Nausea and Vomiting

What are nausea and vomiting?

Nausea is the queasy feeling you usually have before you vomit. Vomiting is the forceful emptying (throwing up) of the stomach's contents through the mouth.

What causes nausea and vomiting?

Nausea and vomiting are symptoms that may occur with many conditions, such as:

• motion sickness
• stomach flu
• food poisoning or other infections
• alcohol use
• exposure to unpleasant odors or sights
• pregnancy
• heart attack
• head injury
• stress and anxiety
• inner ear disorders
• menstruation
• cancer treatment.

It can also occur as a side effect of some medicines.

How is it treated?

Vomiting can protect the body by getting rid of harmful substances. However, vomiting often or for a long time can lead to dehydration, which is the loss of too much fluid from the body. Becoming dehydrated can be very dangerous, especially for children, older adults, and some people who have other medical problems. To avoid this, you need to replace the lost fluids.

At first you should rest your stomach for a few hours by eating nothing solid and sipping only clear liquids. A little later you can eat soft bland foods that are easy to digest.

If you have been vomiting a lot, it is best to have only small, frequent sips of clear liquids. Drinking too much at once, even an ounce or two, may cause more vomiting.

Clear liquids you can drink are water, weak tea, bouillon, apple juice, and sport drinks. You may also drink soft drinks without caffeine (such as 7-UP) after letting them go flat (lose their carbonation). Chilling the liquids may help you keep them down. Suck on ice chips or Popsicles if you feel too nauseated to drink fluids.

Your choice of liquids is important. If water is the only liquid you can drink without vomiting, that is okay for a few hours. However, if you have been vomiting for several hours, you must replace the minerals (sodium and potassium) that are lost when you vomit. These minerals are also called electrolytes. Ask your healthcare provider what sport drinks or other electrolyte replacement drinks could help you replace these minerals. Avoid liquids that are acidic (such as orange juice) or caffeinated (such as coffee) or have a lot of carbonation. If you have diarrhea as well as nausea or vomiting, do not drink milk.

It is important to drink small amounts (1 to 4 ounces) often so that you do not become dehydrated. Gradually drink larger amounts of the clear fluids.

You may start eating soft bland foods when you have not vomited for several hours and are able to drink clear liquids without further upset. Good first choices are:

• soda crackers
• toast
• plain noodles
• rice
• cooked cereal
• baked or mashed potatoes
• gelatin
• boiled or scrambled eggs
• applesauce
• bananas.

Eat slowly and avoid foods that are acidic, spicy, fatty, or fibrous (such as meats, coarse grains, and raw vegetables). Also avoid extremely hot or cold food. In addition, avoid dairy products if you have diarrhea. You may start eating these foods again in 3 days or so, when all signs of illness have passed.

Rest as much as possible. Sit or lie down with your head propped up. Do not lie flat for at least 2 hours after eating. Nausea and vomiting usually last only a short period of time.

Do not take aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDS) without checking first with your healthcare provider. These medicines may make your stomach symptoms worse. Acetaminophen is different and usually does not upset the stomach.

If you have been vomiting for more than a day or have had diarrhea for over 3 days, you may need to have an exam by your provider, including a check for dehydration. If you are very dehydrated, you may need to be given fluids intravenously (IV). In children and older adults dehydration can quickly become life threatening.

When should I call my healthcare provider?

Talk with your provider if you are unable to keep fluids down for more than 12 hours or if you have any of the following symptoms with nausea and vomiting:

• high fever
• severe headache
• severe abdominal pain
• diarrhea and vomiting that last more than 24 hours
• blood in the vomited material that may look red, brown, or black, or like coffee grounds
• bloody diarrhea
• very forceful vomiting
• signs of dehydration such as dry mouth, excessive thirst, little or no urination, severe weakness, dizziness, or lightheadedness.