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There are many medical conditions that can present with nausea and vomiting. I will try to explain the most important causes of persistent nausea and give you some clues on how to differentiate among these causes.

We can divide the conditions that cause persistent nausea into categories.

  • Pregnancy related: When the patient is a female in the reproductive age it is very important to rule out pregnancy as a cause. A blood pregnancy test should be ordered even if a negative urine pregnancy test was presented, these test are far not always correct. The reason it is important to rule out pregnancy first is that pregnancy is very common cause of nausea and we don't want to start treating for another condition with medication that could be harmful to the fetus.
  • Urinary tract infection: Also very common cause of nausea usually presents in association with urinary symptoms such as frequent urination and burning during urination.
  • Side effects from medication, eg chemotherapy, digoxin and theophylline.
  • Uremia: Kidney is an important organ that is responsible for removing the toxins from our blood. When both kidneys are damaged toxins build up in the bloodstream some of these toxins can cause nausea and vomiting that's why patients with renal failure often feel nauseated especially those who are on dialysis.
  • Diabetic ketoacidosis: In diabetes one's body loses some of its ability to use glucose as nutrient. There are two main types of diabetes type1 often occurs in young adults and type2 presents later in older adults. Diabetes type1 can present with nausea vomiting and abdominal pain and that's why I am going to write some details about diabetes type1 here. In type 1 diabetes, the immune system destroys pancreatic cells that produce insulin. Without insulin it is very difficult for the body to use glucose -the main source of energy. When body cannot use glucose it starts utilizing fat. Fat is a good source of energy but it is not a clean source, the break down products of fat called ketones and these toxic products can build up in the blood stream causing nausea and vomiting. Diabetes usually presents with a group of symptoms including frequent urination, increased thirst, hunger and weight loss. Diabetes should be treated as early as possible to reduce its complications.
  • Cyclic vomiting syndrome: this condition presents with episodes of severe vomiting that occur without known cause. Episodes are followed by symptom free periods. This episodes are very similar to each other, they start at the same time of day, and usually last the same duration and are accompanied by the same symptoms and have almost the same level of intensity. Some studies suggested that cyclic vomiting syndrome can present in association with migraines. This syndrome is treated with anti-nausea and migraine medication and by preventing what triggers vomiting episodes.

Other causes of recurrent nausea include:

  • Menieres disease and Vestibular labyrinthitis
  • Raised intracranial pressure
  • Psychiatric illness
  • Alcohol
  • Hepatitis
  • Hypercalcaemia

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