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A systematic search of medical literature was performed in January 2008. The search was limited to human subjects and journals in English language. Keywords included nausea, vomiting, emesis, antiemetic, chemotherapy, pregnancy, motion sickness, postoperative nausea and vomiting. Databases searched included Ovid, PubMed, National Guideline Clearinghouse, and the Cochrane database.

Nausea and vomiting are generalized symptoms that accompany a wide array of disorders and therapies (Tables 13-1 and 13-2). Although severe or prolonged vomiting may signal a complex clinical problem, more commonly, it is a self-limiting, unwanted side effect of medications, medical conditions, or procedures. Nausea and vomiting may be associated with gastrointestinal (GI) diseases, infections, neurologic or metabolic processes, cardiovascular disorders, pregnancy, chemotherapy, and surgical procedures.1,2 Nausea and vomiting pose a significant expense to society as it has been estimated that pregnancy-induced nausea and vomiting account for 8.5 million days of work lost per year and postoperative nausea and vomiting (PONV) increase hospital costs by over $400 per patient.1

Table 13-1. Medications Causing Nausea and Vomiting
Table 13-2. Other Etiologies of Nausea and Vomiting

Nausea, vomiting, and retching are three distinct phases involved in the process of emesis. Nausea is the subjective awareness of the urge to vomit and may be associated with flushing, tachycardia, diaphoresis, and salivation. Vomiting involves contraction of the abdominal muscles, descent of the diaphragm, and opening of the gastric cardia leading to expulsion of gastric contents through the mouth. Retching may precede or alternate with vomiting and involves spasmodic contractions of the thoracic and abdominal muscles as well as the diaphragm without expulsion of stomach contents.1,2

The vomiting center (VC), located in the reticular formation of the medulla, is the final common pathway mediating vomiting from most causes.2,3 It is a diffuse, interconnecting neural network that, upon stimulation, coordinates the respiratory, GI, and abdominal musculature involved in emesis. The VC may be stimulated ...

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