Nausea and Vomiting

Source: DiPiro CV and Ignoffo RJ. Nausea and Vomiting. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7978503. Accessed June 6, 2012.

• Nausea: inclination to vomit; feeling in throat or epigastric region alerting individual that vomiting imminent.
• Vomiting: ejection or expulsion of gastric contents through mouth, often requiring forceful event.

• Specific etiologies associated with nausea and vomiting presented in Table 1.
• Chemotherapeutic agents
• Nonchemotherapeutic cancer-related causes

• Three consecutive phases of emesis:
  • Nausea
  • Retching
  • Vomiting
• Vomiting triggered by afferent impulses to vomiting center from:
  • Sensory centers
    • Chemoreceptor trigger zone (CTZ)
    • Cerebral cortex
  • Visceral afferents
    • Pharynx
    • Gastrointestinal (GI) tract
• Vomiting center sends efferent impulses to:
  • Salivation center
  • Respiratory center
  • Pharyngeal, GI, and abdominal muscles
• Neurotransmitter receptors in vomiting center, CTZ, and GI tract
  • Cholinergic
  • Histaminic
  • Dopaminergic
  • Opiate
  • Serotonin
  • Neurokinin
  • Benzodiazepine

Signs and Symptoms (Table 2)

• Mild to severe distress
• Queasiness
• Discomfort
• Weight loss
• Abdominal pain

Laboratory Tests

• Simple nausea and vomiting: none
• Complex nausea and vomiting
  • Serum electrolyte concentrations

Imaging

• Evaluation of upper and lower GI tract

• Prevent or eliminate symptoms of nausea and vomiting.

• Symptoms related to food ...