The aim of managing vomiting, especially if it is recurrent, prolonged or excessive involves:
- Identifying the cause of recurrent or repeated vomiting. Once identified, the cause of vomiting needs to be addressed. For example, gastric obstruction needs to be carefully ruled out and acute gastroenteritis needs to be treated using antibiotics.
- Vomiting should be reduced or resolved using antiemetic medications.
- Dehydration and electrolyte loss should be prevented and replenished as soon as possible. This may be achieved using oral rehydration therapy as prescribed by the World Health Organization.
- Nausea can be resolved using home remedies as well as antiemetic medications
- Appetite should be restored and food intake should be started as soon as possible
Treatment of vomiting involves:
- Ingestion of ice cold water or crushed ice may help ease vomiting and nausea, especially when the nausea and vomiting is caused by motion sickness.
- Even though vomiting and nausea are associated with loss of appetite, the consumption of small amounts of solid foods may help alleviate nausea to a certain extent. However, such foods should be low in sugar and fats. Sugary foods may exacerbate nausea and fatty foods can lead to feeling overfull and a delayed emptying of the stomach that increases discomfort.
- Home remedies for nausea and vomiting include spices, ginger, citrus fruits and peppermint. These have been shown in studies to be very useful in alleviating nausea.
- Bismuth is used as an over the counter remedy to ease nausea and vomiting.
- Medications that help relieve nausea and vomiting include antiemetics such as:
- Prokinetic agents that hasten the emptying of the gut and relieve nausea, vomiting and uncomfortable fullness of the stomach. Examples include metoclopramide and domperidone.
- Anticholinergic agents such as hyoscinecan but prokinetic and anticholinergic drugs should not be used in combination.
- Sometimes, a combination of more than one antiemetic drug class is necessary.
- Patients who are unable to keep down oral medications, may be given a subcutaneous injection of the antiemetic.
- Vomiting due to motion sickness may benefit from H1 antihistaminic agents such as promethazine, prochlorperazine, cyclizone and meclizine.
- Severe nausea and vomiting caused by chemotherapy or anaesthetic agents after surgery may be relieved with ondansetron, promethazine, dimenhydrinate, dexamethasone or droperidol.
- Pregnancy induced nausea and vomiting can be treated with doxylamine
- Mirtazapine is an antidepressant that also happens to help ease nausea and vomiting.
- Benzodiazepines such as lorazepam or oxazepam may help to relieve vomiting related to anxiety.