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Ejection through the mouth of the contents of the gastrointestinal tract. Vomiting, with diarrhea and hemorrhage, is an important potential cause of dehydration; it may also contribute to aspiration and deplete body stores of potassium. It may result from toxins, drugs (such as those given for cancer chemotherapy), uremia, and fevers; cerebral tumors; meningitis; diseases of the stomach such as ulcer, cancer, dysmotility, or dyspepsia; hormonal changes in early pregnancy, reflux from pressure of the gravid uterus in pregnancy, uterine or ovarian disease, irritation of the fauces, intestinal parasites, biliary colic; intestinal obstruction; motion sickness; and neurological disorders such as migraine. Vomiting may also be psychogenic in origin. Esophageal vomiting may result from reflux or obstruction.
SYN: SEE: emesis SEE TABLE: Causes of Vomiting; SEE: bulimia; SEE: hyperemesis gravidarum

Antiemetic medicines may be administered orally, rectally, intramuscularly, or intravenously. Fluids may be given by mouth if the patient will accept them. If vomiting continues, and dehydration or acid-base imbalances occurs, intravenous fluids and electrolytes must be used to replace those lost in the vomit.

Causative factors such as drugs, food, diseases, and psychological factors are assessed and treated if possible. Frequency, amount, time, and characteristics of the vomit are assessed. The patient is positioned to protect the airway and prevent aspiration; in the hospital, suction equipment is provided for the patient’s safety. Food and fluids are withheld for several hours, and oral care is offered. For the pre-operative patient, restriction of foods and fluids for approx. 8 hr before surgery helps prevent postoperative vomiting. Comfort measures, e.g., a cool cloth applied to the face, are instituted. Vital signs, skin turgor, and urine output are monitored for evidence of dehydration. The health care giver promotes a calm environment and provides distraction.

Causes of Vomiting
Gastrointestinal diseasesEsophageal obstruction, gastric distention, peptic ulcer disease, gastroparesis, cholecystitis, cholelithiasis, pancreatitis, intestinal obstruction, ileus
Metabolic illnessesHyponatremia, hypokalemia, hypercalcemia, adrenal insufficiency, uremia, ketoacidosis
IntoxicationsAcetaminophen, arsenic, mercury, methanol, opiates, mescaline, food poisoning
Drug side effectsAntidepressants, digitalis, erythromycin, theophyllines, many chemotherapeutic drugs for the treatment of cancer, e.g., cisplatin
Intracranial illnessesMigraine, meningitis, intracranial hemorrhage
Febrile illnessesStrep throat (esp. in children), pyelonephritis
PregnancyHyperemesis gravidarum

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