Some Causes of Nausea and Vomiting
Cause | Suggestive Findings* | Diagnostic Approach |
|---|---|---|
Gastrointestinal disorders | ||
Abdominal distention Increased risk after surgery or with severe illness or an electrolyte abnormality | Clinical evaluation Radiograph or CT | |
Obstipation, distention, tympany Often bilious vomiting, abdominal surgical scars, or hernia | Flat and upright abdominal radiographs | |
Vomiting, diarrhea Benign abdominal examination | Clinical evaluation | |
Gastroparesis | Vomiting of partially digested food a few hours after ingestion Often in diabetics with elevated blood glucose or after abdominal surgery | Flat and upright abdominal radiographs Sometimes gastric emptying scan |
Mild to moderate nausea for many days, sometimes vomiting Jaundice, anorexia, malaise Sometimes slight tenderness over the liver | Serum aminotransferases, bilirubin, viral hepatitis titers | |
Perforated viscus or other acute abdomen (eg, appendicitis, cholecystitis, pancreatitis) | Significant abdominal pain Usually peritoneal signs | |
Toxic ingestion (numerous) | Usually apparent based on history | Varies with substance |
Central nervous system (CNS) disorders | ||
Brain tumor | Dizziness and/or headache Sometimes mental status change and/or focal neurologic deficits | Head CT or MRI |
Cannabis use (cannabinoid hyperemesis syndrome) | Persistent nausea, vomiting, and dyspepsia Usually requires chronic use of cannabis Relief with hot bath or marijuana cessation | Clinical evaluation Urine drug screen |
Apparent based on history | Head CT | |
CNS hemorrhage | Sudden-onset headache, mental status change Often meningeal signs | Head CT Lumbar puncture if CT is normal |
CNS infection | Gradual-onset headache Often meningeal signs, mental status change Sometimes petechial rash* due to meningococcemia | Head CT Lumbar puncture |
Increased intracranial pressure (eg, caused by hematoma or mass) | Headache, mental status change Sometimes focal neurologic deficits | Head CT |
Vertigo, nystagmus, symptoms worsened by motion Sometimes tinnitus | ||
Headache sometimes preceded or accompanied by a neurologic aura or photophobia Often a history of recurrent similar attacks In patients with known migraine, possible development of other CNS disorders | Clinical evaluation Head CT and lumbar puncture considered if evaluation is unclear | |
Apparent based on history | Clinical evaluation | |
Psychogenic disorders (eg, anorexia nervosa, bulimia nervosa) | Occurring with stress Eating food is considered repulsive | Clinical evaluation |
Systemic conditions | ||
Advanced cancer (independent of chemotherapy or bowel obstruction) | Apparent based on history | Clinical evaluation |
Polyuria, polydipsia Often significant dehydration With or without history of diabetes | Serum glucose, electrolytes, ketones | |
Medication or illicit drug adverse effect or toxicity | Apparent based on history | Varies with substance |
Liver failure or renal failure | Often apparent based on history Asterixis Often jaundice in advanced liver disease, uremic odor in renal failure | Laboratory tests of liver and renal function Blood ammonia level |
Pregnancy | Often occurring in morning or triggered by food Benign examination (possibly dehydration) | Pregnancy test |
Apparent based on history | Clinical evaluation | |
Severe pain (eg, due to a kidney stone) | Varies with cause | Clinical evaluation |
* Sometimes forceful vomiting (caused by any disorder or condition) causes petechiae on the upper torso and face, which may resemble those of meningococcemia. Patients with meningococcemia are usually very ill, whereas those with petechiae caused by vomiting often appear otherwise quite well. | ||