View source for Nausea

{{Short description|Medical symptom or condition}}
{{hatnote group|
{{distinguish|malaise}}
{{Other uses|Nausea (disambiguation)}}
}}
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'''Nausea''' is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to [[vomiting|vomit]].<ref name=AFP/> It can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat.<ref>{{Cite web|url = http://www.medicinenet.com/script/main/mobileart.asp?articlekey=24732|title = Nausea|access-date = 2015-10-11|archive-date = 2016-03-04|archive-url = https://web.archive.org/web/20160304081033/http://www.medicinenet.com/script/main/mobileart.asp?articlekey=24732|url-status = live}}</ref>

Over 30 definitions of nausea were proposed in a 2011 book on the topic.<ref name=newrev2017/>

Nausea is a [[non-specific symptom]], which means that it has many possible causes. Some common causes of nausea are [[gastroenteritis]] and other [[gastrointestinal disease|gastrointestinal disorders]], [[food poisoning]], [[motion sickness]], [[dizziness]], [[migraine]], [[fainting]], [[low blood sugar]], [[anxiety]], [[hyperthermia]], [[dehydration]] and [[Sleep deprivation|lack of sleep]]. Nausea is a side effect of many medications including [[chemotherapy]], or [[morning sickness]] in early pregnancy. Nausea may also be caused by [[disgust]] and [[Depression (mood)|depression]].<ref name=AFP />

Medications taken to prevent and treat nausea and vomiting are called [[antiemetic]]s. The most commonly prescribed antiemetics in the US are [[promethazine]], [[metoclopramide]], and the newer [[ondansetron]]. The word nausea is from [[Latin]] ''nausea'', from [[Greek language|Greek]] {{lang|grc|ναυσία}} – ''nausia'',<ref>{{cite web|url=https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dnausi%2Fa|title=ναυσία|first1=Henry George|last1=Liddell|first2=Robert|last2=Scott|website=A Greek-English Lexicon|via=Perseus.tufts.edu|access-date=2021-02-20|archive-date=2021-05-15|archive-url=https://web.archive.org/web/20210515085710/https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dnausi%2Fa|url-status=live}}</ref> "ναυτία" – ''nautia'', [[motion sickness]], "feeling sick or queasy".<ref>{{cite web|url=https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dnauti%2Fa|title=ναυτία|first1=Henry George|last1=Liddell|first2=Robert|last2=Scott|website=A Greek-English Lexicon|via=perseus.tufts.edu|access-date=2021-02-20|archive-date=2021-04-18|archive-url=https://web.archive.org/web/20210418100442/https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dnauti%2Fa|url-status=live}}</ref>
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==Causes==
[[Gastroenteritis|Gastrointestinal infections]] (37%) and [[food poisoning]] are the two most common causes of acute nausea and vomiting.<ref name=AFP>{{cite journal | vauthors = Metz A, Hebbard G | title = Nausea and vomiting in adults--a diagnostic approach | journal = Australian Family Physician | volume = 36 | issue = 9 | pages = 688–92 | date = September 2007 | pmid = 17885699 | url = http://www.racgp.org.au/afpbackissues/2007/200709/200709metz.pdf | publisher = [[Royal Australian College of General Practitioners]] | type = Review | access-date = 2016-11-26 | archive-date = 2016-11-26 | archive-url = https://web.archive.org/web/20161126194653/http://www.racgp.org.au/afpbackissues/2007/200709/200709metz.pdf | url-status = live }}{{open access}}</ref> Side effects from medications (3%) and pregnancy are also relatively frequent.<ref name=AFP/> There are many causes of chronic nausea.<ref name=AFP /> Nausea and vomiting remain undiagnosed in 10% of the cases. Aside from morning sickness, there are no sex differences in complaints of nausea. After childhood, doctor consultations decrease steadily with age. Only a fraction of one percent of doctor visits by those over 65 are due to nausea.<ref name=AFPHelena07/>

===Gastrointestinal===
Gastrointestinal infection is one of the most common causes of acute nausea and vomiting.<ref name=AFP /> Chronic nausea may be the presentation of many gastrointestinal disorders, occasionally as the major symptom, such as [[gastroesophageal reflux disease]], [[functional dyspepsia]], [[gastritis]], [[biliary reflux]], [[gastroparesis]], [[peptic ulcer]], [[celiac disease]], [[non-celiac gluten sensitivity]], [[Crohn's disease]], [[hepatitis]], [[Gastrointestinal tract#Upper gastrointestinal tract|upper gastrointestinal]] malignancy, and [[pancreatic cancer]].<ref name=AFP /><ref name=VoltaCaio2017>{{cite journal | vauthors = Volta U, Caio G, Karunaratne TB, Alaedini A, De Giorgio R | title = Non-coeliac gluten/wheat sensitivity: advances in knowledge and relevant questions | journal = Expert Review of Gastroenterology & Hepatology | volume = 11 | issue = 1 | pages = 9–18 | date = January 2017 | pmid = 27852116 | doi = 10.1080/17474124.2017.1260003 | s2cid = 34881689 | type = Review | quote = A lower proportion of NCG/WS patients (from 30% to 50%) complain of upper gastrointestinal tract manifestations, e.g. vomiting, nausea, gastroesophageal reflux disease, aerophagia and aphthous stomatitis. (NCG/WS: Non-coeliac gluten/wheat sensitivity) }}</ref> Uncomplicated ''[[Helicobacter pylori]]'' infection does not cause chronic nausea.<ref name=AFP />

===Food poisoning===
[[Food poisoning]] usually causes an abrupt onset of nausea and vomiting one to six hours after ingestion of contaminated food and lasts for one to two days.<ref name=USA07>{{cite journal | vauthors = Scorza K, Williams A, Phillips JD, Shaw J | title = Evaluation of nausea and vomiting | journal = American Family Physician | volume = 76 | issue = 1 | pages = 76–84 | date = July 2007 | pmid = 17668843 }}</ref> It is due to toxins produced by [[bacteria]] in food.<ref name=USA07/>

===Medications===
Many medications can potentially cause nausea.<ref name=USA07/> Some of the most frequently associated include cytotoxic [[chemotherapy]] regimens for cancer and other diseases, and [[general anaesthesia|general anaesthetic agents]]. An old cure for migraine, [[ergotamine]], is well known to cause devastating nausea in some patients; a person using it for the first time will be prescribed an [[antiemetic]] for relief if needed.{{cn|date=June 2022}}

===Pregnancy===
Nausea or "[[morning sickness]]" is common during early [[pregnancy]] but may occasionally continue into the second and third trimesters. In the first trimester nearly 80 % of women have some degree of nausea.<ref>{{cite journal | vauthors = Koch KL, Frissora CL | title = Nausea and vomiting during pregnancy | journal = Gastroenterology Clinics of North America | volume = 32 | issue = 1 | pages = 201–34, vi | date = March 2003 | pmid = 12635417 | doi = 10.1016/S0889-8553(02)00070-5 }}</ref> Pregnancy should therefore be considered as a possible cause of nausea in any sexually active woman of child-bearing age.<ref name=USA07/> While usually it is mild and self-limiting, severe cases known as [[hyperemesis gravidarum]] may require treatment.<ref name=preg07>{{cite journal | vauthors = Sheehan P | title = Hyperemesis gravidarum--assessment and management | journal = Australian Family Physician | volume = 36 | issue = 9 | pages = 698–701 | date = September 2007 | pmid = 17885701 }}</ref>

===Disequilibrium===
A number of conditions involving balance such as [[motion sickness]] and [[Vertigo (medical)|vertigo]] can lead to nausea and vomiting.<ref>{{Cite journal |last=Lackner |first=James R. |date=2014 |title=Motion sickness: more than nausea and vomiting |journal=Experimental Brain Research |volume=232 |issue=8 |pages=2493–2510 |doi=10.1007/s00221-014-4008-8 |issn=0014-4819 |pmc=4112051 |pmid=24961738}}</ref>

===Gynecologic===
[[Dysmenorrhea]] can cause nausea.<ref name=AFP2014>{{cite journal | vauthors = Osayande AS, Mehulic S | title = Diagnosis and initial management of dysmenorrhea | journal = American Family Physician | volume = 89 | issue = 5 | pages = 341–6 | date = March 2014 | pmid = 24695505 }}</ref>

===Psychiatric===
Nausea may be caused by [[Depression (mood)|depression]], [[anxiety disorder]]s and [[eating disorder]]s.<ref name=SinghYoon2016table1>{{cite journal | vauthors = Singh P, Yoon SS, Kuo B | title = Nausea: a review of pathophysiology and therapeutics | journal = Therapeutic Advances in Gastroenterology | volume = 9 | issue = 1 | pages = 98–112 | date = January 2016 | pmid = 26770271 | pmc = 4699282 | doi = 10.1177/1756283X15618131 | type = Review }}</ref>

===Potentially serious===
While most causes of nausea are not serious, some serious conditions are associated with nausea. These include [[pancreatitis]], [[small bowel obstruction]], [[appendicitis]], [[cholecystitis]], [[hepatitis]], [[Addisonian crisis]], [[diabetic ketoacidosis]], increased [[intracranial pressure]], [[spontaneous intracranial hypotension]], [[brain tumor]]s, [[meningitis]], [[heart attack]], [[rabies]],<ref>{{cite journal | vauthors = O'Connor RE, Brady W, Brooks SC, Diercks D, Egan J, Ghaemmaghami C, Menon V, O'Neil BJ, Travers AH, Yannopoulos D | display-authors = 6 | title = Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care | journal = Circulation | volume = 122 | issue = 18 Suppl 3 | pages = S787-817 | date = November 2010 | pmid = 20956226 | doi = 10.1161/circulationaha.110.971028 | doi-access = free }}</ref> [[carbon monoxide poisoning]] and many others.<ref name=AFP/>

===Comprehensive list===

====Inside the abdomen====
'''Obstructing disorders'''
* [[Gastric outlet obstruction]]
* [[Bowel obstruction|Small bowel obstruction]]
* [[Bowel obstruction|Colonic obstruction]]
* [[Superior mesenteric artery syndrome]]
'''Enteric infections'''
* [[Viral gastroenteritis|Viral infection]]
* [[Gastroenteritis|Bacterial infection]]
'''Inflammatory diseases'''
* [[Celiac disease]]
* [[Cholecystitis]]
* [[Pancreatitis]]
* [[Appendicitis]]
* [[Hepatitis]]
'''Sensorimotor dysfunction'''
* [[Gastroparesis]]
* [[Intestinal pseudoobstruction|Intestinal pseudo-obstruction]]
* [[Gastroesophageal reflux disease]]
* [[Irritable bowel syndrome]]
* [[Cyclic vomiting syndrome]]
'''Other'''
* [[Non-celiac gluten sensitivity]]
* [[Biliary colic]]
* [[Kidney stone]]
* [[Cirrhosis]]
* Abdominal irradiation<ref name=H2015>Hasler WL. Nausea, Vomiting, and Indigestion. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. ''Harrison's Principles of Internal Medicine, 19e''. New York, NY: McGraw-Hill; 2015.</ref><!-- ref for all -->

==== Outside the abdomen ====
'''Cardiopulmonary'''
* [[Cardiomyopathy]]
* [[Myocardial infarction]] (heart attack)
* Paroxysmal cough
'''Inner-ear diseases'''
* [[Motion sickness]]
* [[Labyrinthitis]]
* [[Malignancy]]
'''Intracerebral disorders'''
* [[Malignancy]]
* [[Bleeding|Hemorrhage]]
* [[Abscess]]
* [[Hydrocephalus]]
* [[Meningitis]]
* [[Encephalitis]]
* [[Rabies]]
'''Psychiatric illnesses'''
* [[Anorexia nervosa|Anorexia]] and [[Bulimia nervosa|bulimia]] nervosa
* [[Major depressive disorder|Depression]]
* [[Drug withdrawal]]
'''Other'''
* Post-operative vomiting<ref name=H2015/><!-- ref for all -->
* [[Nociception]]
* [[Altitude sickness]]
* [[Mast cell activation syndrome]]<ref name="PMID33261124">{{cite journal |vauthors=Valent P, Akin C, Nedoszytko B et al. |title=Diagnosis, Classification and Management of Mast Cell Activation Syndromes (MCAS) in the Era of Personalized Medicine |journal=International Journal of Molecular Sciences |volume=21 |issue=23 |date=2020-11-27 |doi=10.3390/ijms21239030 |pmc=7731385 |pmid=33261124 |pages=3 f |url=|doi-access=free}}</ref><ref name="PMID28262205">{{cite journal |vauthors=Afrin LB, Self S, Menk J, Lazarchick J |title=Characterization of Mast Cell Activation Syndrome |journal=The American Journal of the Medical Science |volume=353 |issue=3 |date=2017 |pages=207–215 |doi=10.1016/j.amjms.2016.12.013 |pmc=5341697 |pmid=28262205|url=|doi-access=free}}</ref><ref name="PMID38948000">{{cite journal |vauthors=Özdemir Ö, Kasımoğlu G, Bak A et al. |title=Mast cell activation syndrome: An up-to-date review of literature |journal=World J Clin Pediatr |date=2024-06-09 |volume=13 |issue=2 |doi=10.5409/wjcp.v13.i2.92813 |pmc=11212760 |pmid=38948000 |url=|doi-access=free}}</ref>

==== Medications and metabolic disorders ====
'''Drugs'''
* [[Chemotherapy]]
* [[Antibiotics]]
* [[Antiarrhythmic agent|Antiarrhythmics]]
* [[Digoxin]]
* [[Anti-diabetic medication|Oral hypoglycemic medications]]
* [[Oral contraceptive pill|Oral contraceptives]]
* [[Norepinephrine reuptake inhibitor|Norepinephrine reuptake inhibitors]]
'''Endocrine/metabolic disease'''
* [[Pregnancy]]
* [[Uremia]]
* [[Ketoacidosis]]
* [[Thyroid disease|Thyroid]] and [[Parathyroid disease|parathyroid]] disease
* [[Adrenal insufficiency]]
'''Toxins'''
* [[Liver failure]]
* [[Alcohol abuse|Alcohol]]

== Pathophysiology ==
Research on nausea and vomiting has relied on using animal models to mimic the anatomy and neuropharmacologic features of the human body.<ref>{{cite journal | vauthors = Andrews PL, Horn CC | title = Signals for nausea and emesis: Implications for models of upper gastrointestinal diseases | journal = Autonomic Neuroscience | volume = 125 | issue = 1–2 | pages = 100–15 | date = April 2006 | pmid = 16556512 | pmc = 2658708 | doi = 10.1016/j.autneu.2006.01.008 | url = http://www.autonomicneuroscience.com/article/S1566-0702(06)00011-7/abstract | access-date = 2015-01-11 | archive-date = 2020-01-10 | archive-url = https://web.archive.org/web/20200110182734/https://www.autonomicneuroscience.com/article/S1566-0702(06)00011-7/abstract | url-status = live }}</ref> The physiologic mechanism of nausea is a complex process that has yet to be fully elucidated. There are four general pathways that are activated by specific triggers in the human body that go on to create the sensation of nausea and vomiting.<ref>{{Cite book|title = Principles and Practice of Hospital Medicine|last = Lien|first = C|publisher = McGraw HIll|year = 2012|location = New York, NY|pages = Chapter 217: Domains of Care: Physical Aspects of Care}}</ref>
* [[Central nervous system]] (CNS): Stimuli can affect areas of the CNS including the cerebral cortex and the [[limbic system]]. These areas are activated by elevated intracranial pressure, irritation of the meninges (i.e. blood or infection), and extreme emotional triggers such as anxiety. The [[supratentorial region]] is also responsible for the sensation of nausea.<ref name=newrev2017/>
* [[Chemoreceptor trigger zone]] (CTZ): The CTZ is located in the [[area postrema]] in the floor of the fourth ventricle within the brain. This area is outside the blood brain barrier, and is therefore readily exposed to substances circulating through the blood and cerebral spinal fluid. Common triggers of the CTZ include metabolic abnormalities, toxins, and medications. Activation of the CTZ is mediated by [[dopamine]] (D2) receptors, [[serotonin]] (5HT3) receptors, and [[neurokinin]] receptors (NK1).
* [[Vestibular system]]: This system is activated by disturbances to the vestibular apparatus in the inner ear. These include movements that cause motion sickness and dizziness. This pathway is triggered via [[histamine]] (H1) receptors and [[acetylcholine]] (ACh) receptors.
* Peripheral Pathways: These pathways are triggered via chemoreceptors and mechanoreceptors in the gastrointestinal tract, as well as other organs such as the heart and kidneys. Common activators of these pathways include toxins present in the gastrointestinal lumen and distension of the gastrointestinal lumen from blockage or dysmotility of the bowels. Signals from these pathways travel via multiple neural tracts including the [[Vagus nerve|vagus]], [[Glossopharyngeal nerve|glossopharyngeal]], [[splanchnic]], and [[Sympathetic nervous system|sympathetic]] nerves.
Signals from any of these pathways then travel to the brainstem, activating several structures including the [[Solitary nucleus|nucleus of the solitary tract]], the [[Dorsal nucleus of vagus nerve|dorsal motor nucleus]] of the vagus, and [[central pattern generator]].<ref>{{cite journal | vauthors = Bashashati M, McCallum RW | title = Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting related to cyclic vomiting syndrome and other gastrointestinal disorders | journal = European Journal of Pharmacology | volume = 722 | pages = 79–94 | date = January 2014 | pmid = 24161560 | doi = 10.1016/j.ejphar.2013.09.075 }}</ref> These structures go on to signal various downstream effects of nausea and vomiting. The body's motor muscle responses involve halting the muscles of the gastrointestinal tract, and in fact causing reversed propulsion of gastric contents towards the mouth while increasing abdominal muscle contraction. Autonomic effects involve increased salivation and the sensation of feeling faint that often occurs with nausea and vomiting.

===Pre-nausea pathophysiology===
It has been described that alterations in heart rate can occur as well as the release of [[vasopressin]] from the [[posterior pituitary]].<ref name=newrev2017>{{cite journal | vauthors = Balaban CD, Yates BJ | title = What is nausea? A historical analysis of changing views | journal = Autonomic Neuroscience | volume = 202 | pages = 5–17 | date = January 2017 | pmid = 27450627 | doi = 10.1016/j.autneu.2016.07.003 | pmc = 5203950 }}</ref>

==Diagnosis==

===Patient history===

Taking a thorough patient history may reveal important clues to the cause of nausea and vomiting. If the patient's symptoms have an acute onset, then drugs, toxins, and infections are likely. In contrast, a long-standing history of nausea will point towards a chronic illness as the culprit. The timing of nausea and vomiting after eating food is an important factor to pay attention to. Symptoms that occur within an hour of eating may indicate an obstruction proximal to the small intestine, such as [[gastroparesis]] or [[pyloric stenosis]]. An obstruction further down in the intestine or colon will cause delayed vomiting. An infectious cause of nausea and vomiting such as gastroenteritis may present several hours to days after the food was ingested.<ref name="H2015" /> The contents of the emesis is a valuable clue towards determining the cause. Bits of fecal matter in the emesis indicate obstruction in the distal intestine or the colon. Emesis that is of a bilious nature (greenish in color) localizes the obstruction to a point past the stomach. Emesis of undigested food points to an obstruction prior to the gastric outlet, such as [[achalasia]] or [[Zenker's diverticulum]]. If patient experiences reduced abdominal pain after vomiting, then obstruction is a likely etiology. However, vomiting does not relieve the pain brought on by [[pancreatitis]] or [[cholecystitis]].<ref name="H2015" />

===Physical exam===

It is important to watch out for signs of dehydration, such as [[orthostatic hypotension]] and loss of skin [[turgor]]. Auscultation of the abdomen can produce several clues to the cause of nausea and vomiting. A high-pitched tinkling sound indicates possible [[bowel obstruction]], while a splashing "[[Succussion splash|succussion]]" sound is more indicative of gastric outlet obstruction. Eliciting pain on the abdominal exam when pressing on the patient may indicate an inflammatory process. Signs such as papilledema, visual field losses, or focal neurological deficits are red flag signs for elevated intracranial pressure.<ref name="H2015" />

===Diagnostic testing===

When a history and physical exam are not enough to determine the cause of nausea and vomiting, certain diagnostic tests may prove useful. A chemistry panel would be useful for electrolyte and metabolic abnormalities.<ref name=":1">{{Cite web|url=https://www.med.unc.edu/gi/faculty-staff-website/patient-education/patient-education/8IiiNausauVomitingOverviewACG.pdf|title=Nausea and Vomiting|last=Porter|first=Ryan|publisher=American College of Gastroenterology|website=Med.unc.edu|access-date=24 January 2018|archive-url=https://web.archive.org/web/20170328235736/http://www.med.unc.edu/gi/faculty-staff-website/patient-education/patient-education/8IiiNausauVomitingOverviewACG.pdf|archive-date=28 March 2017|url-status=dead}}</ref> Liver function tests and lipase would identify pancreaticobiliary diseases.<ref name=":1" /> Abdominal X-rays showing air-fluid levels indicate bowel obstruction, while an X-ray showing air-filled bowel loops are more indicative of [[ileus]]. More advanced imaging and procedures may be necessary, such as a CT scan, upper endoscopy, colonoscopy, barium enema, or MRI. Abnormal GI motility can be assessed using specific tests like gastric scintigraphy, wireless motility capsules, and small-intestinal manometry.<ref name="H2015" />

==Treatment==
If dehydration is present due to loss of fluids from severe vomiting, [[Fluid replacement|rehydration]] with oral electrolyte solutions is preferred.<ref name=AFP/> If this is not effective or possible, intravenous rehydration may be required.<ref name=AFP/> Medical care is recommended if: a person cannot keep any liquids down, has symptoms more than 2 days, is weak, has a fever, has stomach pain, vomits more than two times in a day or does not urinate for more than 8 hours.<ref name="autogenerated1">{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000122.htm |title=When you have nausea and vomiting: MedlinePlus Medical Encyclopedia |publisher=Nlm.nih.gov |access-date=2014-03-20 |archive-date=2016-07-05 |archive-url=https://web.archive.org/web/20160705050123/https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000122.htm |url-status=live }}</ref>

===Medications===
Numerous pharmacologic medications are available for the treatment of nausea. There is no medication that is clearly superior to other medications for all cases of nausea.<ref>{{cite journal | vauthors = Furyk JS, Meek RA, Egerton-Warburton D | title = Drugs for the treatment of nausea and vomiting in adults in the emergency department setting | journal = The Cochrane Database of Systematic Reviews | volume = 9 | issue = 9 | pages = CD010106 | date = September 2015 | pmid = 26411330 | pmc = 6517141 | doi = 10.1002/14651858.cd010106.pub2 }}</ref> The choice of [[antiemetic]] medication may be based on the situation during which the person experiences nausea. For people with motion sickness and vertigo, antihistamines and anticholinergics such as [[meclizine]] and [[Hyoscine hydrobromide|scopolamine]] are particularly effective.<ref name=":0">{{cite journal | vauthors = Flake ZA, Linn BS, Hornecker JR | title = Practical selection of antiemetics in the ambulatory setting | journal = American Family Physician | volume = 91 | issue = 5 | pages = 293–6 | date = March 2015 | pmid = 25822385 | url = http://www.aafp.org/afp/2015/0301/p293.html | access-date = 10 November 2015 | archive-date = 19 June 2018 | archive-url = https://web.archive.org/web/20180619140726/https://www.aafp.org/afp/2015/0301/p293.html | url-status = live }}</ref> Nausea and vomiting associated with migraine headaches respond best to dopamine antagonists such as [[metoclopramide]], [[prochlorperazine]], and [[chlorpromazine]].<ref name=":0" /> In cases of gastroenteritis, serotonin antagonists such as [[ondansetron]] were found to suppress nausea and vomiting, as well as reduce the need for IV fluid resuscitation.<ref name=":0" /> The combination of [[pyridoxine]] and [[doxylamine]] is the first line treatment for pregnancy-related nausea and vomiting.<ref name=":0" /> [[Dimenhydrinate]] is an inexpensive and effective over the counter medication for preventing postoperative nausea and vomiting.<ref>{{cite journal | vauthors = Kranke P, Morin AM, Roewer N, Eberhart LH | title = Dimenhydrinate for prophylaxis of postoperative nausea and vomiting: a meta-analysis of randomized controlled trials | journal = Acta Anaesthesiologica Scandinavica | volume = 46 | issue = 3 | pages = 238–44 | date = March 2002 | pmid = 11939912 | doi = 10.1034/j.1399-6576.2002.t01-1-460303.x | s2cid = 22229281 }}</ref> Other factors to consider when choosing an antiemetic medication include the person's preference, side-effect profile, and cost.

[[Nabilone]] is also indicated for this purpose.

===Alternative medicine===
In certain people, [[cannabinoids]] may be effective in reducing chemotherapy associated nausea and vomiting.<ref>{{cite journal | vauthors = Tramèr MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ | title = Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review | journal = BMJ | volume = 323 | issue = 7303 | pages = 16–21 | date = July 2001 | pmid = 11440936 | pmc = 34325 | doi = 10.1136/bmj.323.7303.16 }}</ref><ref>{{cite web | url = http://www.drugpolicy.org/marijuana/medical/challenges/litigators/medical/conditions/nausea.cfm | title = Medicinal Uses of Marijuana: Nausea, Emesis and Appetite Stimulation | access-date = 2007-08-02 | year = 2001 | vauthors = ((Drug Policy Alliance)) | url-status = dead | archive-url = https://web.archive.org/web/20070805041622/http://drugpolicy.org/marijuana/medical/challenges/litigators/medical/conditions/nausea.cfm | archive-date = 2007-08-05 }}</ref> Several studies have demonstrated the therapeutic effects of cannabinoids for nausea and vomiting in the advanced stages of illnesses such as [[cancer]] and [[HIV/AIDS|AIDS]].<ref>{{Cite web |title=Cannabis |url=https://www.who.int/teams/mental-health-and-substance-use/alcohol-drugs-and-addictive-behaviours/drugs-psychoactive/cannabis |access-date=2024-01-20 |website=www.who.int |language=en |archive-date=2019-12-13 |archive-url=https://web.archive.org/web/20191213171022/https://www.who.int/substance_abuse/facts/cannabis/en/ |url-status=live }}</ref><ref>{{cite journal | vauthors = Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, Keurentjes JC, Lang S, Misso K, Ryder S, Schmidlkofer S, Westwood M, Kleijnen J | display-authors = 6 | title = Cannabinoids for Medical Use: A Systematic Review and Meta-analysis | journal = JAMA | volume = 313 | issue = 24 | pages = 2456–73 | date = 2015-06-23 | pmid = 26103030 | doi = 10.1001/jama.2015.6358 | doi-access = free | hdl = 10757/558499 | hdl-access = free }}</ref>

In hospital settings topical anti-nausea gels are not indicated because of lack of research backing their efficacy.<ref name="AAHPMfive">{{Citation |author1 = American Academy of Hospice and Palliative Medicine |author1-link = American Academy of Hospice and Palliative Medicine |title = Five Things Physicians and Patients Should Question |publisher = [[American Academy of Hospice and Palliative Medicine]] |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-hospice-palliative-medicine/ |access-date = August 1, 2013 |archive-date = September 1, 2013 |archive-url = https://web.archive.org/web/20130901101934/http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-hospice-palliative-medicine/ |url-status = live }}, which cites
* {{cite journal | vauthors = Smith TJ, Ritter JK, Poklis JL, Fletcher D, Coyne PJ, Dodson P, Parker G | title = ABH gel is not absorbed from the skin of normal volunteers | journal = Journal of Pain and Symptom Management | volume = 43 | issue = 5 | pages = 961–6 | date = May 2012 | pmid = 22560361 | doi = 10.1016/j.jpainsymman.2011.05.017 | doi-access = free }}
* {{cite journal | vauthors = Weschules DJ | title = Tolerability of the compound ABHR in hospice patients | journal = Journal of Palliative Medicine | volume = 8 | issue = 6 | pages = 1135–43 | date = December 2005 | pmid = 16351526 | doi = 10.1089/jpm.2005.8.1135 }}</ref> [[Topical gels]] containing [[lorazepam]], [[diphenhydramine]], and [[haloperidol]] are sometimes used for nausea but are not equivalent to more established therapies.<ref name="AAHPMfive"/>

[[Ginger]] has also been shown to be potentially effective in treating several types of nausea.<ref name="medind">{{cite journal | vauthors = Marx WM, Teleni L, McCarthy AL, Vitetta L, McKavanagh D, Thomson D, Isenring E | title = Ginger (Zingiber officinale) and chemotherapy-induced nausea and vomiting: a systematic literature review | journal = Nutrition Reviews | volume = 71 | issue = 4 | pages = 245–54 | date = April 2013 | pmid = 23550785 | doi = 10.1111/nure.12016 | s2cid = 19187673 | url = https://eprints.qut.edu.au/59091/2/Ginger_Article_Nutrition_Reviews_Accepted_Version_%28Recovered%29.pdf | access-date = 2019-12-12 | archive-date = 2020-05-07 | archive-url = https://web.archive.org/web/20200507235752/https://eprints.qut.edu.au/59091/2/Ginger_Article_Nutrition_Reviews_Accepted_Version_%28Recovered%29.pdf | url-status = dead }}</ref><ref name="ernst-meta">{{cite journal | vauthors = Ernst E, Pittler MH | title = Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials | journal = British Journal of Anaesthesia | volume = 84 | issue = 3 | pages = 367–71 | date = March 2000 | pmid = 10793599 | doi = 10.1093/oxfordjournals.bja.a013442 | doi-access = free }}</ref>

==Prognosis==
The outlook depends on the cause. Most people recover within few hours or a day. While short-term nausea and vomiting are generally harmless, they may sometimes indicate a more serious condition. When associated with prolonged vomiting, it may lead to [[dehydration]] or dangerous [[electrolyte]] imbalances or both. Repeated intentional vomiting, characteristic of [[bulimia]], can cause [[stomach acid]] to wear away at the [[tooth enamel|enamel]] present on the teeth.<ref>{{cite web|url=http://www.webmd.com/mental-health/bulimia-nervosa/bulimia-nervosa-topic-overview|title=Bulimia Nervosa-Topic Overview|work=WebMD|access-date=26 July 2012|url-status=dead|archive-url=https://web.archive.org/web/20120725072924/http://www.webmd.com/mental-health/bulimia-nervosa/bulimia-nervosa-topic-overview|archive-date=25 July 2012}}</ref>

==Epidemiology==
Nausea and or [[vomiting]] is the main complaint in 1.6% of visits to family physicians in Australia.<ref name=AFPHelena07>{{cite journal | vauthors = Britt H, Fahridin S | title = Presentations of nausea and vomiting | journal = Australian Family Physician | volume = 36 | issue = 9 | pages = 682–3 | date = September 2007 | pmid = 17885697 | url = http://www.racgp.org.au/afp/200709/200709beach.pdf | access-date = 2010-02-15 | archive-date = 2019-03-26 | archive-url = https://web.archive.org/web/20190326113722/https://www.racgp.org.au/afp/200709/200709beach.pdf | url-status = dead }}</ref> However, only 25% of people with nausea visit their family physician.<ref name=AFP/> In Australia, nausea, as opposed to vomiting, occurs most frequently in persons aged 15–24 years, and is less common in other age groups.<ref name=AFPHelena07/>

== See also ==
* [[Cancer and nausea]]
* [[Vasodilation]]

== References ==
{{Reflist}}

== External links ==
* {{Wiktionary-inline}}
{{Medical resources
| ICD10          = {{ICD10|R11.0}}
| ICD9           = {{ICD9|787.03}}
| ICDO           =
| OMIM           =
| DiseasesDB     =
| MedlinePlus    = 003117
| MeshID=D009325
}}
{{Gastroenterology}}
{{Digestive system and abdomen symptoms and signs}}
{{Authority control}}

[[Category:Symptoms and signs: Digestive system and abdomen]]
[[Category:Vomiting]]