What are the main causes of nausea and vomiting. How can these symptoms be treated effectively. When should you seek medical attention for persistent nausea or vomiting. What are the potential complications of prolonged vomiting.

Understanding Nausea and Vomiting: Definition and Differences

Nausea and vomiting are common symptoms that can affect people of all ages. While often occurring together, they are distinct experiences:

• Nausea: The uncomfortable sensation of feeling like you might vomit, without actually doing so.
• Vomiting: An uncontrollable reflex that expels stomach contents through the mouth.

These symptoms can be triggered by various factors and may indicate underlying health issues. Understanding their causes and when to seek medical attention is crucial for proper management and treatment.

Common Causes of Nausea and Vomiting in Adults

Nausea and vomiting in adults can be attributed to numerous factors:

• Intense pain from injury or illness
• Pregnancy (especially during the first trimester)
• Motion sickness
• Emotional stress
• Indigestion
• Food poisoning
• Viral infections
• Exposure to chemical toxins
• Gallstones
• Certain odors (particularly during pregnancy)

Chronic stomach conditions can also lead to persistent nausea and vomiting. These may include:

• Food intolerances (e.g., celiac disease, lactose intolerance)
• Irritable Bowel Syndrome (IBS)
• Crohn’s disease

How is Irritable Bowel Syndrome diagnosed?

Doctors typically diagnose IBS by identifying symptoms and ruling out other stomach and bowel conditions. This process may involve a combination of physical examinations, medical history review, and diagnostic tests.

What methods are used to diagnose Crohn’s disease?

Crohn’s disease is usually diagnosed through a combination of methods:

1. Colonoscopy: A procedure using a small camera to explore the colon
2. Stool sample analysis
3. Blood tests
4. Imaging studies (e.g., CT scans, MRI)

Nausea and Vomiting in Children: Causes and Concerns

While many causes of nausea and vomiting are similar in children and adults, some factors are more common in younger individuals:

• Viral infections
• Food poisoning
• Severe motion sickness
• Coughing
• High fevers
• Overeating

In very young infants, persistent vomiting may indicate a more serious condition such as blocked intestines. This can be caused by:

• Abnormal muscular thickening
• Hernias
• Gallstones
• Tumors

While rare, these conditions require immediate medical attention and should be investigated if unexplained vomiting occurs in an infant.

Lifestyle Factors and Their Impact on Nausea and Vomiting

Certain lifestyle choices can increase the likelihood of experiencing nausea and vomiting:

How does excessive alcohol consumption affect the digestive system?

Consuming large amounts of alcohol can have several negative effects on the digestive system:

• Damage to the lining of the gut
• Reaction with stomach acid
• Increased risk of nausea and vomiting
• Potential bleeding in the digestive tract (in severe cases)

What role do eating disorders play in nausea and vomiting?

Eating disorders can significantly impact digestive health and contribute to nausea and vomiting:

• Bulimia: Characterized by intentional vomiting to purge consumed food
• Anorexia: May cause nausea due to starvation and excess stomach acid

These disorders require professional medical and psychological intervention for proper treatment and management.

Serious Conditions Associated with Nausea and Vomiting

While less common, persistent or severe nausea and vomiting can sometimes indicate more serious underlying conditions:

• Meningitis
• Appendicitis
• Concussions
• Brain tumors
• Migraines

If vomiting persists for an extended period or is accompanied by other concerning symptoms, it’s crucial to seek medical attention promptly.

When to Seek Medical Care for Nausea and Vomiting

Knowing when to consult a healthcare professional is essential for proper management of nausea and vomiting. General guidelines include:

• Persistent vomiting lasting more than a week
• Nausea that doesn’t improve after several days

What are the specific guidelines for seeking medical care for children under 6 years old?

For children under 6 years old, seek emergency care if:

• Vomiting is accompanied by diarrhea
• Projectile vomiting occurs
• Signs of dehydration are present (e.g., wrinkled skin, irritability, weak pulse, reduced consciousness)
• Vomiting persists for more than 2-3 hours
• Fever exceeds 100째F (38째C)
• No urination for more than 6 hours

When should medical attention be sought for children over 6 years old?

For children over 6 years old, emergency care is recommended if:

• Vomiting has lasted for more than 24 hours
• Dehydration symptoms are present
• No urination for more than 6 hours
• The child appears confused or lethargic
• Fever is higher than 100째F (38째C)

Potential Complications of Prolonged Nausea and Vomiting

While most cases of nausea and vomiting resolve within 6 to 24 hours, prolonged episodes can lead to various complications:

What are the risks associated with dehydration due to excessive vomiting?

Dehydration is a significant concern with prolonged vomiting and can lead to:

• Electrolyte imbalances
• Weakness and fatigue
• Dizziness
• Decreased urine output
• In severe cases, organ damage

How can repeated vomiting affect the digestive system?

Frequent or forceful vomiting may cause:

• Esophageal tears (Mallory-Weiss syndrome)
• Tooth enamel erosion
• Acid reflux and esophagitis
• Weakening of the lower esophageal sphincter

Treatment Options for Nausea and Vomiting

The treatment for nausea and vomiting depends on the underlying cause and severity of symptoms. Some general approaches include:

What are some effective home remedies for managing nausea?

Several home remedies can help alleviate mild nausea:

• Ginger tea or supplements
• Peppermint tea or aromatherapy
• Acupressure wristbands
• Small, frequent meals of bland foods
• Staying hydrated with clear fluids

When are medications prescribed for nausea and vomiting?

In more severe cases or when home remedies are ineffective, healthcare providers may prescribe:

• Antiemetic medications (e.g., ondansetron, promethazine)
• Antacids or proton pump inhibitors for acid-related issues
• Antispasmodics for digestive tract cramping

It’s important to consult a healthcare professional before taking any medications, especially for pregnant women or individuals with chronic health conditions.

Preventive Measures to Reduce the Risk of Nausea and Vomiting

While not all cases of nausea and vomiting can be prevented, certain strategies may help reduce their frequency and severity:

How can dietary changes help prevent nausea and vomiting?

Modifying your diet can significantly impact digestive health:

• Eat smaller, more frequent meals
• Avoid trigger foods (e.g., spicy, fatty, or highly acidic foods)
• Stay hydrated with clear fluids
• Incorporate probiotic-rich foods to support gut health

What lifestyle modifications can help reduce the risk of nausea and vomiting?

Several lifestyle changes may contribute to better digestive health:

• Manage stress through relaxation techniques or meditation
• Get regular exercise to promote healthy digestion
• Avoid excessive alcohol consumption
• Quit smoking
• Practice good food hygiene to prevent foodborne illnesses

By implementing these preventive measures and understanding the various causes and treatments for nausea and vomiting, individuals can better manage these common yet sometimes distressing symptoms. Remember to consult a healthcare professional if symptoms persist or worsen, as they may indicate an underlying condition requiring medical attention.

Nausea and Vomiting: Causes, Treatments, and Complications

What are nausea and vomiting?

Vomiting is an uncontrollable reflex that expels the contents of the stomach through the mouth. It’s also called “being sick” or “throwing up.” Nausea is a term that describes the feeling that you might vomit, but aren’t actually vomiting.

Both nausea and vomiting are very common symptoms and can be caused by a wide range of factors. They occur in both children and adults, although they’re probably most common in pregnant women and people undergoing cancer treatments.

Nausea and vomiting may occur together or separately. They can be caused by a number of physical and psychological conditions.

Nausea

The most common causes of nausea are intense pain — usually from an injury or illness — and the first trimester of pregnancy. There are also a number of other relatively common causes, including:

• motion sickness
• emotional stress
• indigestion
• food poisoning
• viruses
• exposure to chemical toxins

If you have gallstones, you’re also likely to feel nauseated.

You may find that certain smells bring on the feeling of nausea. This is a very common symptom during the first trimester of pregnancy, although it can also occur in people who aren’t pregnant. Pregnancy-induced nausea usually goes away by the second or third trimester.

Vomiting in children

The most common causes of vomiting in children are viral infections and food poisoning. However, vomiting can also be caused by:

• severe motion sickness
• coughing
• high fevers
• overeating

In very young infants, blocked intestines can also cause persistent vomiting. The intestines may become blocked by abnormal muscular thickening, hernia, gallstones, or tumors. This is uncommon, but should be investigated if unexplained vomiting occurs in an infant.

Vomiting in adults

Most adults rarely vomit. When it does occur, a bacterial or viral infection or a type of food poisoning usually causes vomiting. In some cases, vomiting can also be the result of other illnesses, especially if they lead to a headache or high fever.

Chronic stomach conditions

Chronic, or long-term, stomach conditions can often cause nausea and vomiting. These conditions can come along with other symptoms, such as diarrhea, constipation, and stomach pain. These chronic conditions include food intolerances, such as celiac disease and dairy protein and lactose intolerance.

Irritable bowel syndrome (IBS) is a common stomach condition that causes bloating, nausea, vomiting, heartburn, fatigue, and cramping. It occurs when parts of the gut become overactive. Doctors usually diagnose IBS by identifying symptoms and ruling out other stomach and bowel conditions.

Crohn’s disease is an inflammatory bowel disease that commonly affects the intestines, though it can occur anywhere in the digestive tract. Crohn’s disease is an autoimmune condition in which the body attacks its own healthy gut tissue, causing inflammation, nausea, vomiting, and pain.

Doctors usually diagnose Crohn’s disease using a colonoscopy, a procedure that uses a small camera to explore the colon. Sometimes they also need a stool sample to help diagnose the condition.

Lifestyle choices

Certain lifestyle choices can increase your chance of experiencing nausea and vomiting.

Consuming a large amount of alcohol can cause damage to the lining of the gut. Alcohol can also react with stomach acid. Both of these will cause nausea and vomiting. In some cases, excessive alcohol consumption can also cause bleeding in the digestive tract.

Eating disorders

An eating disorder is when a person adjusts their eating habits and behaviors based on an unhealthy body image. It can cause nausea and vomiting.

Bulimia is an eating disorder in which a person induces vomiting deliberately to purge the stomach of any consumed food. People with anorexia may also feel nausea due to starvation and excess stomach acid.

Serious conditions

Though rare, vomiting can sometimes occur as a symptom of a more serious condition, including:

• meningitis
• appendicitis
• concussion
• a brain tumor
• migraines

If you’re persistently vomiting, go see your doctor.

Seek medical care if you have nausea or are vomiting for more than a week. Most cases of vomiting clear up within 6 to 24 hours after the first episode.

Under 6 years old

Seek emergency care for any child under 6 years old who:

• has both vomiting and diarrhea
• has projectile vomiting
• is showing symptoms of dehydration, like wrinkled skin, irritability, a weak pulse, or reduced consciousness
• has been vomiting for more than two or three hours
• has a fever of above 100°F (38°C)
• hasn’t urinated in more than six hours

Over 6 years old

Seek emergency care for children over 6 years old if:

• vomiting has lasted for more than 24 hours
• there are symptoms of dehydration
• the child hasn’t urinated in more than six hours
• the child appears confused or lethargic
• the child has a fever higher than 102°F (39°C)

Adults

Seek emergency medical care if you have any of the following symptoms:

• a severe headache
• a stiff neck
• lethargy
• confusion
• blood in the vomit
• a rapid pulse
• rapid breathing
• a fever of over 102°F (39°C)
• decreased responsiveness
• severe or persistent abdominal pain

You can use a number of methods to relieve nausea and vomiting, including home remedies and medications.

Self-treatment for nausea

To treat nausea at home:

• Consume only light, plain foods, such as bread and crackers.
• Avoid any foods that have strong flavors, are very sweet, or are greasy or fried.
• Drink cold liquids.
• Avoid any activity after eating.
• Drink a cup of ginger tea.

Self-treatment for vomiting

• Eat smaller, more frequent meals.
• Drink a large amount of clear fluids to remain hydrated, but consume it in small sips at a time.
• Avoid solid foods of any kind until vomiting stops.
• Rest.
• Avoid using medications that may upset your stomach, such as nonsteroidal anti-inflammatory drugs or corticosteroids.
• Use an oral rehydration solution to replace lost electrolytes.

Medical care

Before prescribing medication, you doctor will ask you questions about when the nausea and vomiting began and when it’s at its worst. They may also ask you about your eating habits and whether anything makes the vomiting and nausea better or worse.

A number of prescription medications can control nausea and vomiting, including medications you can use during pregnancy. These include promethazine (Phenergan), diphenhydramine (Benadryl), trimethobenzamide (Tigan), and ondansetron (Zofran).

If you need help finding a primary care doctor, then check out our FindCare tool here.

Most nausea and vomiting will clear up on its own, unless you have an underlying chronic condition.

However, persistent vomiting can cause dehydration and malnutrition. You may also find that your hair and nails become weak and brittle, and that constant vomiting decays your tooth enamel.

You can avoid nausea by eating smaller meals throughout the day, eating slowly, and resting after eating. Some people find that avoiding certain food groups and spicy foods prevents nausea.

If you start to feel nauseated, eat plain crackers before getting up and try to consume a high-protein food, such as cheese, lean meat, or nuts, before you go to sleep.

If you’re vomiting, try to drink small amounts of a sugary liquid, such as a soda or fruit juice. Drinking ginger ale or eating ginger can help settle your stomach. Avoid acidic juices, such as orange juice. They may upset your stomach further.

Over-the-counter medications, such as meclizine (Bonine) and dimenhydrinate (Dramamine), can lessen the effects of motion sickness. Limit snacks during car rides and look straight out of a front window if you’re prone to motion sickness.

Nausea and Vomiting: Causes, Treatments, and Complications

What are nausea and vomiting?

Vomiting is an uncontrollable reflex that expels the contents of the stomach through the mouth. It’s also called “being sick” or “throwing up.” Nausea is a term that describes the feeling that you might vomit, but aren’t actually vomiting.

Both nausea and vomiting are very common symptoms and can be caused by a wide range of factors. They occur in both children and adults, although they’re probably most common in pregnant women and people undergoing cancer treatments.

Nausea and vomiting may occur together or separately. They can be caused by a number of physical and psychological conditions.

Nausea

The most common causes of nausea are intense pain — usually from an injury or illness — and the first trimester of pregnancy. There are also a number of other relatively common causes, including:

• motion sickness
• emotional stress
• indigestion
• food poisoning
• viruses
• exposure to chemical toxins

If you have gallstones, you’re also likely to feel nauseated.

You may find that certain smells bring on the feeling of nausea. This is a very common symptom during the first trimester of pregnancy, although it can also occur in people who aren’t pregnant. Pregnancy-induced nausea usually goes away by the second or third trimester.

Vomiting in children

The most common causes of vomiting in children are viral infections and food poisoning. However, vomiting can also be caused by:

• severe motion sickness
• coughing
• high fevers
• overeating

In very young infants, blocked intestines can also cause persistent vomiting. The intestines may become blocked by abnormal muscular thickening, hernia, gallstones, or tumors. This is uncommon, but should be investigated if unexplained vomiting occurs in an infant.

Vomiting in adults

Most adults rarely vomit. When it does occur, a bacterial or viral infection or a type of food poisoning usually causes vomiting. In some cases, vomiting can also be the result of other illnesses, especially if they lead to a headache or high fever.

Chronic stomach conditions

Chronic, or long-term, stomach conditions can often cause nausea and vomiting. These conditions can come along with other symptoms, such as diarrhea, constipation, and stomach pain. These chronic conditions include food intolerances, such as celiac disease and dairy protein and lactose intolerance.

Irritable bowel syndrome (IBS) is a common stomach condition that causes bloating, nausea, vomiting, heartburn, fatigue, and cramping. It occurs when parts of the gut become overactive. Doctors usually diagnose IBS by identifying symptoms and ruling out other stomach and bowel conditions.

Crohn’s disease is an inflammatory bowel disease that commonly affects the intestines, though it can occur anywhere in the digestive tract. Crohn’s disease is an autoimmune condition in which the body attacks its own healthy gut tissue, causing inflammation, nausea, vomiting, and pain.

Doctors usually diagnose Crohn’s disease using a colonoscopy, a procedure that uses a small camera to explore the colon. Sometimes they also need a stool sample to help diagnose the condition.

Lifestyle choices

Certain lifestyle choices can increase your chance of experiencing nausea and vomiting.

Consuming a large amount of alcohol can cause damage to the lining of the gut. Alcohol can also react with stomach acid. Both of these will cause nausea and vomiting. In some cases, excessive alcohol consumption can also cause bleeding in the digestive tract.

Eating disorders

An eating disorder is when a person adjusts their eating habits and behaviors based on an unhealthy body image. It can cause nausea and vomiting.

Bulimia is an eating disorder in which a person induces vomiting deliberately to purge the stomach of any consumed food. People with anorexia may also feel nausea due to starvation and excess stomach acid.

Serious conditions

Though rare, vomiting can sometimes occur as a symptom of a more serious condition, including:

• meningitis
• appendicitis
• concussion
• a brain tumor
• migraines

If you’re persistently vomiting, go see your doctor.

Seek medical care if you have nausea or are vomiting for more than a week. Most cases of vomiting clear up within 6 to 24 hours after the first episode.

Under 6 years old

Seek emergency care for any child under 6 years old who:

• has both vomiting and diarrhea
• has projectile vomiting
• is showing symptoms of dehydration, like wrinkled skin, irritability, a weak pulse, or reduced consciousness
• has been vomiting for more than two or three hours
• has a fever of above 100°F (38°C)
• hasn’t urinated in more than six hours

Over 6 years old

Seek emergency care for children over 6 years old if:

• vomiting has lasted for more than 24 hours
• there are symptoms of dehydration
• the child hasn’t urinated in more than six hours
• the child appears confused or lethargic
• the child has a fever higher than 102°F (39°C)

Adults

Seek emergency medical care if you have any of the following symptoms:

• a severe headache
• a stiff neck
• lethargy
• confusion
• blood in the vomit
• a rapid pulse
• rapid breathing
• a fever of over 102°F (39°C)
• decreased responsiveness
• severe or persistent abdominal pain

You can use a number of methods to relieve nausea and vomiting, including home remedies and medications.

Self-treatment for nausea

To treat nausea at home:

• Consume only light, plain foods, such as bread and crackers.
• Avoid any foods that have strong flavors, are very sweet, or are greasy or fried.
• Drink cold liquids.
• Avoid any activity after eating.
• Drink a cup of ginger tea.

Self-treatment for vomiting

• Eat smaller, more frequent meals.
• Drink a large amount of clear fluids to remain hydrated, but consume it in small sips at a time.
• Avoid solid foods of any kind until vomiting stops.
• Rest.
• Avoid using medications that may upset your stomach, such as nonsteroidal anti-inflammatory drugs or corticosteroids.
• Use an oral rehydration solution to replace lost electrolytes.

Medical care

Before prescribing medication, you doctor will ask you questions about when the nausea and vomiting began and when it’s at its worst. They may also ask you about your eating habits and whether anything makes the vomiting and nausea better or worse.

A number of prescription medications can control nausea and vomiting, including medications you can use during pregnancy. These include promethazine (Phenergan), diphenhydramine (Benadryl), trimethobenzamide (Tigan), and ondansetron (Zofran).

If you need help finding a primary care doctor, then check out our FindCare tool here.

Most nausea and vomiting will clear up on its own, unless you have an underlying chronic condition.

However, persistent vomiting can cause dehydration and malnutrition. You may also find that your hair and nails become weak and brittle, and that constant vomiting decays your tooth enamel.

You can avoid nausea by eating smaller meals throughout the day, eating slowly, and resting after eating. Some people find that avoiding certain food groups and spicy foods prevents nausea.

If you start to feel nauseated, eat plain crackers before getting up and try to consume a high-protein food, such as cheese, lean meat, or nuts, before you go to sleep.

If you’re vomiting, try to drink small amounts of a sugary liquid, such as a soda or fruit juice. Drinking ginger ale or eating ginger can help settle your stomach. Avoid acidic juices, such as orange juice. They may upset your stomach further.

Over-the-counter medications, such as meclizine (Bonine) and dimenhydrinate (Dramamine), can lessen the effects of motion sickness. Limit snacks during car rides and look straight out of a front window if you’re prone to motion sickness.

Common side effects

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3. • HIV and Confection Treatment

Treatment of HIV and co-infections

03 February 2019
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When talking about side effects, keep the following in mind:
Many symptoms, such as headache, diarrhea, nausea, vomiting, rash, may not be related to antiretroviral drugs. If you develop one of these symptoms, it is not necessarily caused by HIV treatment.
You should tell your doctor about suspected side effects. It is important to find their cause. You don’t have to put up with side effects – you can almost always find a way to help deal with them.

Diarrhea

Diarrhea is a possible side effect of most antiretroviral drugs.
With some medications, diarrhea resolves within the first weeks or months after starting treatment. However, in some people, it becomes a constant “companion” of a certain drug.

Changes in diet have little effect on diarrhea if it is caused by protease inhibitors or other drugs that have a similar side effect. There are various medicines that can be used to control diarrhea, such as loperamide (trade name Imodium). If you start taking an antiretroviral drug that can cause diarrhea, your doctor must write you a prescription for one of the antidiarrheals.

It is important that you continue to eat and drink even if the drugs you are taking cause diarrhea. If diarrhea becomes a problem, talk to your doctor about changing your treatment regimen.

Be aware that diarrhea can have other causes, so if it persists for a long time, it makes sense to tell your doctor about it in order to conduct an investigation to determine its etiology.

Nausea and vomiting

Nausea and vomiting are possible side effects of most antiretroviral drugs. If you start taking antiretrovirals that have nausea and vomiting as side effects, your doctor should prescribe pills to help prevent these symptoms.

Like many other side effects, nausea and vomiting are usually more pronounced in the first few weeks after starting treatment, then they decrease or disappear completely.

Causes of nausea and vomiting can vary, meaning they are not always related to antiretroviral drugs. If you experience nausea or vomiting, it makes sense to talk to your doctor, especially if it occurs against the background of other symptoms, such as fever.

Whatever the cause of nausea and vomiting, you must not tolerate it: your nutritious diet will be compromised and you will not be able to stick to your antiretroviral regimen. In addition to talking to your doctor about medications that reduce nausea and vomiting, you may find the following practical tips helpful (discuss these with your doctor as well):

• It is better to eat during the day in small portions, but often, rather than two or three times a lot.
• Liquid and solid foods should not be consumed at the same time. Make a gap between them, at least one hour.
• Do not eat fatty, fried or spicy foods. Choose light, non-spicy foods.
• Eat dry foods, such as toasted bread, biscuits, cereals, and fruits and vegetables with a “mild” flavor.
• Nausea can be reduced by eating salty foods such as salted biscuits and popcorn. Take a package of these products with you when you leave the house.
• It is better not to lie down for at least an hour after eating.
• Food should be cold or at room temperature – hot food may increase nausea.
• Herbal tea (such as mint or chamomile) or ginger root can help with digestive problems.

Headache

Headache is a possible side effect of many antiretroviral drugs. In most cases, the headache is not very severe and decreases or disappears after a few weeks of treatment with antiretroviral drugs. Pain relievers such as paracetamol can provide relief.

Tell your doctor if you have a headache, especially if it is “acute” or lasts for several days.
Sleep problems, mood instability

Efavirenz, emtricitabine, and tenofovir, drugs combined in one Atripla once-daily tablet, can cause mood and sleep problems.

These symptoms are usually mild and improve or disappear after a few weeks of treatment. But some people tolerate them so badly that they need to change their treatment regimen. Tell your doctor if you experience any of these side effects.

Taking antiretrovirals just before bed or a small course of sleeping pills may help relieve or reduce symptoms.

Rash

Rash is a side effect of some antiretroviral drugs.

The rash usually decreases or disappears after a few weeks of treatment, but should still be reported to your doctor as some rashes may indicate serious side effects (especially if you are taking abacavir, etravirine or nevirapine) or the presence of an infection.

Fatigue

Fatigue is a possible side effect of most antiretroviral drugs.

As with many other side effects, the risk of developing fatigue is highest in the first few weeks after starting antiretroviral therapy and then decreases or disappears.

If your fatigue is due to antiretroviral drugs, you can easily get help. But increased fatigue can be caused by other reasons. It is important to tell your doctor about it so that he can conduct a study.

Getting enough sleep, a well-balanced diet and regular exercise can also help you cope with increased fatigue

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Nausea and vomiting in children with cancer

Nausea and vomiting are common side effects of cancer and its treatment. Symptoms can range from mild to severe and occur before, during, or after treatment. Children with cancer and their families often report nausea as one of the side effects that worries them the most. If left untreated, nausea and vomiting can negatively affect the patient’s emotional state, interfere with adherence to treatment, or interfere with daily activities. In addition, they can cause malnutrition, weight loss and other complications.

For most children with cancer, there are effective ways to manage nausea and vomiting. These include anti-nausea medications, dietary adjustments, and techniques such as deep breathing and distraction. In addition, alternative therapies, including acupuncture, aromatherapy, and hypnosis, may be effective.

In the course of cancer treatment, the patient’s family may come across terms derived from the word “emesis”. Emesis is Latin for vomiting. Antiemetics are medicines used to treat nausea and vomiting.

What is nausea?

Nausea is a feeling of malaise or discomfort that a person associates with vomiting. Nausea is a subjective feeling. This means that it depends on the personal experiences of the person. Nausea usually refers to discomfort in the throat, esophagus, or stomach. Other sensations that may be associated with nausea are dizziness, difficulty swallowing, sweating, and a feeling of chills or flushing of the face.

What is vomiting?

Vomiting occurs due to contraction of the diaphragm and abdominal muscles. By contracting, these muscles push the contents of the stomach up the esophagus and out of the mouth. The process of vomiting is regulated by nerves and develops in response to certain stimuli. Viruses and bacteria, movement, and physical or chemical signals are common triggers for nausea or vomiting. These factors lead to the activation of the neural pathways that control the gag reflex.

Nausea and vomiting are related but can occur separately.

Doctors sometimes use a visual rating scale to help children talk about the nausea they are experiencing. This scale, called BARF (Baxter Animated Retching Faces), presents drawings of faces to assess the degree of nausea in children. Pictures are especially helpful for young children who may not know how to describe their symptoms. They will also help track how the severity of nausea changes over time to see if treatment is helping to manage the nausea.

Causes of nausea and vomiting in children with cancer

The main cause of nausea in children with cancer is chemotherapy. However, radiation therapy and other medications can also cause nausea. Some children experience nausea as a result of the cancer itself or other health problems. Children with brain tumors may develop hydrocephalus, which is a buildup of fluid in the brain. The increased pressure can irritate the nerves, which causes vomiting.

Common causes of nausea and vomiting in children with cancer:

• Chemotherapy
• Other drugs, including antibiotics, opioid analgesics and anticonvulsants
• Radiotherapy
• Cancer itself, especially if the tumor affects the brain or digestive system
• Disorders of the stomach and digestive tract
• Pathology of the inner ear
• Hormonal and metabolic disorders
• Fever and infection
• Stress and anxiety
• Pain
• Previous vomiting

Nausea and vomiting result from the complex interaction of several body systems, including the autonomic nervous system, central nervous system, endocrine system, and digestive system. Thoughts and emotions also play an important role in causing nausea and vomiting.

Nausea and vomiting during chemotherapy

About 70% of children undergoing chemotherapy experience nausea at some point during treatment. Symptoms range from mild stomach upset to severe vomiting. There are 3 types of nausea and vomiting associated with chemotherapy:

1. Acute vomiting – occurs within the first 24 hours after chemotherapy. As a rule, it begins 1-2 hours after chemotherapy, improvement occurs after 4-6 hours.
2. Delayed vomiting – develops after 24 hours. Delayed vomiting usually peaks 48 to 72 hours after chemotherapy and then improves over the next few days.
3. Anticipated vomiting – occurs before chemotherapy and is caused by factors that are associated in a person with chemotherapy. This is a conditioned reflex that most often develops in patients who have had episodes of severe nausea and vomiting during prior treatment.

Chemotherapy drugs can be classified by risk or likelihood of nausea and vomiting as follows:

• High risk (>90%)
• Moderate risk (30-90%)
• Low risk (10-30%)
• Minimal risk (<10%)

These categories are based on the likelihood of experiencing symptoms of nausea and vomiting without taking antiemetics. Children who are prescribed chemotherapy drugs with a high or moderate risk of vomiting are usually given antiemetics before symptoms develop.

Which cancer drugs cause nausea and vomiting?

Why does chemotherapy cause nausea and vomiting?

The mechanism of nausea and vomiting during chemotherapy is not fully understood. However, it is known that therapy can lead to the release of certain neurotransmitters responsible for nausea and vomiting. These neurotransmitters include dopamine, serotonin, and substance P. They act as chemical signals in the brain regions that control nausea and vomiting. The action of a number of antiemetics is directed to neurotransmitter systems in order to block these signals.

Treatments for nausea and vomiting in children

There are several ways to manage nausea and vomiting during cancer treatment. It is important that the patient’s family and medical staff work together to manage the child’s symptoms.

Medicines for nausea

Antiemetics (antiemetics) may be used to prevent and treat nausea and vomiting. The following drugs are often prescribed for children with cancer:

• Ondansetron (Zofran®)
• Granisetron (Kytril®)
• Lorazepam (Ativan®)
• Diphenhydramine (Benadryl®)
• Dexamethasone (Decadron®, Dexamethasone Intensol®, Dexpak®)
• Aprepitant (Emend®)
• Metoclopramide (Reglan®)
• Olanzapine (Zyprexa®)
• Scopolamine (Transderm Scop®)

Some patients may be given a combination of drugs. Many drugs used to relieve nausea and vomiting have other indications for use. Relatives of the patient should always tell the doctor or pharmacist the purpose and dosage of each drug that the child takes.

Doctors prescribe antiemetics based on the chemotherapy plan, the child’s age, diagnosis, and other individual factors. For some patients, drugs are prescribed before chemotherapy begins. However, antiemetics are also prescribed as needed. Family members should discuss symptoms with doctors to find the best way to manage nausea and vomiting.

Dietary changes to help combat nausea

Certain foods and odors can make nausea worse. Many patients suffer from loss of appetite during treatment. When unwell, children can be very picky about food. Sometimes the right option has to be determined by trial and error. The following are general recommendations:

• Eat and snack in small portions.
• Eat and drink slowly.
• Avoid drinking liquids with meals.
• Offer dry, neutral food (such as crackers or toast).
• Avoid spicy, sour and rich flavored foods.
• Eat in a place where there are no strong odors.
• Let your child choose when and what to eat.

See other nutritional advice for patients with nausea and vomiting.

The nutritionist is an important member of the care team, especially for children with nausea and vomiting. A dietitian can help a family find ways to solve nutritional problems. If your child has severe nausea and vomiting, they may need to have an enteral feeding tube or intravenous nutrition (parenteral nutrition). These are important supportive therapies to ensure adequate nutrition and fluid replacement. Learn more about clinical nutrition in children with cancer.

Other treatments for nausea and vomiting

Various coping strategies and complementary treatments have been shown to be effective in controlling nausea and vomiting. These include:

• Psychotherapy
• Biofeedback
• Deep breathing and relaxation techniques
• Hypnosis
• Acupuncture
• Acupressure
• Aromatherapy
• Herbal Supplements – Ginger
• Distraction techniques (video games, art, music)
• Physical exercise

Before using any complementary therapies, the patient’s family should consult a physician to ensure they are safe. The care team can also help the family find the best combination of different symptom management options.

Nausea and vomiting in children with cancer: family advice

• Talk to your doctor about nausea and vomiting. There are medications and approaches that can help.
• Keep a symptom diary. Note when nausea occurs, what makes it worse, what makes it worse, and other symptoms, including pain, loss of appetite, diarrhea, or constipation. This will help you and your healthcare team review your symptoms and develop a treatment plan.
• Tell the doctor or nurse if your child has difficulty eating or drinking. Nutritional support or fluid therapy may be required.
• Do not offer favorite foods if the child is sick. This food may subsequently be associated with feelings of nausea.
• Offer chewing gum, lollipop or ice.
• Avoid lying down after meals.
• Be sure to rinse your mouth after vomiting. The acidic contents of the stomach can cause mouth irritation and tooth decay.