Helping a patient with nausea and vomiting

Nausea and vomiting

Nausea is an unpleasant sensation in the epigastric, retrosternal area and in the oral cavity that occurs before vomiting. Often it is accompanied by an increase in heart rate, dyspnea, tachycardia. Nausea occurs as a result of excitation of the emetic center, but its intensity is insufficient for the occurrence of vomiting. Nausea almost always precedes vomiting, but not always it ends.

Vomiting is a reflex act, during which the removal of gastric contents from the body through the mouth or nose occurs. The occurrence of vomiting is associated with the development of anti-peristaltic waves as a result of the reduction of the pyloric part of the stomach and the opening of the cardiac sphincter, simultaneously with which the abdominal and diaphragmatic muscles contract and the outflow of gastric contents out. During vomiting, vomit does not enter the respiratory tract due to the fact that the soft palate and larynx rises, and the epiglottis, on the contrary, descends, closing the lumen of the respiratory tract.

Almost always vomiting is accompanied by an increase in the frequency of respiratory movements, lacrimation, tachycardia, coughing, salivation, which is related to the close location of the emetic center with respiratory, vasomotor, cough and salivation centers.

It should be noted that in physiological terms, vomiting is considered a protective reaction of the body in response to ingestion of toxic substances into the gastrointestinal tract.

Nausea and vomiting are only a manifestation of a large number of various diseases.

The most common cause of vomiting is the pathology of the gastrointestinal tract:

• Acute abdominal pathology: appendicitis, acute cholecystitis, adhesions, gastrointestinal tumors, hernias, acute peritonitis;

• chronic diseases of the gastrointestinal tract: chronic esophagitis, gastritis, peptic ulcer, gastroesophageal reflux disease, peptic ulcer of the stomach and duodenum, obstruction of the esophagus due to a tumor of the esophagus or as a result of its compression by neoplasm in the lungs or bronchi;

• toxicinfection or acute gastritis, which occur in acute infectious diseases of the digestive system.

Often, the cause of nausea and vomiting is the accumulation in the blood of endogenous and exogenous toxic substances that have an irritant effect directly on the vomiting center. The hematogenous-toxic mechanism of the occurrence of vomiting occurs in diabetes mellitus, hepatic, renal and adrenal insufficiency, with violations of the acid-base state of the organism, with far-reaching forms of cancer, alcohol intoxication.

Another cause of nausea and vomiting is the pathology of the central nervous system. Vomiting of the central genesis can occur with hydrocephalus, tumors, hemorrhages and brain traumas, infectious diseases of the nervous system( encephalitis, meningoencephalitis), lesion of the labyrinth( acute labyrinthitis, Meniere's disease).As a rule, with diseases of the nervous system, vomiting is not preceded by nausea, and before its appearance the patient feels a headache, there is an increased sensitivity to light.

More rarely, the cause of nausea and vomiting is cardiac pathology, namely acute myocardial infarction, mainly posterior wall and transmural, as well as chronic heart failure.

It should be remembered that some medications( chlorpromazine, amitriptyline, opioids digoxin, phenytoin, carbamazepine, depaxin, metronidazole) may cause nausea and even vomiting, as well as psychogenic( negative emotions caused by an unpleasant appearance or smell of objects, fear and anxiety) or mental disorders( anorexia, bulimia).

To clarify the cause of vomiting, it is necessary to pay attention to the nature of vomit, according to which vomiting can be freshly eaten or eaten on the eve of food, bile, bloody( "coffee grounds" - altered blood under the influence of hydrochloric acid), fecal and purulent. Attention should be paid to the volume of vomit( vomiting "fountain"), whether the patient is relieved after vomiting, the time of vomiting( in the morning on an empty stomach or after eating), the frequency of vomiting( multiple resistant or single).

As mentioned above, nausea and vomiting are only manifestations of the disease, and not the disease itself, which is why the main treatment should be aimed at eliminating the disease that led to them.

In order to improve the patient's well-being, symptomatic treatment is performed.

In case of nausea, the patient is recommended to breathe slowly and deeply, which reduces the contraction of the stomach muscles. Often, several sips of non-carbonated liquid at room temperature help to reduce manifestations.

In the process of vomiting, there is a loss of fluid from the body, which can lead to hypovolemia, impaired cardiac function and kidney function, which is why it is necessary to fill the lost volume of fluid. If the patient is conscious, then give a liquid through the mouth, in small sips, 5-15 ml, every 5 minutes. If the volume of oral rehydration is insufficient, intravenous fluid is administered. The food should also be fractional, small portions( several spoons) and consist only of light meals. If the cause of vomiting is food-borne disease or intestinal infection, as well as acute oral poisoning, then it is necessary to rinse the stomach as soon as possible, best through a probe.

Drug treatment for nausea and vomiting is provided by antiemetics - blockers of dopamine receptors. These include the following drugs:

• thiethylperazine( tourekan) - the drug is prescribed 1 tablet( 6.5 mg) 1-3 times a day, or 1 suppository 2 times a day, or 1-2 ml 0.65%solution;

• cerukal( metoclopramide, raglan) - is available in tablets for oral administration at 5, 10 mg and in ampoules for intramuscular injection. Children older than 6 years are prescribed 1 / 2-1 tablet 3 times a day, adults - 1 -2 tablets 3 times daily before meals or 2 ml 0.5% solution 1-3 times a day;

• domperidone( motilium, motilac) - for children, the drug is prescribed at the rate of 0.25 mg / kg orally, children with a body weight of 20-30 kg by 1/2, tablets, children weighing more than 30 kg 1 tablet 3 times a day15-30 minutes before meals, adults but I tablet 3-4 times a day. The drug is available in tablets of 10 mg;

• ondansetron( zofran, latran) - the drug is prescribed at a rate of 0.15 mg / kg 3 times a day.