Risk Factors and Causes for Nausea And Vomiting

It is thought that vomiting is controlled by the vomiting center located in the brain called the chemotrigger zone. Nausea is less well understood. The timing of the nausea or vomiting can indicate the cause. When it appears shortly after a meal, nausea or vomiting may indicate a mental disorder, such as bulimia, or a peptic ulcer. Nausea or vomiting one to eight hours after a meal may indicate food poisoning. Food borne diseases, such as Salmonella, may take eight to 72 hours after eating contaminated food to produce symptoms because of the incubation time.

Chemotherapy induced nausea and vomiting: Chemotherapy medications are commonly used to treat various types of cancers. Some chemotherapy medications cause more nausea and vomiting than others, including cisplatin (Platinol ®) and cyclophosphamide (Cytoxan ®). These two drugs cause nausea and vomiting in greater than 90% of those receiving the drug when no nausea treatment is given.

Chemotherapy induced nausea and vomiting can be divided into several categories. Acute nausea and vomiting usually occurs a few minutes to several hours after the chemotherapy is initiated and goes away within the first 24 hours. The vomiting will be at its worst usually after five to six hours. Delayed vomiting develops more than 24 hours after chemotherapy is given. It might occur with cisplatin (Platinol ®) or cyclophosphamide (Cytoxan ®). Cisplatin-related vomiting will be at its worst usually from 48-72 hours following chemotherapy and can last six to seven days. Anticipatory nausea/vomiting is learned from previous experiences with vomiting. Anticipatory nausea and vomiting occurs as a result of an unpleasant experience with chemotherapy. It occurs as the individual is preparing for the next dose of chemotherapy, usually within 30-60 minutes before the chemotherapy is started. The individual anticipates that nausea and vomiting will occur as it did before. Breakthrough vomiting occurs despite treatment to prevent it. It requires more anti-nausea and vomiting treatment. Refractory vomiting occurs after one, a few, or several chemotherapy treatments even though the individual is being treated to prevent or control nausea and vomiting. The anti-nausea and vomiting treatment is no longer effective. The individual no longer responds to treatment to prevent nausea and vomiting.

Diabetes: Diabetes can cause nausea, especially when blood sugar levels are poorly controlled. Blood sugar levels of 100-125 milligrams/deciliter indicates an individual has a form of pre-diabetes called impaired fasting glucose (IFG), meaning that the individual is more likely to develop type 2 diabetes but does not have the condition yet. A level of 126 milligrams/deciliter is diabetes. Diabetes can lead to a condition of the stomach called gastroparesis, which also can cause nausea and difficulty eating. Gastroparesis causes stomach contents to not be emptied quickly enough, resulting in nausea.

Emotional stress: Sensitive individuals under extreme emotional stress may become nauseous and vomit.

Gallstones: Gallstones are solid deposits of cholesterol or calcium salts that form in the gallbladder or nearby bile ducts. Gallstones may cause nausea, vomiting, indigestion, and abdominal pain.

Gastroenteritis: Gastroenteritis is inflammation of the lining of the stomach and intestines. Gastroenteritis is typically caused by a viral infection or bacteria from contaminated food or water. In addition to nausea and vomiting, the individual may have watery diarrhea and abdominal cramps.

Gastroesophageal reflux disease (GERD): Gastroesophageal reflux disease (GERD) is irritation to the esophagus that causes inflammation. GERD is often due to stomach acid that backs up into the esophagus Stomach acid in the lower esophagus can trigger nausea and regurgitation of food. It may also be associated with vomiting. Foods and beverages that may cause GERD include alcoholic beverages, soft drinks, tea, and coffee.

Headache: An intense headache, such as a migraine, can cause nausea and vomiting. A rare cause of headache and nausea with vomiting is a brain tumor.

Kidney failure: Nausea and vomiting may develop if the kidneys are not able to rid the body or toxins effectively, such as in nephritis.

Liver disease: If the liver becomes inflamed, called hepatitis, the individual may experience nausea and vomiting. If the liver is damaged to the point of liver failure, waste products are not removed effectively and nausea and vomiting may result. Hepatitis can result from a viral infection, chronic alcohol abuse, and certain medications including acetaminophen (Tylenol ®).

Motion sickness: Motion sickness is a normal response to real, perceived, or anticipated movement. Individuals tend to experience motion sickness on a moving boat (seasickness), train, airplane, automobile, or amusement park rides. Although this condition is fairly common and only a minor nuisance for the occasional traveler, it may be incapacitating for people with an occupation that requires constant movement, such as a flight attendant, pilot, astronaut, or ship crew member. Symptoms generally consist of dizziness, fatigue, and nausea, which may progress to vomiting. Fortunately, most symptoms disappear once the journey is over. Treatment can include over-the-counter (OTC) antihistamines including dimenhydrinate (Dramamine ®) and integrative therapies including acupressure and ginger (Zingiber officinale).

Pancreatitis: Pancreatitis is a condition where digestive enzymes attack the pancreas rather than break down food in the small intestine. Pancreatitis causes mild to severe abdominal pain, often accompanied by nausea, vomiting, and fever.

Peptic ulcers: Peptic ulcers are lesions that develop on the lining of the stomach, upper small intestine, or esophagus. The classic symptom of peptic ulcer is burning pain anywhere from the navel to the breastbone, but peptic ulcers may cause nausea and vomiting as well.

Pregnancy: It is estimated that 50-90% of pregnant women experience nausea during the first trimester, while 25-55% experience vomiting. The hormonal changes of early pregnancy have been thought to cause nausea and vomiting. For most women, nausea begins between the 2^nd and 5^th week and ends between the 8^th and 14^th week post-conception. For 35% of pregnant women, nausea and vomiting are severe enough that they lose time from work.

Radiation therapy nausea and vomiting: Whether radiation therapy causes nausea and vomiting depends on the part of the body being treated, the amount of radiation given, and how often the treatment is given. When the area of the body being treated includes a large part of the abdomen, specifically, the small intestine (or small bowel), there is a greater chance of nausea and vomiting occurring. About 50% of the people with cancer who receive standard doses of radiation to their abdomen will have nausea and vomiting. These symptoms can occur one to two hours after treatment and can last for several hours. Of those being treated with total body radiation therapy used in bone marrow transplants, about 60-90% will develop nausea and vomiting if not given preventative medicines. These people may also receive high doses of chemotherapy to prepare for the transplant. The combination of radiation therapy and chemotherapy increases the chance of nausea and vomiting. Individuals who receive one large dose of radiation therapy (500 rem or more) have a greater chance of nausea and vomiting than those who receive radiation therapy in smaller doses (less than 100 rem).

Toxins: Toxins in the blood, including alcohol, nicotine, and medications (such as antibiotics), can cause nausea and vomiting. Withdrawal from addictive substances, such as narcotic pain relievers and heroin, can lead to nausea and vomiting.

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