Nausea and vomiting

Nausea and vomiting originate from peripheral (gastrointestinal tract or middle ear) or central stimuli. Nausea is often precipitated by medication. Pregnancy, recent surgery and alcohol excess are also common causes. Rarely, endocrine disease, uraemia and psychiatric causes are contributing factors. Accurate history and examination usually direct the physician to the cause and allow a more tailored approach to anti-emetic therapy if necessary. Antagonists to dopamine, serotonin, or acetylcholine can all be used. Accurate assessment of fluid status is crucial in vomiting patients to prevent clinical deterioration and electrolyte disturbance. Specific investigation and treatment depends on the likely aetiology, but should be performed urgently if alarm features are present. Relief of nausea and vomiting is a mainstay of good palliative care.