Wikipedia - Nausea (CHECKED)

A 1681 painting depicting a person vomiting

Specialty Gastroenterology

ICD-10 R11.0 (http://apps.who.int/classifications/icd10/browse/2015/en#/R11.0)

ICD-9 787.03 (http://www.icd9data.com/getICD9Code.ashx?icd9=787.03)

MedlinePlus 003117 (http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm)

Nausea

NauseaFrom Wikipedia, the free encyclopedia

Nausea (Latin nausea, from Greek ναυσία -nausia,[1] "ναυτία" - nautia, motion sickness","feeling sick or queasy"[2]) is a sensation of uneaseand discomfort in the upper stomach with aninvoluntary urge to vomit.[3] It occasionally precedesvomiting. A person can suffer nausea withoutvomiting. (Greek ναῦς - naus, "ship"; ναυσία startedas meaning "seasickness".)

Nausea is a non-specific symptom, which means thatit has many possible causes. Some common cause ofnausea are motion sickness, dizziness, migraine,fainting, gastroenteritis (stomach infection) or foodpoisoning. Side effects of many medicationsincluding cancer chemotherapy, nauseants or morningsickness in early pregnancy. Nausea may also becaused by anxiety, disgust and depression.[4][5][6]

Medications taken to prevent and treat nausea arecalled antiemetics. The most commonly prescribedantiemetics in the US are promethazine,metoclopramide and ondansetron.

Contents1 Differential diagnosis

1.1 Food poisoning1.2 Medications1.3 Pregnancy1.4 Disequilibrium1.5 Stress and depression1.6 Potentially serious1.7 Diagnostic approach

2 Treatment2.1 Medications

3 Prognosis4 Epidemiology5 See also6 References

Nausea - Wikipedia, the free encyclopedia https://en.wikipedia.org/wiki/Nausea

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Pablo G. Bledt

Differential diagnosis

There are many causes of nausea. One organization listed 700 in 2009.[7] Gastrointestinal infections(37%) and food poisoning are the two most common causes.[3][8] Side effects from medications (3%)and pregnancy are also relatively frequent.[3][8] In 10% of people the cause remains unknown.[8]

Food poisoning

Food poisoning usually causes an abrupt onset of nausea and vomiting one to six hours after ingestion ofcontaminated food and lasts for one to two days.[9] It is due to toxins produced by bacteria in food.[9]

Medications

Many medications can potentially cause nausea.[9] Some of the most frequently associated includecancer and systemic chemotherapy regimens and general anaesthetic agents.

Pregnancy

Nausea or "morning sickness" is common during early pregnancy but may occasionally continue into thesecond and third trimesters. In the first trimester nearly 80% of women have some degree of nausea.[10]

Pregnancy should therefore be considered as a possible cause of nausea in any women of child bearingage.[9] While usually it is mild and self-limiting severe cases known as hyperemesis gravidarum mayrequire treatment.[11]

Disequilibrium

A number of conditions involving balance such as motion sickness and vertigo can lead to nausea andvomiting.

Stress and depression

Nausea may be caused by stress and depression.

Potentially serious

While most causes of nausea are not serious, some serious causes do occur. These include: IntercranialPressure secondary to head trauma or hemorrhagic stroke, diabetic ketoacidosis, brain tumor, surgicalproblems, heart attack,[12] pancreatitis, small bowel obstruction, meningitis, appendicitis, cholecystitis,Addisonian crisis, Choledocholithiasis (from gallstones), hepatitis, as a sign of carbon monoxide poisonand many others.[3]

Diagnostic approach

Often, a good oral history of the symptom will lead to appropriate treatment where few investigations


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Pablo G. Bledt

Pablo G. Bledt

Pablo G. Bledt

Pablo G. Bledt

Pablo G. Bledt

Pablo G. Bledt

Pablo G. Bledt

are needed; however, basic lab tests may be appropriate.[3] If a bowel obstruction is possible, abdominalx-rays may be useful.[3] For instance, if severe anxiety appears to be the cause of nausea, then a shortcourse of an anti-anxiety medication such as lorazepam (Ativan) may be all that is needed. If pain ispresent the nausea can be caused by pain or by opioids used to treat the pain. These may includecodeine, hydrocodone, meperidine, morphine, oxycodone, hydromorphone, or fentanyl. These drugscause nausea in several ways. They may stimulate the eighth cranial nerve which causes vestibulareffects such as dizziness or they may stimulate what is called the Chemo Receptor Trigger zone (CTZ)which in turn stimulates the Vestibular Apparatus in the brain which in turn causes nausea and perhapsvomiting. In addition, opioids may slow gastric emptying, causing constipation, which is oftenaccompanied by nausea. If changing opioids does not abate the symptom then addition of antiemeticsbecomes necessary? Choice of treatment then is indicated by causation. If pain and anxiety are presentthen drugs or doses need to be increased; if nausea is caused by movement then adding an over thecounter medication such as meclizine is indicated; if constipation is the cause then a laxative is in order;if these fail then often addition of metacloperamide (to stimulate gastric emptying) and haloperidol invery low doses (to block stimulation of the CTZ) will often give relief. If the nausea is very acute,followed by vomiting, in an otherwise healthy person, it is often best to with hold food and then giveclear liquids at least in the first 24 hours may be best as the nausea/vomiting my be a defense mechanismwhere the body is ridding itself of a toxin. If this is done, however, the age and general condition of theperson has to be considered. An infant or small child can become dangerously dehydrated in 2–3 hours,while a healthy 21year old can withstand the fluid loss for somewhat longer. In no case should theperson be left alone, they should be watched and medical help called for if symptoms of dehydrationsuch as very concentrated (very yellow) urine, poor skin turgor (pull gently on a pinch of skin and if itstays pinched for even a few seconds), confusion, dry eyes and mouth, occur. Nausea can also be causedby poor kidney or liver function. Acutely this is a medical emergency. If the person has a chroniccondition then often judicious use of metacloperamide and haloperidol can be very helpful as theseconditions cause toxins to accumulate in the blood which stimulate the CTZ, like opioids, and thenausea/vomiting usually respond to the same treatment. Nausea/vomiting caused by chemotherapy iscaused in yet a different way and therefore needs medications such as ondansetron for control. Note thatthere is no all purpose antiemetic. Successful treatment depends on identification of cause.

TreatmentIf dehydration is present due to loss of fluids from severe vomiting, rehydration with oral electrolytesolutions is preferred.[3] If this is not effective or possible, intravenous rehydration may be required.[3]

NIH Medline recommends drinking clear fluids, sitting quietly and eating bland foods.[13] Medlinerecommends you call a doctor if you:

Cannot keep any food or liquid downVomit 3 or more times in 1 dayAre nauseated for more than 48 hoursFeel weaknessHave feverHave stomach painDo not have to urinate for 8 hours or more [13]


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Medications

Dimenhydrinate (Gravol) is an inexpensive and effective over the counter medication for preventingpostoperative nausea and vomiting.[14] Meclizine is another antihistamine antiemetic. In certain people,cannabinoids may be effective in reducing chemotherapy associated nausea and vomiting.[15][16]

Ondansetron (Zofran) is effective for nausea and vomiting.[9] Pyridoxine or metoclopramide are the firstline treatments for pregnancy related nausea and vomiting.[11] Many consider medical marijuana to bean effective herbal remedy for nausea. Several studies have demonstrated the therapeutic effects ofcannabinoids for nausea and vomiting in the advanced stages of illnesses such as cancer and AIDS.[17]

In hospital settings topical anti-nausea gels are not indicated because of lack of research backing theirefficacy.[18] Topical gels containing lorazepam, diphenhydramine, and haloperidol are sometimes usedfor nausea but are not equivalent to more established therapies.[18]

Ginger has also been shown to be potentially effective in treating several types of nausea.[19][20]

PrognosisWhile short-term nausea and vomiting are generally harmless, they may sometimes indicate a moreserious condition. When associated with prolonged vomiting, it may lead to dehydration and/ordangerous electrolyte imbalances. Repeated intentional vomiting, characteristic of bulimia, can causestomach acid to wear away at the enamel in teeth.[21]

Epidemiology

Nausea and or vomiting is the main complaint in 1.6% of visits to family physicians in Australia.[8]

However, only 25% of people with nausea visit their family physician.[3] It is most common in those15–24 years old and less common in other ages.[8]

See alsoCancer and nausea

Referencesναυσία (http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dnausi%2Fa), Henry George Liddell, RobertScott,.A Greek-English Lexicon, on Perseus

1.

ναυτία (http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dnauti%2Fa), Henry George Liddell, RobertScott, A Greek-English Lexicon, on Perseus

2.

Metz A, Hebbard G (September 2007). "Nausea and vomiting in adults--a diagnostic approach". Aust FamPhysician 36 (9): 688–92. PMID 17885699 (https://www.ncbi.nlm.nih.gov/pubmed/17885699).

3.


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"Stress symptoms: Effects on your body, feelings and behavior" (http://www.mayoclinic.com/health/stress-symptoms/SR00008_D). Mayo Clinic.

4.

"Diagnostic Criteria: Clinical Guidelines for the Management of Anxiety" (http://www.ncbi.nlm.nih.gov/books/NBK45852/). PubMed.

5.

"Disease Information for Stress/Emotional/Physical: Clinical Manifestations" (http://en.diagnosispro.com/disease_information-for/clinical-manifestations-stress-emotional-physical/19955-104.html).

6.

"Differential Diagnosis for Nausea" (http://en.diagnosispro.com/differential_diagnosis-for/nausea/37707-154.html).

7.

Helena Britt; Fahridin, S (September 2007). "Presentations of nausea and vomiting" (http://www.racgp.org.au/afp/200709/200709beach.pdf) (PDF). Aust Fam Physician 36 (9): 673–784. PMID 17885697(https://www.ncbi.nlm.nih.gov/pubmed/17885697).

8.

Scorza K, Williams A, Phillips JD, Shaw J (July 2007). "Evaluation of nausea and vomiting". Am FamPhysician 76 (1): 76–84. PMID 17668843 (https://www.ncbi.nlm.nih.gov/pubmed/17668843).

9.

Koch KL, Frissora CL (March 2003). "Nausea and vomiting during pregnancy". Gastroenterol. Clin. NorthAm. 32 (1): 201–34, vi. doi:10.1016/S0889-8553(02)00070-5 (https://dx.doi.org/10.1016%2FS0889-8553%2802%2900070-5). PMID 12635417 (https://www.ncbi.nlm.nih.gov/pubmed/12635417).

10.

Sheehan P (September 2007). "Hyperemesis gravidarum--assessment and management". Aust Fam Physician36 (9): 698–701. PMID 17885701 (https://www.ncbi.nlm.nih.gov/pubmed/17885701).

11.

O’Connor RE, Brady W, Brooks SC, Diercks D, Egan J, Ghaemmaghami C, Menon V, O’Neil BJ, TraversAH, Yannopoulos D. Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines forCardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S788.

12.

"When you have nausea and vomiting: MedlinePlus Medical Encyclopedia" (http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000122.htm). Nlm.nih.gov. Retrieved 2014-03-20.

13.

Kranke P, Morin AM, Roewer N, Eberhart LH (March 2002). "Dimenhydrinate for prophylaxis ofpostoperative nausea and vomiting: a meta-analysis of randomized controlled trials". Acta AnaesthesiolScand 46 (3): 238–44. doi:10.1034/j.1399-6576.2002.t01-1-460303.x (https://dx.doi.org/10.1034%2Fj.1399-6576.2002.t01-1-460303.x). PMID 11939912 (https://www.ncbi.nlm.nih.gov/pubmed/11939912).

14.

Tramèr MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ (July 2001). "Cannabinoids forcontrol of chemotherapy induced nausea and vomiting: quantitative systematic review"(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC34325). BMJ 323 (7303): 16–21.doi:10.1136/bmj.323.7303.16 (https://dx.doi.org/10.1136%2Fbmj.323.7303.16). PMC 34325(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC34325). PMID 11440936 (https://www.ncbi.nlm.nih.gov/pubmed/11440936).

15.

Drug Policy Alliance (2001). "Medicinal Uses of Marijuana: Nausea, Emesis and Appetite Stimulation"(http://www.drugpolicy.org/marijuana/medical/challenges/litigators/medical/conditions/nausea.cfm).Retrieved 2007-08-02.

16.

World health Organization, Cannabis - epidemiology. http://www.who.int/substance_abuse/facts/cannabis/en/17. American Academy of Hospice and Palliative Medicine, "Five Things Physicians and Patients ShouldQuestion" (http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-hospice-palliative-medicine/), Choosing Wisely: an initiative of the ABIM Foundation (American Academy of Hospice andPalliative Medicine), retrieved August 1, 2013, which cites

Smith, T. J.; Ritter, J. K.; Poklis, J. L.; Fletcher, D.; Coyne, P. J.; Dodson, P.; Parker, G. (2012). "ABHGel is Not Absorbed from the Skin of Normal Volunteers". Journal of Pain and SymptomManagement 43 (5): 961–966. doi:10.1016/j.jpainsymman.2011.05.017 (https://dx.doi.org/10.1016%2Fj.jpainsymman.2011.05.017). PMID 22560361 (https://www.ncbi.nlm.nih.gov/pubmed/22560361).Weschules, D. J. (2005). "Tolerability of the Compound ABHR in Hospice Patients". Journal ofPalliative Medicine 8 (6): 1135–1143. doi:10.1089/jpm.2005.8.1135 (https://dx.doi.org/10.1089%2Fjpm.2005.8.1135). PMID 16351526 (https://www.ncbi.nlm.nih.gov/pubmed/16351526).

18.

Marx, WM; Teleni L; McCarthy AL; Vitetta L; McKavanagh D; Thomson D; Isenring E. (2013). "Ginger(Zingiber officinale) and chemotherapy-induced nausea and vomiting: a systematic literature review". NutrRev 71 (4): 245–54. doi:10.1111/nure.12016 (https://dx.doi.org/10.1111%2Fnure.12016). PMID 23550785(https://www.ncbi.nlm.nih.gov/pubmed/23550785).

19.


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Look up nausea inWiktionary, the freedictionary.

Ernst, E.; Pittler, M.H. (1 March 2000). "Efficacy of ginger for nausea and vomiting: a systematic review ofrandomized clinical trials" (http://bja.oxfordjournals.org/cgi/reprint/84/3/367) (PDF). British Journal ofAnesthesia 84 (3): 367–371. doi:10.1093/oxfordjournals.bja.a013442 (https://dx.doi.org/10.1093%2Foxfordjournals.bja.a013442). PMID 10793599 (https://www.ncbi.nlm.nih.gov/pubmed/10793599). Retrieved 6 September 2006.

20.

"Bulimia Nervosa-Topic Overview" (http://www.webmd.com/mental-health/bulimia-nervosa/bulimia-nervosa-topic-overview). WebMD. Retrieved 26 July 2012.

21.

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Wikipedia - Nausea (CHECKED)