain that can cause vomiting.

Gastroesophageal reflux disease (GERD)

It is a condition in which stomach acid repeatedly flows back into the tube connecting your mouth and stomach. This can lead to nausea and even vomiting in some cases.

Migraines

These are a type of headaches that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. They are usually accompanied by nausea, vomiting, and extreme sensitivity to light and sound.

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Medications

Nausea and vomiting are common side effects of many medications. These include antibiotics, vitamins, birth control pills, analgesics, and antidepressants. So talk to your doctor if you feel nauseated after taking any medications. He/she might consider changing the medications.

Chemotherapy

Chemotherapy-induced nausea and vomiting (CINV) is a debilitating side effect of cancer treatment, affecting up to 40% of patients.

Concussion

It is a traumatic brain injury that affects your brain function. It is of utmost importance to seek emergency care if you experience repeated vomiting or nausea after a head injury.

Crohn’s disease

It is a type of inflammatory bowel disease (IBD) that causes swelling of the tissues in your digestive tract. It can cause a narrowing of the intestine that prevents food from normally traveling through the digestive tract, causing nausea and vomiting.

Other causes of vomiting

These may include:

• Bowel obstruction

• Menstruation

• Excessive alcohol consumption

• Anxiety

• Intense pain

• Kidney infections and stones

• Irritable bowel syndrome (IBS)

• Food allergies

• Exposure to toxins

Did you know?

Nausea and vomiting also occur in about 20-30% of postoperative patients as a complication of anesthesia. The term PONV is typically used to describe nausea and/or vomiting in the immediate 24 postoperative hours. Postdischarge nausea and vomiting (PDNV) refer to symptoms that occur after discharge for outpatient procedures.

Causes of vomiting in babies

Common causes of vomiting in babies may include:

• Viral gastroenteritis

• Swallowing milk too quickly

• Food allergies

• Milk intolerance

• Urinary tract infections (UTIs)

• Middle ear infections

• Pneumonia

• Meningitis

• Ingesting toxic substances accidentally

• Congenital pyloric stenosis (a condition present at birth that causes narrowing of the passage between stomach and bowel)

• Blockages in the bowel.

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Diagnosis Of Vomiting

Vomiting can be a symptom of many causes, sometimes it can be as simple as indigestion and sometimes it can be due to an underlying disorder. Though the diagnosis of vomiting can be simple, its cause should not be neglected and every possibility must be evaluated. Diagnosis mainly consist of:

1. Medical history

Past history is very important in determining the cause of vomiting. Questions such as onset duration and frequency, any chronic illness, the timing of vomiting, and associated symptoms must be asked to get a thorough understanding of the reason behind vomiting.

2. Physical examination

3. Laboratory tests

Tests are directed by the history and physical examination to determine the underlying cause or to evaluate for the consequences of vomiting. These tests include:

1. Complete blood count (CBC): It is done to diagnose any changes in blood cell count.

2. Serum electrolytes: this test is done to check for acidosis (too much acid in the body fluids), alkalosis (excess base in body fluids), azotemia (build-up of nitrogen products in the blood), and hypokalemia ( deficiency of potassium in the blood)

3. Erythrocyte sedimentation rate(ESR): To check for inflammation

4. Pancreatic/liver enzymes: For patients with upper abdominal pain or jaundice

5. Pregnancy test: In case of any female of childbearing age

6. Protein/albumin: In patients with chronic organic illness or malnutrition

7. Specific toxins: To check for any ingestion or use of potentially toxic medications

8. Thyroid-stimulating hormone(TSH): For patients with signs of thyroid toxicity or unexplained nausea and vomiting.

4. Imaging tests

Supine and upright abdominal radiography are done to check for small bowel or any other kind of obstruction. 

5. Other tests

Further testing may be needed to evaluate obstructions or any other cause. These tests may include:

• Esophagogastroduodenoscopy

• Computed tomography (CT) 

• Abdominal ultrasonography (USG)

• Magnetic resonance imaging (MRI) of the brain

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Prevention Of Vomiting

The sequence before vomiting is nausea and when you begin feeling nauseous, there are a few steps you can take to potentially stop yourself from actually vomiting. The following tips that can prevent vomiting include:

• Take deep breaths as soon as you begin to feel nauseous

• Drink plenty of water and other liquids

• Eat fresh or candied ginger or try ginger tea

• If you are prone to motion sickness, take an OTC (over-the-counter) medication to stop vomiting

• Suck on ice chips

• Avoid oily or spicy foods if you have indigestion

• Sit down or lie down with your head and back propped up

• Do not consume an excess of alcohol

• Do not sleep immediately after eating

• Avoid staring at screens while traveling

• Try to avoid any kind of activity when you feel nauseous

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Specialists To Visit

Vomiting can be caused due to several reasons. In case of frequent vomiting, doctors that can help you diagnose the exact cause and provide treatment include:

• General physician

• Pediatrician (in case of children)

• Gastroenterologist

A gastroenterologist is a medical practitioner qualified to diagnose and treat disorders of the stomach and intestines.

When to see a doctor?

It is essential to see a doctor in case of the following symptoms:

In children:

1. Vomiting lasts more than a few hours

2. Diarrhea and signs of dehydration are present

3. Fever higher than 100 degrees Fahrenheit

4. Your child hasn't urinated for six hours

In adults:

• Blood in the vomit

• Severe headache along with stiff neck

• Fatigue 

• Confusion and disorientation

• Severe abdominal pain

• Fever over 101 degrees Fahrenheit

• Diarrhea 

• Rapid breathing or heart rate.

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Treatment Of Vomiting

The basic management of vomiting is to avoid any environmental triggers such as crowded places, odors, and heat. Also, treating the underlying cause is important to stop the episodes of vomiting. 

However, nausea and vomiting can be very vigorous in individuals undergoing treatment for cancer, or who have undergone any kind of surgery. Treatment in such cases includes:

1. Antiemetic drugs

Antiemetics are drugs used to combat nausea and vomiting. These work by blocking the pathways involved in vomiting. Most commonly used antiemetics include:

• Scopolamine

• Diphenhydramine

• Hydroxyzine

• Promethazine

• Prochlorperazine

• Droperidol

• Metoclopramide

• Ondansetron

2. Newer agents

These agents work by blocking the action of a chemical messenger (neurokinin) in the brain that may cause nausea and vomiting during anti-cancer treatment (chemotherapy).

Aprepitant is the first of these agents to be introduced, but its efficacy is not yet established.

Note: Glucocorticoids (corticosteroids) such as dexamethasone are well-established antiemetics for chemotherapy-induced as well as postoperative nausea and vomiting.


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Home-care For Vomiting

Vomiting can be a one-time affair or can happen regularly due to various reasons. However, the feeling is not quite welcoming and can take a toll on the mind and the body. The first and foremost step is to keep yourself hydrated. The following tips should be kept in mind for the management of vomiting in children:

• Avoid solid foods for up to 24 hours in case of persistent vomiting.

• Keep your child hydrated.

• Lay your child on their side to minimize the chance of them inhaling vomit into their airways.

• Do not try medications and alternative treatments without a doctor’s approval.

There are numerous tips to manage nausea and vomiting and some of the most effective home remedies include:

• Ginger (Adrak): Ginger is a widely used herb for its many natural medicinal properties and particularly as an antiemetic. 

• Lemon (Nimbu): According to studies, 40% of women have used lemon scent to relieve nausea and vomiting, and 26.5% of them have reported it as an effective way to control their symptoms.

• Peppermint oil: It significantly reduces the frequency of nausea, vomiting, and retching.

• Fennel (Sauf): It refreshes the flavor of your mouth and helps stop vomiting. You can have it as it is or as fennel seeds tea.

• Cumin (Zeera): The powder and seeds of cumin are known to be effective in relieving nausea and vomiting. 

• Cinnamon (Dalchini): It helps to reduce menstrual bleeding, nausea, and vomiting. Studies also showed significant improvements in gastrointestinal symptoms with cinnamon.

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Complications Of Vomiting

In most cases, nausea and vomiting might clear up on their own unless there is an underlying chronic condition. Persistent vomiting can lead to the following complications:

1. Dehydration: May be caused by failure to replace obligate water losses and the most common causes are vomiting, diarrhea, sweating, etc.

2. Loss of enamel: Studies demonstrate that self-induced vomiting can lead to the erosion of the outer layer of teeth (enamel).

Alternative Therapies For Vomiting

Nausea and vomiting are distressing symptoms that may significantly detract from the overall quality of life and greatly influence an individual’s overall mood and social activities. Chronic vomiting can also be managed with alternative therapies that have shown some good results. These therapies include:

1. Acupuncture and acupressure

Acupuncture and acupressure are two techniques commonly used to manage chronic vomiting. During acupuncture, a therapist inserts thin needles into specific points on the body. Acupressure aims to stimulate the same points of the body but uses pressure instead of needles to do so. Both techniques stimulate nerve fibers, which transmit signals to the brain and spinal cord and some believe these signals can decrease nausea.

2. Aromatherapy therapy

This type of therapy may help relieve nausea and vomiting, although studies on its effectiveness are mixed. To practice aromatherapy, try deep breathing with an open essential oil bottle, or an essential oil diffuser, or add a few drops to a cotton ball. If you have asthma or another respiratory condition, ask your doctor before diffusing essential oils.

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3. Traditional Chinese medicine (TCM)

According to TCM, vomiting is a manifestation of impaired homeostasis and reversed upward qi (in Chinese philosophy, qi, is the life force that every person and thing has) flow within the stomach, resulting in the expulsion of the stomach’s contents through the mouth.

This alternative therapy involves a variety of therapeutic techniques and the key to treatment lies in harmonizing the stomach and diminishing qi counter flow.