nausea%20-and-%20vomiting
NAUSEA & VOMITING
Nausea is the sensation felt immediately before vomiting.
Vomiting is a partially voluntary act of forceful expelling of stomach contents up to and out of the mouth that may or may not be preceded by nausea.
Retching or repetitive active contraction of the abdominal muscles occurs between nausea and vomiting.
Management includes correction of clinically relevant metabolic complications, pharmacological therapy and treatment of underlying cause.

Supportive Therapy

Rehydration

  • Patients with nausea and vomiting may become dehydrated and malnourished because of inadequate oral intake of fluid and nutrients, including electrolytes
  • Fluids and electrolytes, notably K+, are lost directly in the vomitus
  • Patients’ fluid and electrolyte status should be properly assessed to ensure adequate replacement
  • Normal saline solutions are commonly used, together with K+ supplementation as needed
  • In patients with gastric distension, a nasogastric tube may have to be inserted and tube output measured, so that appropriate replacement may be given
  • No study has compared the different fluid replacements for nausea and vomiting of pregnancy

Other Supportive Measures

  • Other measures to reduce nausea and vomiting may be useful, particularly in patients who have nausea and vomiting of pregnancy
  • Pregnant patients should be advised to increase their rest, because tiredness may make nausea worse
  • Advise patients to avoid sensory stimuli that trigger symptoms eg strong odors
  • Enlist support from patient’s family and friends
  • Acupressure, acupuncture and acustimulation may be beneficial in patients with PONV and in women with nausea and vomiting of pregnancy
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