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Nausea and vomiting - causes, therapies: what helps?

Nausea and vomiting - causes, therapies: what helps?


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Nausea with vomiting

Few symptoms can be caused by so many causes as nausea and vomiting. The potential triggers range from psychosomatic ailments to acute food poisoning and chronic diseases of the stomach or other digestive organs, to acute cardiovascular diseases or a brain tumor. The following sections provide an explanation of the terminology and a rough overview of the causes and possible countermeasures.

What quickly helps with nausea and vomiting?

Smelling a lemon can help prevent nausea. If you want to intensify this effect, you can suck the lemon or squeeze it into a glass with still mineral water and drink it in small sips. Ginger tea has also proven effective against nausea. Simply pour a couple of slices of unpeeled ginger with about half a liter of boiling water and let it steep for 15 minutes. The ginger can then be removed and the tea drunk in sips. For more information, see the article "Home Remedies for Nausea".

Nausea and vomiting - a brief overview

The causes can be very diverse. Often, however, those affected have a suspicion of what might be the cause. For example, if you drink liters of beer or wine in the evening, you will be able to assign the subsequent vomiting. Likewise, nausea during a cruise is probably related to motion sickness. In some cases, however, the cause is not immediately apparent, such as in the case of undiscovered underlying diseases or allergies. Here is a brief overview of the symptoms without claiming to be complete:

  • definition: Nausea (medical nausea) is the preliminary stage of vomiting (medical emesis or vomitus). Vomiting is a protective reflex triggered in the vomiting center of the brain, through which the contents of the stomach are suddenly emptied orally.
  • Possible accompanying symptoms: Increased saliva production, excessive sweating, paleness of the face, drop in blood pressure, loss of appetite, abdominal pain, stomach cramps, diarrhea, dizziness, irritation and inflammation of the esophagus (with frequent vomiting), tear in the esophagus (very rare).
  • Possible causes: Protective reaction of the body against germs or poisoning, strains of the sense of balance, psychosomatic factors (disgust, inner restlessness, excitement, nervousness), infectious diseases, diseases of the internal organs or the cardiovascular system, migraines, pregnancy, menstrual disorders, eating disorders, concussion and other.
  • therapy: Depends heavily on the cause, drugs are often used to reduce nausea and reduce the nausea; the loss of nutrients and fluids must also be treated, for example by electrolyte solutions or a drip.

Definition

Vomiting is a reflex triggered in the so-called vomiting center of the brain, through which the stomach contents are suddenly emptied orally. The medical literature also speaks of emesis or vomitus. Nausea (also called nausea) denotes the preliminary stage or the feeling of having to vomit. The first break signals such as increased intestinal or stomach pressure often come from the digestive tract. Irritation from inflammation, medication, chemicals or alcohol can also trigger such signals. Furthermore, other areas of the body such as the sense of balance or the brain can initiate the break signal. These signals trigger an alarm in the vomiting center of the brain, which initiates the reflexes necessary for vomiting.

Complaint picture

Nausea and vomiting are triggered by a reflex-like mechanism of the vomiting center in the brain. The vomiting center in the brainstem is in constant communication with the gastrointestinal tract (via the vagus nerve), the cerebellum, the balance organs and the cerebral cortex (responsible, for example, for the sense of smell and psychological well-being). The vomiting center also receives information on the blood values ​​or the toxins in the blood via the so-called area postrema. If the connected sensory organs send corresponding alarm signals to the crushing center, a feeling of nausea and then the refractive reflex are first triggered here via neural processes that have not yet been fully explored.

How does the vomiting reflex come about?

It is known that the vomiting reflex is associated with activation of the ninth and tenth cranial nerves, certain nerves of the respiratory tract, abdominal muscles and the diaphragm. In the run-up to vomiting, body reactions such as increased saliva production, excessive sweating and a drop in blood pressure (fluctuations in blood pressure) appear. In the act of breaking, the coordinated movement or contraction and relaxation of the diaphragm, abdominal and respiratory muscles creates a pressure wave inside the body, which, with the support of the esophagus, leads to oral emptying of the stomach.

Possible damage from repeated vomiting

Repeated severe vomiting causes irritation and possibly inflammation of the esophagus as a result of contact with the stomach acid. In very rare cases, there is a tear in the esophagus, the so-called spontaneous esophageal perforation. Such an esophageal perforation is life-threatening and represents a medical emergency. Extreme pain under the sternum or back, coughing and shortness of breath indicate such a tear. If there are any signs, the emergency call 112 must be alerted immediately. Another emergency is a tear in the mucous membrane at the transition to the stomach. This so-called Mallory-Weiss syndrome is often manifested by vomiting blood.

Caution: There are some alarm signals that require immediate medical attention. For example, if there is blood in the vomit (coffee grounds break), if there is severe pain after vomiting, if the vomit smells of faeces, or if there is additional blood in the stool or a black, tar-like stool, a doctor must be called in immediately.

Other damage that can occur from repeated vomiting is loss of fluid, deficiency symptoms, metabolic disorders, unwanted weight loss and tooth damage. Depending on the different causes of nausea and vomiting, numerous accompanying symptoms are possible, which are then explained in more detail in connection with the triggers of the symptoms.

Causes

Vomiting is actually a protective reflex of the organism, with the help of which the body is freed from harmful substances and germs. But extreme disgust at certain smells and visual impressions can also cause nausea. Furthermore, strains on the sense of balance, such as in rough seas on a ship or in a roller coaster, can sometimes trigger nausea.

Psychosomatic factors

Psychosomatic factors can also play a role here, for example in the case of a so-called nervous stomach, which is characterized by nausea when extremely excited or mentally tense. Heartache and grief for the deceased are also occasionally associated with an uncomfortable feeling in the stomach area and nausea. Mental disorders such as anxiety disorders, panic attacks and depression can also sometimes cause nausea.

Consequence of anesthesia

Furthermore, nausea and vomiting are often a result of operations under anesthesia, whereby a self-protective reaction of the organism to the anesthetics used is suspected as the cause.

Cause infectious diseases

Numerous infectious diseases hit the stomach on the stomach, whereby a distinction can be made between infections directly in the gastrointestinal tract, such as, for example, from Salmonella, Escheria Coli or other viruses and bacteria, and general infectious diseases, such as, for example, tick-borne disease.

The side effects indicate the cause

On the basis of the accompanying symptoms, a classification can usually be made quite easily. If those affected predominantly show symptoms in the immediate gastrointestinal area, such as abdominal pain, stomach cramps or diarrhea, it is reasonable to suspect a viral or bacterial gastrointestinal infection. The pathogens, which are usually taken orally, migrate from top to bottom through the digestive tract. Nausea and vomiting are usually at the beginning of the gastrointestinal infection, while diarrhea often follows at the end of the course of the disease.

Although other symptoms such as headache, fever or body aches can also be observed in gastrointestinal infections, they play a minor role in view of the massive complaints in the gastrointestinal area. In the case of general infectious diseases, on the other hand, nausea and vomiting are more likely to accompany symptoms and other complaints.

Lyme disease, early summer meningoencephalitis, legionellosis

For example, patients with Lyme disease only occasionally suffer from nausea. The main symptoms of the disease are, however, a round reddish itchy rash and general symptoms such as chronic fatigue, headache, fever, visual disturbances and dizziness. They are often so pronounced that nausea and possible vomiting are more of a by-product. This also applies to early summer meningoencephalitis, which is also transmitted by ticks, and to other infectious diseases, such as legionnaires' disease (legionellosis), so-called Q fever or diphtheria, which are also sometimes accompanied by nausea and vomiting.

Indigestion

If there is chronic nausea without vomiting and without conventional medical findings, this can indicate a lack of production of digestive juices but also a digestive disorder (dyspepsia) due to an improperly populated intestinal flora (intestinal dysbiosis, intestinal mycosis).

Diseases of the internal organs

Various diseases of the digestive organs are associated with nausea and vomiting, whereby inflammatory processes often play a role here. For example, inflammation of the esophagus (esophagitis), inflammation of the stomach, gastric ulcer, duodenum, appendicitis and peritonitis are considered possible causes of nausea and vomiting. Diseases of the kidneys, liver or biliary tract can also lead to vomiting.

Critical alarm signals
The accompanying complaints are extremely different for the various diseases of the internal organs, with some critical alarm signals that in any case require immediate medical examination. This includes, for example, vomiting blood, the so-called coffee grounds vomiting and black stool (also called tar chair). If the vomit smells of fecal matter, it can also indicate a medical emergency.

Poisoning as the cause

It is not uncommon for nausea and subsequent vomiting to result from poisoning, the causes of which can range from excessive alcohol consumption, the consumption of poisonous mushrooms or food poisoning, to contact with toxic chemicals. In addition to the vomiting attacks after excessive alcohol consumption, food poisoning is one of the relatively common triggers in Germany.

If the symptoms appear immediately after eating, food poisoning should therefore urgently be considered, especially since this can possibly be fatal. Fortunately, contact with highly toxic chemicals is relatively rare in Germany these days, so the nausea and vomiting are only relatively rarely due to poisoning with the corresponding chemicals.

Food allergies

A distinction to be made between food poisoning is food intolerance and food allergies, such as lactose intolerance (milk sugar intolerance) or a nut allergy, which can also cause nausea and vomiting immediately after eating. In addition, severe abdominal pain, bloating (abdominal distension) and diarrhea can often be observed.

Cardiovascular diseases

The symptoms can often be observed in acute cardiovascular complaints, such as a heart attack or a stroke. In these life-threatening events, the nausea is by no means the main symptom. Rather, a heart attack is characterized by massive chest pain or heart pain, radiating pain in the arms and upper abdomen, and tightness in the chest, difficulty breathing and fear of death. In the case of a stroke, the most noticeable symptoms are massive headaches, hemiplegia, dizziness and speech disorders as well as perceptual disorders.

Hypertension Crisis (Hypertensive Crisis)

Cardiovascular complaints that can trigger nausea and vomiting include a sudden increase in blood pressure as part of a so-called hypertensive crisis (high blood pressure crisis). A corresponding derailment of blood pressure can often be observed, for example, in cardiovascular patients who voluntarily discontinue their medication to lower blood pressure. However, the hypertensive crisis can also be triggered by psychological factors, such as a panic attack. In rare cases, the hypertension crisis is also related to acute kidney disease. In addition to the sudden high blood pressure, those affected may show symptoms such as headache, nosebleeds and dizziness.

Circulatory collapse (syncope)

If the blood pressure suddenly drops, for example as part of a so-called circulatory collapse (syncope), this may also be associated with nausea and vomiting. The lack of blood supply to the brain can result in short-term loss of consciousness for those affected. Dizziness, buzzing in the ears and flare-ups can be mentioned as frequent accompanying symptoms of a sudden drop in blood pressure.

Other causes of nausea and vomiting

In addition to the causes mentioned so far, there is a wide range of other possible triggers of a sudden nausea. This ranges from pregnancies and menstrual pain to a heat attack, migraines and diseases of the inner ear to psychologically related eating disorders. Then some of these complaints are briefly outlined.

Migraine

In addition to the attack-like extreme headache, many migraine patients show other symptoms such as visual disturbances or nausea and vomiting. Sensory disorders (numbness or tingling in the limbs, balance disorders and increased sensitivity to light are also known as aurasymptoms in migraine attacks. People may also perceive noises and smells to be significantly more intense and extremely unpleasant. Some migraineurs also have language difficulties.

Sunstroke

The symptoms can also occur as a result of sunstroke. This is caused by excessive sun exposure in the head area and leads to further symptoms such as headache, dizziness, an increased pulse rate, drowsiness and, in the worst case, a circulatory collapse. A stiff neck may also be observed in connection with a sunstroke.

Overheating

The consequences of a general overheating of the organism are usually quite similar to those of a sunstroke, but the cause is not too much sun exposure in the head and neck area, but usually an overexertion of the body at high temperatures. A long stay in closed, warm rooms (for example a car parked in the sun) can overwhelm the body's temperature regulation and result in overheating, which is accompanied by nausea and vomiting.

Concussions

As the mildest form of a traumatic brain injury, concussions after a fall on the head are relatively common and, in addition to short-term loss of consciousness, can trigger headaches, dizziness, balance problems, nausea and vomiting immediately after the event. Occasionally, those affected by a traumatic brain injury also start squinting or show pupils of different sizes. If increasing disturbances in consciousness occur after a while, this should be regarded as an indication of a more severe traumatic brain injury and possibly existing bleeding in the skull.

Tumor diseases

Different forms of malignant tumors can form in the brain (for example plexus carcinoma, glioblastoma), which increase intracranial pressure, disrupt the sensitive neural network of the vomiting center and thus repeatedly cause nausea and vomiting. In addition to headaches, language difficulties, visual disturbances and any signs of paralysis, epileptic seizures also occasionally appear as additional symptoms in the course of the tumor diseases of the brain.

Nausea during cancer therapy

Nausea and vomiting can often be observed as part of cancer therapy or as a result of chemotherapy. The complaints are not due to the cancer itself, but are triggered by the chemotherapy drugs (including cytostatics). To put it simply, the drugs specifically poison the organism to eliminate the cancer. The brain recognizes the poisoning and reacts with a corresponding nausea. This represents a significant disadvantage of chemotherapy, which has not yet been overcome, because the already weakened patients lose more strength due to the loss of fluid and nutrients.

Nausea of ​​pregnancy

Many women experience increased nausea and vomiting during pregnancy, although the severity of this so-called pregnancy sickness can differ significantly. While some only feel nausea in the morning, others have to vomit several times a day, feel constantly nauseous and can hardly keep food with them. If there is constant weight loss in addition to severe pregnancy sickness, a doctor's visit is urgently recommended. In the worst case, there is a risk of an undersupply of nutrients, which can also have an adverse effect on the development of the unborn child.

Menstrual cramps

Some women also experience nausea and vomiting as a side effect of their monthly cycle. In addition to cramp-like abdominal pain (menstrual pain), you experience a feeling of fullness during menstruation, which can increase until you give up. The women concerned are often significantly restricted in their everyday life.

Travel sickness

Travel sickness (kinetosis) or its most famous form, sea sickness, is based on a conflict between the reported information about the sense of balance and the eyes. The brain is unable to overlay them and responds by increasing the release of stress hormones. At first, those affected often show dizziness, cold sweats and, later on, a strong urge to vomit, which only subsides briefly after vomiting. In some cases, the weaker symptoms may persist for several days after the actual event.

Common triggers of motion sickness

In addition to shipping in waves, plane trips, bus trips and unusual movements, such as in a carousel or a roller coaster, are known to be frequent triggers. However, kinetosis can be caused by countless other factors, whereby movements of the subsurface (e.g. fluctuating, very high buildings) often - but not always - play a role. A counterexample is the kinetosis caused by virtual impressions, such as in a computer game, virtual reality glasses or in 3D cinema.

Meniere's disease

Meniere's disease describes an inner ear disorder that is associated with severe dizziness, tinnitus (ringing in the ears) and one-sided loss of hearing. The vertigo attacks often last for some time and can cause nausea and vomiting. Often, those affected have to sit down first so as not to lose their balance. People between the ages of 40 and 60 are particularly often affected, and women tend to be affected more often than men.

Radiation sickness

The so-called radiation sickness (triggered by radioactive radiation) can also be mentioned as a possible, but fortunately rare, cause of nausea and vomiting attacks. Accompanying this are other symptoms such as an itchy rash, hair loss, ulcers, nervous system disorders, anemia and numerous rather unspecific complaints. The higher the radiation dose to which the patient was exposed, the more serious and long-lasting the symptoms of radiation sickness are.

Always clarify frequent vomiting with the doctor

Ultimately, numerous other factors can also lead to the symptoms, whereby individual perception often plays a decisive role. Since repeated vomiting is not only an expression of possibly existing diseases, but also always poses a health risk, a medical check should be carried out here after the second day at the latest.

What does the time of vomiting say?

The point in time or the way in which vomiting occurs is already indicative of the tendency to cause. However, these can differ in individual cases and do not replace professional diagnosis. For example, morning vomiting often occurs in connection with pregnancy, with heavy alcohol consumption the evening before or as a result of kidney failure. If you vomit during or shortly after eating, this sometimes indicates psychosomatic causes or acute gastrointestinal inflammation (gastroenteritis). If you vomit an hour or more after eating, you may have a stomach ulcer, narrowing or paralysis.

What do the accompanying symptoms say about the cause?

Likewise, the accompanying symptom that appears can narrow down the possible causes. A pronounced loss of appetite may indicate appendicitis, inflammation of the liver or paralysis of the stomach, for example. If eye pain occurs, this can be a sign of a glaucoma attack. Severe chest pain, which can also radiate into the arms, may be a heart attack and must be treated immediately. For example, nausea coupled with headache occurs in meningitis.

If there is a fever and cough in addition to nausea and vomiting, this is an indication of flu infections or influenza. Additional diarrhea could be a gastrointestinal infection. If yellow eyes appear as a symptom, the biliary tract or liver may be diseased. Flank pain also indicates biliary tract disease. If dizziness and buzzing in the ears occur, this is an indication of an existing Meniere disease. If the victim vomits in a gush without previous nausea, this could be a sign of brain injury or disease.

Diagnosis

Often, the causes can already be clearly narrowed down by questioning the patient about the occurrence of the symptoms and possible accompanying symptoms. A first physical examination (palpation, eavesdropping) can provide further important information about the diagnosis. In addition, laboratory tests of blood, bowel movements and urine often provide very clear indications of possible infectious diseases or inflammation in the digestive tract. Poisoning can also be determined in the course of the laboratory tests.

Ultrasound, CT and MRI

Ultrasound scans are generally an important element in the diagnosis of diseases of the digestive organs. This also applies to the other so-called imaging procedures, such as computer tomography (CT) or magnetic resonance imaging (MRI), which are also used to diagnose any traumatic brain injury or bleeding in the skull and to detect tumors.

EKG and otoscopy

So-called electrocardiograms (EKG) can also be created to identify existing heart diseases. If Menière's disease is suspected, hearing tests and optical examinations inside the ear (otoscopy) are appropriate. In women of childbearing potential, the possibility of nausea during pregnancy should also be considered, particularly in the case of nausea and vomiting without additional accompanying symptoms. A pregnancy test provides quick and uncomplicated information here.

Obvious causes

In many cases, the cause of the surrender is well known to those affected, since the causal connection also opens up to medical laypersons. This applies, for example, to motion sickness or vomiting after excessive alcohol consumption. But even with a sunstroke, those affected often realize without medical advice what caused their complaints.

Treatment

Basically, the treatment should be based on the respective causes. A detailed description of all therapeutic approaches against the possibly existing infectious diseases, cardiovascular problems, diseases of the internal organs, tumor diseases, poisoning and psychological triggers would clearly go beyond the scope here. Therefore, the following explanations relate exclusively to therapeutic approaches that have a direct effect on or avoid the nausea or which are intended to correct the immediate consequences of vomiting, such as the massive loss of fluid.

Medicines for nausea

Various nausea-reducing medications (antiemetics) are available for drug treatment, such as corticosteroid, dexamethasone, the neuroleptic droperidol or the antihistamine dimenhydrinate. Certain so-called prokinetics, which influence the muscular activity of the hollow organs (peristalsis) in the digestive tract, also work against the nausea. Other medicines start immediately in the information processing in the vomiting center of the brain, where they block the serotonin receptors and thus prevent the urge to vomit. Since oral intake is sometimes hardly possible due to vomiting, the medicinal products are often administered as suppositories or injected directly into the bloodstream.

Treat nutrient and fluid loss

The loss of nutrients and fluids in vomiting represents a health risk that should not be underestimated, which can be counteracted by drinking electrolyte solutions or administering them via a drip. Especially if there are signs of an acute lack of fluids (dry mouth, noticeably low urine output), action should be taken quickly here. In the case of severe pregnancy-related vomiting, it is usually also advisable to give electrolyte solutions so as not to endanger the development of the unborn child. Increased attention should be paid to compensating for the loss of fluids, minerals and nutrients in babies and toddlers.

Naturopathy for nausea and vomiting

Naturopathy offers numerous treatment options, whereby a distinction can be made between external applications and the intake of certain nausea-reducing substances. The external applications of naturopathy, which are supposed to alleviate the urge to vomit, include, for example, special forms of acupuncture and acupressure.

Homeopathy for nausea

Homeopathics such as Arsenicum album, Ipecacuanha, Sepia or Nux vomica are suitable for internal use. The choice of suitable remedies and their potencies should always be left to experienced therapists. The active ingredient cocculus has proven itself in homeopathy against motion sickness. Schüßler salts can also be used as part of naturopathic treatment, especially Schüßler salt:

  • No. 3 Ferrum phosphoricum,
  • No. 5 potassium phosphoricum,
  • No. 8 sodium chloratum,
  • No. 9 sodium phosphoricum (for motion sickness),
  • and No. 10 sodium sulfuricum.

Herbal medicine

Ginger has made a name for itself in the field of herbal treatment, but chamomile is also said to have an extremely positive effect. It is usually taken as tea, but this can be difficult for patients due to the urge to vomit. With chamomile tea there is also a roll cure for the stomach and intestines against the complaints.

Balance intestinal cleansing or acid-base balance

If an association with the intestinal flora is suspected in the event of occasional nausea, an intestinal rehabilitation can also be carried out. In naturopathy, an imbalance in the acid-base balance or an overacidification of the organism is also sometimes associated with the feeling of nausea and increased nausea, which is why appropriate regulatory measures are taken if necessary.

What to eat in case of nausea and vomiting?

In general, it is advisable to temporarily change your diet to light, easily digestible food, which is taken in several small meals throughout the day. Among other things, a carrot soup according to Morro is recommended here, which has also proven itself very well for diarrheal diseases. Rusk, oatmeal or dry white bread can also calm the irritated stomach somewhat. Begleitend ist auf ausreichende Flüssigkeitsaufnahme zu achten. Hier sind Kräutertees aus Ingwer, Pfefferminz oder Kamille empfehlenswert. (fp, vb; aktualisiert am 12. September 2018)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters

Swell:

  • Norton J. Greenberger: Übelkeit und Erbrechen, MSD Manual, (Abruf 15.08.2019), MSD
  • Sonam Puri et al.: Prediction of Chemotherapy-Induced Nausea and Vomiting from Patient-Reported and Genetic Risk Factors, Supportive Care in Cancer, (Abruf 15.08.2019), PubMed
  • Lawrence R. Lustig: Menière-Krankheit, MSD Manual, (Abruf 15.08.2019), MSD
  • Peter J. Goadsby et al.: Pathophysiology of Migraine: A Disorder of Sensory Processing, Physiological reviews 2017, (Abruf 15.08.2019), PubMed
  • George L. Bakris: Hypertensive Notfälle, MSD Mnaual, (Abruf 15.08.2019), MSD
  • Monique Weissenberger-Leduc: Nausea and Vomitio - Nausea and Vomiting, in the Palliative Care Handbook, Springer Verlag, 4th edition, 2008
  • H. R. Koelz, P. G. Lankisch, S. Müller-Lissner: Primer of the leading gastrointestinal symptoms, Springer Verlag, 1995

ICD codes for this disease: R11ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


Video: Morning Sickness Relief (June 2022).


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