What is nausea?
Nausea is a subjective feeling of needing to vomit. It may be combined with paleness, cold sweats, increased salivation, dizziness, and decreased appetite.
Vomiting is a protective reflex but can cause fluid and salt depletion when repeated. Elderly people, pregnant women and people with chronic illnesses may be particularly susceptible.
Nausea occurs with many stomach problems but can also come from the brain, balance organs, hormones or medications.
Common and possible causes of nausea
Stomach upset, food poisoning, functional dyspepsia, reflux and constipation are common causes. Gallstones, inflammation of the pancreas and intestinal obstruction are less common but can cause significant abdominal pain.
Pregnancy, migraines, dizziness, stress and anxiety can cause nausea without a primary stomach disorder. Medications, alcohol and anesthesia are other common triggers.
Metabolic conditions such as low blood sugar, kidney disease, or hormonal imbalances can also cause nausea. Other symptoms and test results will determine whether such causes need to be investigated.
When should you seek medical attention for nausea?
Seek emergency medical attention if you experience bloody or coffee-ground-like vomit, black stools, severe or rapidly increasing abdominal pain, severe abdominal distension, chest pain or severe shortness of breath.
Emergency assessment is also needed for severe headaches with neck stiffness, confusion, new weakness, speech impairment, or after a serious head injury.
Contact healthcare if nausea continues, if you lose weight, do not drink enough fluids, or if vomiting recurs without a clear explanation.
Seek medical attention quickly if you are unable to keep fluids down, urinate very little, become confused, or have nausea along with severe pain or neurological symptoms.
How is prolonged or recurrent nausea investigated?
The healthcare provider asks about time, meals, vomiting, bowel movements, headaches, dizziness, menstruation, possibility of pregnancy, and medications. The physical examination focuses on the abdomen, nervous system, and fluid balance.
Blood tests can assess infection, blood sugar, liver, kidneys and salts. Pregnancy tests, urine tests or stool tests may be relevant depending on the situation.
In case of upper stomach complaints, gastroscopy or testing for Helicobacter pylori may be necessary. Dizziness and neurological symptoms follow a different path of investigation.
When is ultrasound, CT or MRI used?
Ultrasound is commonly used when gallstones or disease of certain abdominal organs are suspected. CT is often used in acute abdominal pain when the bowel, pancreas, or other structures need to be assessed quickly.
Abdominal MRI can be used for specific questions about soft tissues, liver, biliary tract or other abdominal organs, but is not a general first-line examination for isolated nausea.
Imaging cannot assess all common causes. Functional dyspepsia, drug side effects, and some hormonal causes may require other tests.
What can you do while you wait for the assessment?
Drink small amounts frequently if larger glasses trigger vomiting. Fluid replacement may be appropriate for repeated vomiting or diarrhea. Monitor urine output and signs of dizziness or dehydration.
Small meals and foods that have less strong odors may be easier to tolerate. Avoid alcohol and foods that clearly worsen the symptoms.
Do not change prescribed medications on your own. Document which medications you are taking and when the nausea started to facilitate medication review.