76 American Family Physician
www.aafp.org/afp
Volume 76, Number 1 ◆ July 1, 2007
Evaluation of Nausea and Vomiting
KEITH SCORZA, MD, AARON WILLIAMS, DO, J. DANIEL PHILLIPS, MD, and JOEL SHAW, MD
Dewitt Army Community Hospital Family Medicine Residency, Fort Belvoir, Virginia
N
ausea is the unpleasant, painless
sensation that one may poten-
tially vomit. Vomiting is an
organized, autonomic response
that ultimately results in the forceful expul-
sion of gastric contents through the mouth.
Vomiting is intended to protect a person
from harmful ingested substances. However,
chronic nausea and vomiting are typically
a pathologic response to any of a variety of
conditions.1
Nausea and vomiting significantly affect
quality of life. In a study of 17 gastroin-
testinal conditions in the United States, it
was estimated that the cost of acute gas-
trointestinal infections exceeds $3.4 billion
annually.2,3 When other causes of nausea
and vomiting are taken into account, the
associated medical costs and loss of worker
productivity are considerable.
This article reviews common and signifi-
cant causes of nausea and vomiting, offers
an approach to evaluation, and provides a
brief overview of treatment options.
Causes
The etiologies of nausea and vomiting include
iatrogenic, toxic, or infectious causes; gas-
trointestinal disorders; and central nervous
system or psychiatric conditions. A differ-
ential diagnosis for nausea and vomiting is
provided in Table 1,2,4-10 and each category is
discussed in the following.
iatrogeniC, toxiC, and infeCtious
Almost any medication can cause nausea and
vomiting. Chemotherapeutic agents are the
most well-known; however, many commonly
prescribed medications can cause these symp-
toms. Medications typically cause nausea and
vomiting early in their course, although the
onset of symptoms may be insidious. Over-
doses of alcohol, illicit substances, and other
toxins may also cause acute symptoms.6,7,9
Infectious etiologies typically result in an
acute onset of sympt