Nausea and vomiting - adults

Common problems that may cause nausea and vomiting include:

• Food allergies
• Infections of the stomach or bowels, such as the "stomach flu" or food poisoning
• Leaking of stomach contents (food or liquid) upward (also called gastroesophageal reflux or GERD)
• Medicines or medical treatments, such as cancer chemotherapy or radiation treatment
• Migraine headaches
• Morning sickness during pregnancy
• Seasickness or motion sickness
• Severe pain, such as with kidney stones

Nausea and vomiting may also be early warning signs of more serious medical problems, such as:

• Appendicitis
• Blockage in the intestines
• Cancer or a tumor
• Ingesting a drug or poison, especially by children
• Ulcers in the lining of the stomach or small intestine

Once you and your health care provider find the cause, you will want to know how to treat your nausea or vomiting.

You may need to:

• Take medicine.
• Change your diet, or try other things to make you feel better.
• Drink small amounts of clear liquids often.

If you have morning sickness during pregnancy, ask your provider about possible treatments.

The following may help treat motion sickness:

• Remaining still.
• Taking over-the-counter antihistamines, such as dimenhydrinate (Dramamine).
• Using scopolamine prescription skin patches (such as Transderm Scop). These are helpful for extended trips, such as an ocean voyage. Use the patch as your provider instructs. Scopolamine is for adults only. It should NOT be given to children.

Call 911 or go to an emergency room if you:

• Think the vomiting is from poisoning
• Notice blood or dark, coffee-colored material in the vomit

Call a provider right away or seek medical care if you or another person has:

• Been vomiting for longer than 24 hours
• Been unable to keep any fluids down for 12 hours or more
• Headache or stiff neck
• Not urinated for 8 or more hours
• Severe stomach or belly pain
• Vomited 3 or more times in 1 day

Signs of dehydration include:

• Crying without tears
• Dry mouth
• Increased thirst
• Eyes that appear sunken
• Skin changes: For example, if you touch or squeeze the skin, it doesn't bounce back the way it usually does
• Urinating less often or having dark yellow urine

Your provider will perform a physical exam and will look for signs of dehydration.

Your provider will ask questions about your symptoms, such as:

• When did the vomiting begin? How long has it lasted? How often does it occur?
• Does it occur after you eat, or on an empty stomach?
• Are other symptoms present such as abdominal pain, fever, diarrhea, or headaches?
• Are you vomiting blood?
• Are you vomiting anything that looks like coffee grounds?
• Are you vomiting undigested food?
• When was the last time you urinated?

Other questions you may be asked include:

• Have you been losing weight?
• Have you been traveling? Where?
• What medicines do you take?
• Did other people who ate at the same place as you have the same symptoms?
• Are you pregnant or could you be pregnant?

Diagnostic tests that may be performed include:

• Blood tests (such as CBC with differential, blood electrolyte levels, and liver function tests)
• Urinalysis
• Imaging studies (ultrasound or CT) of the abdomen

Depending on the cause and how much extra fluids you need, you may have to stay in the hospital or clinic for a period of time. You may need fluids given through your veins (intravenous or IV).

Crane BT, Eggers SDZ, Zee DS. Central vestibular disorders. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 166.

Guttman J. Nausea and vomiting. In: Walls RM, Hockberger RS, Gaushe-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 26.