O Nausea and vomiting are symptoms that can be due to a number of different causes. Various disorders of the GI, cardiac, neurologic, and endocrine systems can lead to nausea and vomiting (Table 20-1).1-4 Cancer chemotherapy agents are rated according to their emetogenic potential, and anti-emetic therapy is prescribed based on these ratings. Due to potentially severe nausea and vomiting, some patients are unable to complete their chemotherapy treatment regimen. Radiation therapy can induce nausea and vomiting, especially when it is used to treat abdominal malignancies.5
Oral contraceptives, hormone therapy, oral hypoglycemic agents, anticonvulsants, and opioids are other common therapies that can cause nausea and vomiting.1,6 Some medications, such as digoxin and theophylline, cause nausea and vomiting in a dose-related fashion. Nausea and vomiting may indicate higher-than-desired drug concentrations. Ethanol and other toxins also cause nausea and vomiting.
Table 20-1 Causes of Nausea and Vomiting
OthtrCauifi Therapy Induced Endocrine/Metabolic^
OtetaKting disorder? Pytofic; obstruction Soul bowl Otnlrui riyn Cokinic cfcAucfofl Achalasia
SutitTkn wstniei k; JI tiry iynyVome Emmie infeclkmi Inflammatory hon^l diseases Parcimtitis Aj^xsndiriiis Cholec^ltti
disease CdidbmytifviUiiv Myxdrdial mf.KCttm
hemorrhage MertngMi MydiOCfptiaki', Psychogenic
Bulnfai ind anofexta iWivOsJ tycl* vomiting syndrome tjnceccheiTKirieTifiy ATlibtohci
CJ<iJiii imijnhylhmiiv Dtgosin
Oil hypoglycemics i>il COrtf WfpiLu«
Wnsgrkjixy (morning sickness and hypeifiinesiS qrividaikiiKO Renal (feease (uiemiai Jipwafkicrii^l nevoid and parathyroid disease Aiiieiwi insufficiency Electrolyte ■tk normalities d-iyponstremfa, hypercalcemia
Postoperative nausea and vomiting (PONV) occurs in 30% of surgical patients
overall and in up to 70% of high-risk patients. This can be due to severing or disturbing the vagus nerve leading to gastric motility abnormalities. Additional risk factors for PONV include female gender, history of motion sickness or PONV, nonsmoking status, and use of opioids in the postoperative period.9_11 The choice of anesthetic agents and the duration of surgery may also contribute to PONV.7,9,11
Pregnancy-associated nausea and vomiting is common, affecting 70% to 85% of pregnant women, especially early in pregnancy.12 Approximately one-half of pregnant women experience nausea and vomiting of pregnancy (NVP), one-quarter experience nausea alone, and one-quarter are not affected.12 In 0.5% to 2% of pregnancies, this can lead to hyperemesis gravidarum, a potentially life-threatening condition of prolonged nausea, vomiting, and consequently, malnutrition.12
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