Nausea and vomiting
Last updated: July 21, 2021
Nausea refers to an unpleasant sensation that is often localized to the abdomen and typically interpreted as an urge to vomit. Vomiting is the forceful oral expulsion of gastric contents. Common causes of nausea and/or vomiting include gastrointestinal pathologies, early pregnancy, and adverse effects of medications. However, nausea and vomiting may be caused by pathology in any organ system, including the CNS, endocrine, and vestibular systems, as well as be a manifesting symptom of a functional disorder. Patients presenting with acute onset of recurrent vomiting should be evaluated for signs of dehydration and electrolyte and acid-base disorders, which should be corrected at the earliest opportunity. A thorough history and physical examination should be performed to narrow down the differential diagnoses and guide further diagnostic workup and treatment. Accompanying symptoms (e.g., fever, abdominal pain, headache) may provide clues as to the underlying disorder. Nausea and vomiting in children are not addressed here.
Approach to management 
- ABCDE survey
- Establish IV access.
- Perform screening examination and targeted diagnostics to rule out life-threatening causes (see below).
- Once life-threatening causes have been ruled out:
- Identify and treat hypovolemia (see fluid resuscitation).
- Identify and treat electrolyte imbalance (see electrolyte repletion).
- Identify and treat acid-base disorders.
- Identify and treat the underlying cause.
- Minimize or discontinue any contributing medications.
- Administer antiemetic therapy.
- Consider NPO diet.
Red flags for nausea and vomiting
- Chest tightness
- Feeling of impending doom
Immediately life-threatening causes
The diagnostic workup should be guided by the pretest probability of the possible diagnoses. The following list includes some commonly used diagnostic tools that can help to diagnose or rule out possible etiologies in a patient with nausea and vomiting.
Routine  
In patients with severe and sustained vomiting
Further diagnostic testing to consider based on localization of symptoms 
In patients with suspected gastroenteritis without signs of sepsis, it may not be necessary to do any diagnostic testing.
Life-threatening causes of nausea and vomiting
Other causes of nausea and vomiting
Medications are a common cause of nausea and vomiting. Consider replacing the medication with a suitable alternative or decreasing the dose and then slowly up titrating it to minimize this adverse effect.
Infectious causes of nausea and vomiting
Noninfectious causes of nausea and vomiting
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