Contents

Search

nausea

An unpleasant, but not painful sensation generally perceived in the upper abdomen. It is generally accompanied by hypersalivation & the desire to vomit or the feeling that vomiting is imminent. It may be brief, prolonged & sometimes occurs in waves. See vomiting. Etiology: - gut wall dilation -constipation, bowel obstruction, ileus (GUT)* - gut mucosal injury - radiation therapy, chemotherapy, infection, inflammation (gastritis), direct tumor invasion (GUT)* - drugs, metabolites, bacterial toxins (CTZ)* - motion sickess, labyrinthine disorders (vesibular)* - anticipatory nausea (cerebral cortex)* - increased intracranial pressure (?)* * see pathology for mechanism at site or origin Pathology: - mediated by - dopamine D2 receptors or 5-HT3 receptors in GI tract - dopamine D2 receptors, 5-HT3 receptors or neurokinin-1 receptors in the chemoreceptor trigger zone (CTZ) - histamine H1 receptors & muscarinic receptors in the vestibular system - unknown mediators in the cerebral cortex (putative) Management: 1) sucking of hard candy or popsicle especially in children 2) anticholinergics for motion sickness - scopolamine 3) antihistamines - inner ear dysfunction or motion sickness a) dimenhydrinate (Dramamine) 50 mg PO/IV/IM every 4 hours b) promethazine (Phenergan) 25-50 mg PO/IV/IM every 4-6 hours 4) dopaminergic antagonist (metochlopramide, prochlorperazine, haloperidol) for dopamine D2 receptor mediated nausea 5) antacids for nausea due to gastritis [2] 6) serotonin antagonists (ondansetron, granisetron) for 5-HT3 receptor (chemotherapy) mediated nausea 7) aprepitant for resistant chemotherapy-induced nausea [2] 8) benzodiazepines for anticipitory nausea 9) glucocorticoids for increased intracranial pressure 10) octreotide for nausea due to bowel obstruction 11) do not use topical agents for treatment of nausea [2] 12) treatment of nausea in palliative care a) if due to constipation, bowel obstruction, ileus - dopaminergic antagonists - metoclopramide, prochlorperazine, haloperidol, olanzapine b) if due to chemotherapy, radiation, inflammation, cancer - ondansetron, granisetron - if intractable nausea & vomiting use ondanstetron 4 mg every 8 hours around the clock [2] c) if due to drugs, metabolites, bacterial toxins - dopaminergic antagonists, glucocorticoids, serotonin receptor antagonists - neurokinin-1 receptor antagonists: aprepitant, netupitant d) if due to labyrinthine disorder, motion sickness - anticholinergic agents: scopolamine, diphenhydraine, promethazine e) increased intracranial pressure: glucocorticoids 13) also see vomiting

Related

vomiting

Specific

nausea/vomiting - chemotherapy induced post-operative nausea & vomiting

General

sign/symptom

References

  1. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
  2. Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022