Vomiting

 

Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Undesired vomiting may result from many causes, ranging from gastritis or poisoning to brain tumors, or elevated intracranial pressure. The feeling that one is about to vomit is called nausea. It usually precedes, but does not always lead to vomiting. Antiemetics are sometimes necessary to suppress nausea and vomiting, and, in severe cases where dehydration develops, intravenous fluid may need to be administered to replace fluid volume.  Vomiting is different from regurgitation, although the two terms are often used interchangeably. Regurgitation is the return of undigested food (that has not yet reached the stomach) back up the esophagus to the mouth. The causes of vomiting and regurgitation are generally different.

Gastric secretions and likewise vomit are highly acidic. Recent food intake will be reflected in the gastric vomit. Irrespective of the content, vomit tends to be malodorous.

If the vomiting reflex continues for an extended period with no appreciable vomitus, the condition is known as non-productive emesis or dry heaves, which can be painful and debilitating.

 

 

Causes

Vomiting may be due to a large number of causes, and protracted vomiting has a long differential diagnosis.

 

Digestive tract

Causes in the digestive tract

• Gastritis (inflammation of the gastric wall, usually by viruses)
• Pyloric stenosis (in babies, this typically causes a very forceful "projectile vomiting" and is an indication for urgent surgery)
• Bowel obstruction
• Acute abdomen and/or peritonitis
• Ileus
• Cholecystitis, pancreatitis, appendicitis, hepatitis
• Food allergies
• In children, it can be caused by an allergic reaction to cow's milk proteins (milk allergy)

 

Sensory system and brain

Causes in the sensory system

• Movement: motion sickness (which is caused by overstimulation of the labyrinthine canals of the ear)
• Ménière's disease

Causes in the brain

• Concussion
• Cerebral hemorrhage
• Migraine
• Brain tumors, which can cause the chemoreceptors to malfunction
• Benign intracranial hypertension and hydrocephalus

Metabolic disturbances (these may irritate both the stomach and the parts of the brain that coordinate vomiting)

• Hypercalcemia (high calcium levels)
• Uremia (urea accumulation, usually due to renal failure)
• Adrenal insufficiency
• Hypoglycemia

Pregnancy

• Hyperemesis, Morning sickness

Drug reaction (vomiting may occur as an acute somatic response to)

• alcohol (being sick while being drunk or being sick the next morning, suffering from the after-effects, i.e., the hangover).
• opioids
• selective serotonin reuptake inhibitors
• many chemotherapy drugs
• some entheogens (such as peyote or ayahuasca)

Illness

• Norwalk virus

Other

• Self-induced
  • Eating disorders (anorexia nervosa or bulimia nervosa)
  • To remove a poison in case such has been ingested (some poisons should not be vomited as they may be more toxic when inhaled or aspirated; it is, in general, considered better to ask for help before inducing vomiting)
  • Some people who are engaged in binge drinking will induce vomiting in order to make room in their stomachs for further alcohol consumption. In the United Kingdom, this practice is known as tactical chundering, or hitting the reset button. In the United States, it is known as boot and rally or pulling the trigger.
• After surgery (postoperative nausea and vomiting)
• Disagreeable sights, smells or thoughts (such as decayed matter, others' vomit, thinking of vomiting), etc.
• Extreme pain, such as intense headache or myocardial infarction (heart attack)
• Violent emotions
• Cyclic vomiting syndrome (a poorly-understood condition with attacks of vomiting)
• High doses of ionizing radiation will sometimes trigger a vomit reflex in the victim
• Violent fits of coughing, hiccups, or asthma
• Nervousness
• Performing physical activity (such as swimming) short time after a meal.

 

 

Related medication

 

Emetics

An emetic, such as syrup of ipecac, is a substance that induces vomiting when administered orally or by injection. An emetic is used medically where a substance has been ingested and must be expelled from the body immediately. Inducing vomiting can remove the substance before it is absorbed into the body. Ipecac abuse can lead to detrimental health effects.

Antiemetics

An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side-effects of some opioid analgesics and chemotherapy directed against cancer.Antiemetics act by inhibiting the receptor sites associated with emesis. Hence, anticholinergics, antihistamines, dopamine antagonists, serotonin antagonists, and cannabinoids are used as anti-emetics.

 

 

 

 

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Strychnos Nux-Vomica (Maqianzi, Poison Nut) [1, 26, 27, 28]:

WARNING! This substance is HIGHLY POISONOUS. The seeds contain Strychnine, which may cause convulsions, breathing difficulties and death, even if as little as 5 milligrams is ingested

Recommendation: Strongly against (There is no evidence in the form of clinical trials which reports the effectiveness of Strychnos Nux-Vomica, because it is highly poisonous to humans, and is not recommended.)

Grade of Evidence: very low quality of evidence

Mugwort (Artemisa Vulgaris) [1, 23, 24, 25]:

Please note, this management does NOT treat the condition itself. It has been proposed only as a weak supportive symptomatic support, and even then, has been discounted due life-threatening side effects

Recommendation: No recommendation (There is insufficient evidence to support claims that mugwart helps to treat vomiting. More research is needed.)

Grade of Evidence: very low quality of evidence

Cannabis (Marijuana, weed, hemp) [1, 14, 15, 16, 17, 18, 19, 20, 21, 22]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly in favor (Evidence shows that smoking or ingesting cannabis may help in relieving symptoms of vomiting, although some studies have yielded mixed results)

Grade of Evidence: low quality of evidence

Green Tea [1, 9, 10, 11, 12, 13]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly in favor (There is insufficient evidence to support claims that Green Tea helps to treat vomiting in any way. Although reports are positive, more studies are needed.)

Grade of Evidence: low quality of evidence

Ginger  [1, 6, 7, 8]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (Research regarding claims that ginger helps treat vomiting has yielded mixed results)

Grade of Evidence: low quality of evidence

Cloves (Caryophyllum Aromaticum, Eugenia Caryophyllata) [1, 2, 3, 4, 5]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation  (There is insufficient evidence to support claims that Cloves help to treat vomiting in any way)

Grade of Evidence: very low quality of evidence

Reiki:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (Research shows that at least some patients have reduced nausea after treatment with Reiki, although results were ambiguous)

Grade of Evidence: very low quality of evidence

Acupuncture:

Recommendation: weakly in favor(recent early evidence shows that Acupuncture may at least mildy help reduce symptoms of nausea)

Grade of Evidence: low quality of evidence

Hypnosis:

Recommendation: strongly in favor  (Research has shown that hypnosis helps reduce anticipatory nausea)

Grade of Evidence: low quality of evidence

Image Therapy:

Recommendation: strongly in favor (Research has shown that image therapy helps reduce anticipatory nausea)

Grade of Evidence: low quality of evidence

Music Therapy:

Recommendation: strongly in favor (Research has shown that music therapy does indeed help reduce symptoms of nausea)

Grade of Evidence: moderate quality of evidence

* www.gradeworkinggroup.org

 

 

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. Balch, Phyllis and Balch, James. Prescription for Nutritional Healing, 3rd ed., Avery Publishing, ©2000, pg. 94.

3. Chinese Herbal Medicine: Materia Medica, Third Edition by Dan Bensky, Steven Clavey, Erich Stoger, and Andrew Gamble 2004

4. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/cloves

5. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-clove.html

6. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/ginger

7. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginger.html

8. http://www.ncbi.nlm.nih.gov/pubmed/10793599

9. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/green-tea

10. http://www.ncbi.nlm.nih.gov/pubmed/16968850

11. http://www.denverpost.com/nationworld/ci_4326770

12. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-green_tea.html

13. http://nccam.nih.gov/health/greentea/index.htm

14. http://www.nlm.nih.gov/medlineplus/marijuana.html

15. http://nccam.nih.gov/research/extramural/awards/2004/

16. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/marijuana

17. http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/treatments/complementary--alternative-medicine/marijuana/index.aspx

18. http://www.ncbi.nlm.nih.gov/pubmed/16957511

19. http://www.ncbi.nlm.nih.gov/pubmed/12965981

20. http://www.ncbi.nlm.nih.gov/pubmed/17589370

21. http://mct.aacrjournals.org/content/6/11/2921.long

22. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2562334/?tool=pmcentrez 

23. Anliker MD, Borelli S, Wüthrich B. Occupational protein contact dermatitis from spices in a butcher: a new presentation of the mugwort-spice syndrome. Contact Dermatitis. 2002;46:72-74.

24. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/mugwort

25. Fetrow CW, Avila JR. Professional's Handbook of Complementary & Alternative Medicines. Philadelphia, PA: Lippincott Williams & Wilkins; 2004.

26. David Michael Wood et al. Case report: Survival after deliberate strychnine self-poisoning, with toxicokinetic data. Critical Care October 2002 Vol 6 No 5

27. Arnold, M.D., Harry L. (1968). Poisonous Plants of Hawaii. Tokyo, Japan: Charles E. Tuttle Co.. p. 20. ISBN 0804804745.

28. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/strychnos-nux-vomica













 

 

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