Nausea is a painful sensation in the stomach and throat that may be accompanied by weakness, increased salivation, and sweating and often precedes vomiting, which is a sudden involuntary emptying of the stomach. According to Sanger and Andrews (2018), “nausea and vomiting involve multiple organs and systems, including the central nervous system” (p. 24). Both are symptoms of many diseases and conditions, from pregnancy to serious pathologies such as brain tumors, epilepsy, and myocardial infarction. The immediate work plan should first include a thorough questioning of the patient on the aspects listed above to compose a comprehensive medical history. Diagnostics methods should further determine the potential causes of nausea and vomiting and help develop a differential diagnosis.
First, a general blood test needs to be conducted, as an increase in white blood cells may indicate an infection as a possible cause of nausea and vomiting. Additionally, an increase in the number of red blood cells points to the thickening of the blood due to dehydration. ESR or erythrocyte sedimentation rate analysis can also be useful in the blood department. With inflammation, the protein composition of the blood changes, electrolytes stick together more easily, and their sedimentation rate increases. Thus, an increase in ESR may indicate infection or chronic inflammation as a possible cause of nausea and vomiting.
Another important test is the quantitative analysis of potassium and sodium levels in blood serum. Both participate in the transmission of a nerve impulse and muscle contraction, maintaining the acid-base balance of the blood. A decrease in serum potassium and sodium levels may indicate blood clotting and dehydration, while an increase is associated with kidney disease and adrenal dysfunction. An ultrasound examination of abdominal organs is also in order for patients with nausea and vomiting, as it can help assess the state of these organs and determine whether there is a dysfunction. If the patient presents with any neurological traumas, an MRI and CT of the skull are also necessary, as nausea and vomiting are common symptoms of concussion and brain damage. Finally, an endoscopic examination of the gastrointestinal tract can be performed to assess the internal tissue of the esophagus, stomach and duodenum.
First, possible diagnosis is an intestinal infection, such as rotavirus, salmonellosis, botulism, or dysentery. It is usually accompanied by abdominal pain and fever, in addition to nausea and vomiting. In terms of the treatment of intestinal infections, it is important to maintain fluid balance so that there is no dehydration and loss of electrolytes. This is achieved by constant fractional drinking of liquids such as electrolyte solutions. Additionally, sorbents are taken to accelerate the removal of toxins and improve well-being, as well as astringent medications. Dietary restrictions are also necessary, in particular, for the consumption of foods saturated with carbohydrates in the form of fruits, sugar, and vegetables.
Another potential disorder that can cause nausea and vomiting is a gastric ulcer – damage to the mucous membrane of the stomach under the influence of gastric juice. It may be accompanied by belching, heartburn, and abdominal pain. Treatment for ulcers depends on the cause of it but usually includes selected antibiotics for Helicobacter pylori if it is found. Cangemi and Kuo (2019) state that “conventional therapies such as antiemetics and prokinetics are commonly used to manage acute nausea and vomiting” (p. 170). Moreover, medicines that suppress the production of stomach acid – proton pump inhibitors or antacids – are prescribed.
Finally, an increase in intracranial pressure during brain injuries, tumors, or infections such as meningitis and encephalitis may be accompanied by nausea and vomiting. In this case, treatment depends heavily on the main cause of the increase in pressure; however, there are non-specific methods that can help alleviate the symptoms. First of all, diuretic drugs should be prescribed to remove excess fluid from the brain tissues, and the overall fluid intake must be limited. In order to improve microcirculation and blood supply to tissues, neuroprotectors and nootropics should be used.
References
Cangemi, D. J., & Kuo, B. (2019). Practical perspectives in the treatment of nausea and vomiting. Journal of Clinical Gastroenterology, 53(3), 170–178.
Sanger, G. J., & Andrews, P. L. (2018). A history of drug discovery for treatment of nausea and vomiting and the implications for future research. Frontiers in Pharmacology, 9.