digestive disorders
Nausea and Vomiting in Adults
Evaluation of Nausea and Vomiting
Not every episode of nausea and vomiting requires immediate evaluation by a doctor. The following information can help people decide whether a doctor’s evaluation is needed and help them know what to expect during the evaluation. Certain symptoms and characteristics are cause for concern. They include Signs of Dehydration (such as thirst, dry mouth, little or no urine output, and feeling weak and tired) Headache, stiff neck, confusion, or decreased alertness Constant abdominal pain Tenderness when the abdomen is touched Distended (swollen) abdomen People who have warning signs should see a doctor right away, as should people who vomited any blood or who recently had a head injury. People who have nausea and vomiting but no warning signs should see a doctor if vomiting continues for more than 24 to 48 hours or if they are unable to tolerate more than a few sips of liquid. People who have a few episodes of vomiting (with or without diarrhea) but are able to tolerate at least some liquids should call their doctor. Depending on their age, other symptoms, and known medical conditions (such as cancer or diabetes), the doctor may suggest that people be seen for an evaluation or stay home and try simple remedies. Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the vomiting and the tests that may need to be done ( see Table: Some Causes and Features of Nausea and Vomiting ). During the history, doctors ask whether the person is pregnant or has diabetes, migraines, liver or kidney disease, or cancer (including the timing of any chemotherapy or radiation therapy). All recently ingested drugs and substances are noted because certain substances may not be toxic until several days after ingestion (such asacetaminophenand some mushrooms). During the physical examination, doctors look for the following: Symptoms (such as a rapid heart rate, low blood pressure, and dry mouth) Signs of a serious abdominal disorder (such as a distended abdomen and/or severe tenderness to the touch) Decreased alertness or any other neurologic abnormalities suggesting a brain disorder Doctors note any previous abdominal surgery because fibrous bands of scar tissue (adhesions) may have formed and caused an Intestinal Obstruction . Although people with previously known disorders that cause vomiting (such as migraine) may simply be having a recurrence of that disorder, doctors thoroughly look for signs of a new, different problem. The need for tests depends on what doctors find during the history and physical examination, particularly whether warning signs are present and whether findings suggest a particular disorder ( see Table: Some Causes and Features of Nausea and Vomiting ). Possible tests include Pregnancy test Blood and urine tests Girls and women of childbearing age typically should have a pregnancy test. Otherwise healthy adults and older children who have only a few episodes of vomiting (with or without diarrhea) and no other symptoms typically do not require any testing. People whose vomiting is severe or has lasted more than 1 day or who have signs of dehydration need laboratory tests of blood (particularly electrolyte levels and sometimes liver tests) and urine. 