Causes and Treatment of Nausea and vomiting

Nausea and vomiting of pregnancy

Nausea and vomiting

Nausea and vomiting have many causes, including local irritation of the gastric mucosa, alterations of gastric motility, and stimulation of the brain by several mechanisms. Several neurotransmitters (chemical substances used to transfer stimulations along the nerve network) are involved in producing emesis, including acetylcholine, dopamine, and serotonin (5-hydroxytryptamine). The common causes of nausea and vomiting that are self-diagnosed and self-treated are motion sickness and local irritation from food and drink. Vomiting causes both fluid and electrolyte loss; if it persists for more than 24 to 48 hours, an individual should consult a physician.

Antiemetic for motion sickness

Drug category and indications for use

Antiemetics are drugs that prevent or treat nausea, vomiting and/or dizziness associated with motion sickness. Motion sickness involves stimulation of nerves of the vestibular apparatus (semicircular canals of the inner ear), which are responsible for maintaining balance and equilibrium. Signals from the vestibular nerves stimulate cholinergic centers in the vomiting center of the medulla of the brain and this activates cranial nerves and causes muscles in the GI tract to expel gastric content. Vertigo causes some symptoms that are similar to motion sickness, but there are other causes of vertigo that require diagnosis by a physician. Only motion sickness is a self treatable condition.

causes of nausea, vomiting and motion sickness 

Causes of motion sickness
Motion sickness is usually precipitated by riding in any type of motor vehicle, train, boat, or airplane. Amusements rides, especially those with circular motion, are likely to cause motion sickness.That type of motion causes the release of different substances like histamine and neurotransmitters. All of the OTC antiemetics are antihistamines that have anticholinergic activity (acts on the parasympathetic system which controls the body involuntary actions). These drugs block the action of acetylcholine both centrally in the brain and peripherally in the parasympathetic nervous system.

Monograph ingredients
OTC antiemetics include Cyclizine, Dimenhydrinate, Diphenhydramine, and Meclizine(used for treatment of nausea and vomiting of pregnancy)..

Warnings and precautions
These antiemetics may cause drowsiness and should not be used with alcohol, sedatives, or tranquilizers. Caution is required if driving a motor vehicle or operating machinery when using these drugs. The degree of drowsiness depends on the specific chemical structure of the drug, dimenhydrinate and diphenhydramine causing the greatest degree of drowsiness. Meclizine causes the least drowsiness and some of its products contain the words ‘less drowsy’ in their names.
These drugs should not be taken unless directed by a physician by anyone who has breathing problems (such as shortness of breath, emphysema or chronic bronchitis), glaucoma, or difficulty in urination owing to enlargement of the prostate gland.

N.B. antiemetics should be taken 30 to 60 minutes before engaging in the activity that causes motion sickness. 

Alternative therapy: Ginger

Ginger

Ginger is a dietary supplement that is a GRAS drug and used to treat nausea and vomiting; it may have some effect in preventing motion sickness. Ginger has demonstrated effectiveness for nausea and vomiting associated with pregnancy, but no medications should be recommended for pregnant women without the approval of their physician.

Mode of action
Ginger inhibits serotonin (a neurotransmitter) receptors in the GI tract and the brain and may prevent both local and central stimulation of nerves that cause vomiting.
Warnings and precautions
Ginger may cause heartburn, diarrhea, or irritation of the oral mucosa (G.I.T tract lining layer of cells). It may increase the risk of bleeding if an individual is taking warfarin (anti-coagulant).
Recommended dose
Powered ginger 250–1000 mg up to four times a day.

Phosphorylated carbohydrates
Drug category and indications for use
Concentrated carbohydrates may relieve nausea associated with upset stomach or intestinal flu.
Mode of action
Phosphorylated carbohydrates are theorized to alter gastric emptying to provide relief but the actual mode of action is unknown. A common home remedy for nausea is the use of concentrated coke syrup and its use is based on this same theory.
Warnings and precautions
Phosphorylated carbohydrate products contain 1.87 g glucose and fructose (levulose) and 21.5mg phosphoric acid per 5 mL. Individuals who have diabetes should not use these products without consulting their physicians; individuals who have fructose intolerance should not use these products.
Recommended dose
Children 2 to 12 years of age may take 5 to 10mL every 15 minutes until symptoms subside, but should not take more than five doses in an hour; adults and children over 12 years of age may take 15 to 30mL every 15 minutes until symptoms subside, but also should not take more than five doses in an hour. Phosphorylated carbohydrates should not be diluted with liquids before ingestion.

Devices for preventing or treating nausea
Mechanical devices
Activation of certain pressure points in the body based on Chinese acupuncture and acupressure, P6 or nei-kuan have demonstrated the ability to suppress nausea. The FDA approved two types of device for motion sickness and for nausea associated with pregnancy (morning sickness).
Mode of action
Adjustable wrist bands containing a bead are placed on the underside of both wrists to create acupressure by the bead. The amount of pressure is adjustable and the bands should be used approximately 5 minutes before travel or motion begins.
Products
Sea-Band and Psi Band. These devices cost less than $10.00.

Electronic devices
Mode of action
A battery-powered wrist band provides an electronic pulse to the underside of the wrist to prevent nausea. A conductivity gel must be applied to the wrist before wearing the device. The device is adjusted so that a pulse or tingling feeling is felt in the palm of the hand or in the middle fingers.
Warnings and precautions
The device should not be used if the individual has a cardiac pacemaker. The device also contains latex and should not be used by anyone having a latex allergy. Mild skin irritation may occur. If the irritation is not relieved in 24 hours, a physician or pharmacist should be consulted. The device is not waterproof and should not be submerged in water.