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Nausea

Overview

Nausea is a feeling of discomfort associated with the urge to vomit. It may be followed by vomiting or persist as an uncomfortable feeling due to internal or external factors. It is not a disease rather a symptom of multiple diseases or conditions. Nausea may be acute or chronic depending on its causative factor. It can be managed with home care remedies in mild cases and does not require medications. Severe or persistent cases of nausea require medical attention to seek out the underlying cause. 

Causes

Various factors may occur individually or simultaneously to cause nausea. Some of the common causes of nausea are associated with digestive tract diseases. These include gastritis, gastroesophageal reflux disease, peptic ulcer, dyspepsia, food poisoning, celiac disease, biliary reflux, etc. In most of these conditions, nausea is often followed by vomiting. Pregnancy is another common cause. Females often experience nausea during the first trimester, and it is commonly termed morning sickness. 

Traveling is another common cause of nausea, especially when traveling over water. It is referred to as seasickness or motion sickness in common terms. Nausea can also occur as a side effect of medications such as chemotherapeutic agents, general anesthetic agents, antibiotics, etc. Some people may experience nausea after eating or smelling certain food or drink items. Patients with mental health issues such as anxiety, depression, etc., or eating disorders also suffer nausea that may recur more than once a week. In certain cases of migraine, nausea occurs in the initial phase along with other relative symptoms. Some serious diseases with nausea as a symptom include appendicitis, pancreatitis, cholecystitis, diabetic ketoacidosis, angina pectoris, hepatitis, meningitis, encephalitis, adrenal insufficiency, liver failure, etc.

Risk Factors And Epidemiology

Risk factors of nausea depend on its underlying cause. The presence of a chronic gastrointestinal disease such as prolonged standing peptic ulcer, gastroesophageal reflux disease, etc., increases the risk of recurrent nausea. Nausea frequently occurs during pregnancy, but the risk may be greater among young women or women experiencing pregnancy for the first time. It is also higher among women living in rural or poverty-stricken areas. Patients with prior history of nausea have a higher tendency to develop severe nausea while undergoing general anesthesia or chemotherapy. Traveling over water or in mountainous regions is another risk factor for not frequent travelers. Pre-existing gastrointestinal, systemic, or psychological diseases may also increase the risk of repetitive nausea. 

Nausea can occur at any age and gender, but it is more prevalent among females. Teenage and adolescent females tend to develop nausea associated with menstruation, pregnancy, and motion sickness. The risk of nausea reduces with increasing age, as indicated by research. 

Signs And Symptoms

Since nausea itself is a symptom of an underlying condition, it may occur with other symptoms that are diagnostic of other diseases or conditions. It often occurs as a strong feeling of discomfort and an urge to vomit. Nausea experienced due to gastrointestinal disorders or food poisoning is usually followed by vomiting of ingested food substances. Pregnancy-induced nausea may or may not occur with vomiting. Migraine-associated nausea is present with a severe one-sided headache, light sensitivity, or irritability. Other symptoms, along with nausea in case of systemic diseases, medications, or drug toxicity, include fever, chills, abdominal pain, chest pain, diarrhea, lack of appetite, weight loss, dizziness, vertigo, tiredness, etc. 

Diagnosis

Diagnosis of nausea is made by taking a detailed patient history and performing a clinical examination if necessary. Your doctor may inquire about the onset, duration, recurrence, and severity of nausea, along with other associated symptoms if present. A history of drug use, medications, previous treatments, traveling, or sexual activity may be noted to rule out the possible causes. Nausea occurring in a sexually active, otherwise healthy female can be an early indication of pregnancy. Pregnancy tests are done in that case to confirm it. Clinical examination is done if nausea is suspected due to an underlying systemic disease. Laboratory tests and radiographic imaging may be required if specified by your doctor to confirm the diagnosis of an infection, drug toxicity, or any other systemic illness. 

Differential Diagnosis

Nausea can occur due to several factors; therefore, it is important to differentiate among its different causative agents. It can occur due to gastrointestinal diseases or other systemic illnesses, including meningitis, encephalitis, migraine, pancreatitis, appendicitis, diabetic ketoacidosis, etc. 

Treatment

Treatment of nausea is done after diagnosing its underlying cause. In the majority of the cases that present with no other serious symptoms, nausea is treated by marinating electrolyte imbalance, drinking plenty of water, and modifying dietary habits if required. Few home remedies such as drinking ginger tea, mint-infused drinks, or eating menthol chewing gum may help but are not effective in all cases. Moderate to severe cases of nausea require medications. 

Medication

Antiemetic drugs are the primary medicines used to treat nausea and vomiting. These include benzodiazepines such as lorazepam, antihistamines such as diphenhydramine, cyclizine, anticholinergics such as scopolamine, and a few other drugs. They are often given before beginning general anesthesia or chemotherapy to avoid the risk of nausea. Oral dosages of these drugs are suggested to be used as prescribed by your doctor. 

Prognosis

Most cases of nausea can be managed effectively by proper diet, hydration, and the use of medications. Cases that persist or develop severity should be tested for underlying diseases. 

Prevention

Nausea can be prevented by maintaining a balanced diet and drinking plenty of water to prevent dehydration. Diet should be low in fats and fiber to be digested with ease. Excessive oily or greasy foods should be avoided. While eating, it is recommended to eat in small bites and chew properly instead of gulping a large bolus of food at once. If the sight or smell of any food is known to trigger nausea, it’s best to avoid it. Placing higher pillows during rest may also aid in reducing discomfort associated with nausea.