Nausea & Vomiting: Treatment

For effective treatment of nausea and vomiting the first step is to establish the cause of nausea and vomiting and treatment is directed toward the cause if possible. If the cause can be identified than proper treatment can be instituted. If no cause of vomiting cab be identified than symptomatic treatment is given.

General principles of treatment of nausea and vomiting:

The general principle of treatment of nausea and vomiting should be aimed at correction of medically or surgically remediable abnormalities if possible. If there is severe dehydration due to severe vomiting, hospitalization should be considered, especially if oral fluid replenishment cannot be sustained. Once oral foods can be tolerated, foods are restarted with liquids that are low in fat, (because fats/lipids delay gastric emptying). Foods high in fibers (indigestible residues) also should be avoided as these also delay gastric emptying (prolong gastric retention).

Treatment of vomiting and nausea with anti-emetic medications:

The most important is to treat the cause of vomiting if it can be identified, e.g. if vomiting is due to traveling by vehicle (motion sickness) antihistamines such as meclizine and dimenhydrinate and anticholinergic drugs like scopolamine which act on labyrinthine-activated pathways and are useful.

If the cause of vomiting is any medication, toxic substance, and metabolic disturbance dopamine D2 antagonists are used. Examples of dopamine D2 antagonists are metoclopramide (Reglan), domperidone (Domstal) etc. But dopamine antagonists can freely cross the blood-brain barrier and cause side effects like anxiety, dystonic reactions, hyperprolactinemic effects, and irreversible tardive dyskinesia.

Postoperative vomiting, prevention of cancer chemotherapy induced vomiting and vomiting after radiation therapy is treated with Serotonin 5-HT3 antagonists such as ondansetron and granisetron.

Chronic idiopathic (cause can not be established) nausea and functional vomiting and also in diabetic patients with nausea and vomiting (with long standing diabetes) low-dose tricyclic antidepressant agents provide symptomatic relief.

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