Nausea and vomiting

Nausea is having a sick or queasy feeling in the stomach, and vomiting is throwing up food or liquids from the stomach. Nausea can occur even when a person is not thinking about food. A person can vomit even if they have not eaten anything and haven’t had any nausea. Nausea or vomiting can be caused by eating something that disagrees with you, bacteria in food, infections, or by radiation or chemo treatments for cancer. Many people have little or no nausea and vomiting with these treatments. For others, just thinking about going for one of the treatments can cause nausea or vomiting. Cancer by itself may cause nausea and vomiting.

Frequent vomiting can be dangerous because it can lead to dehydration. (See the section called "Fluids and dehydration.") It can also cause choking or inhaling food or liquids. Talk with your doctor about what is causing your nausea and vomiting and what you can do about it.

What to look for

• Changes in eating habits
• Foul mouth odor
• Yellow or green foul-smelling fluids on bedclothes
• Feeling queasy or having an upset stomach
• Increased saliva, clamminess, and sweating that may come before vomiting

What the patient can do

For nausea:

• Eat bland foods, such as dry toast and crackers.
• If the nausea only happens between meals, eat frequent, small meals and have a snack at bedtime.
• Drink clear liquids served cold and sipped slowly. (Clear liquids are those that you can see through, such as ginger ale, apple juice, broth, tea, etc.) Also try Popsicles or gelatin.
• Seek out the foods you like. Many people develop a dislike for red meat and meat broths during treatment. Try other protein sources, such as fish, chicken, beans, and nuts.
• Suck on hard candy with pleasant smells, such as lemon drops or mints, to help get rid of bad tastes.
• Eat food cold or at room temperature to decrease its smell and taste. Avoid fatty, fried, spicy, or very sweet foods.
• Try small amounts of foods high in calories that are easy to eat (such as pudding, ice cream, sherbets, yogurt, and milkshakes) several times a day. Use butter, oils, syrups, sauces, and milk in foods to raise calories. Avoid low-fat foods unless fats upset your stomach or cause other problems.
• Tart or sour foods may be easier to keep down (unless you have mouth sores).
• Try to rest quietly while sitting upright for at least an hour after each meal.
• Distract yourself with soft music, a favorite television program, or the company of others.
• If you have nausea, relax and take slow, deep breaths.
• Tell your doctor about the nausea because there are several drugs that can help it.
• Take your anti-nausea medicine at the first signs of nausea to help prevent vomiting.
• If nausea occurs just before chemo or doctor visits, ask about medicines, hypnosis, relaxation, or behavioral treatment to lessen this problem.

For vomiting:

• If you are in bed, lie on your side so that you will not inhale the vomit.
• Request that medicines be prescribed in suppository form, if possible. Take medicine at the first hint of nausea to prevent vomiting.
• Try liquids in the form of ice chips or frozen juice chips, which can be taken slowly.
• After vomiting stops, begin by taking in 1 teaspoon of cool liquid every 10 minutes. Gradually increase to 1 tablespoon every half hour. If you are able to keep that down after an hour or so, try larger amounts.

What caregivers can do

• When the patient feels nauseated, offer to make meals or ask others to make meals to reduce bothersome food odors. Use kitchen vent fans to reduce smells.
• Cover or remove foods with strong or unpleasant smells.
• Try plastic forks and spoons rather than metal ones, which may cause a bitter taste.
• If the patient starts vomiting, weigh them at the same time each day to help decide whether dehydration is getting severe.
• Talk to the doctor about medicines to help prevent vomiting.
• Watch the patient for dizziness, weakness, or confusion.
• Try to help the patient avoid constipation and dehydration. Either of these can make nausea worse.

Call the doctor if the patient:

• May have inhaled some of the vomited material
• Vomits more than 3 times an hour for 3 or more hours
• Vomits blood or material that looks like coffee grounds
• Cannot take in more than 4 cups of liquid or ice chips in a day or cannot eat substantial foods for more than 2 days
• Cannot take their medicines
• Becomes weak, dizzy, or confused
• Loses 2 or more pounds in 1 to 2 days (This means they are losing too much water.)
• Develops dark yellow urine and doesn’t have to urinate as often as usual