Key messages

• Many different pathological and pharmacological stimuli cause vomiting.

• Identification of the central neurotransmitters involved in vomiting has provided the basis for current antiemetic treatment.

• Pulmonary aspiration is the major complication of vomiting in patients with impaired consciousness or bulbar dysfunction.

• Antiemetics are used to relieve distress and minimize loss of fluid and electrolytes.

• The 5-hydroxytryptamine3 receptor antagonists are the most effective antiemetics for most causes of vomiting, but are expensive. Introduction

Nausea and vomiting are common but debilitating symptoms of illness affecting not only the gastrointestinal tract but also other organs ( Table.1). The diversity of associations suggests that a variety of stimuli may trigger a final pathway leading to the conscious appreciation of nausea and the active process of retching and vomiting. Vomiting must be distinguished from the passive process of reflux of gastric contents. Passive reflux of gastric contents occurs in patients with a hiatus hernia or an incompetent lower esophageal sphincter if abdominal pressure exceeds pharyngeal pressure. Maintaining a head-up posture usually eliminates reflux of gastric contents into the mouth and pharynx.

Table 1 Conditions associated with nausea and vomiting

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