Nausea and vomiting

Nausea and vomiting originate from peripheral (gastrointestinal tract or middle ear) or central stimuli. Nausea is often precipitated by a patient’s medication. Pregnancy, recent surgery and alcohol excess are other common causes. Rarer causes comprise endocrine disease, uraemia and psychiatric causes. Careful history and examination usually direct the physician to the cause. This allows tailoring of anti-emetic therapy, determining whether antagonists to dopamine, serotonin, or acetylcholine should be used. Accurate assessment of fluid status is crucial in patients who vomit. Thereafter, 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. Applying a systematic approach when considering the likely cause of nausea or vomiting is recommended.