Patient history

Patient history

• medical history, earlier experience or periods with nausea and/or vomiting, (change of) medication (including medical self-care), recent chemo- or radiotherapy
• presence, duration, course, and severity of nausea
• presence, frequency, course and severity of retching and/or vomiting; amount of vomit; characteristics and odour; presence of food remnants and/or blood in vomit; relation to mealtimes and the nature of the food
• relationship between nausea and vomiting; improvement in nausea after vomiting
• triggering factors (meals, type of food, posture or movement, specific smell or environment)
• effective intake of food and fluids, changes in weight
• use of antiemetics and the effects of these medications
• concomitant complaints, such as: anorexia, difficulty swallowing or digesting, early satiety, burping, acid burn, regurgitation, abdominal pain or cramps, swollen abdomen, stomach rumbling, flatulence, constipation or diarrhoea, thirst, polyuria, pain (other than abdominal pain or headache), coughing, hiccups, dizziness, hearing impairment, neurological complaints, shortness of breath
• anxiety, stress, depression, and their effect on symptoms

The history may provide important information regarding the cause of nausea and/or vomiting:

• early satiety, small amounts of vomit with varying degrees of nausea may indicate gastroparesis
• severe vomiting with food remnants directly after meals, resulting in rapid dehydration, indicates a pyloric or duodenal obstruction
• small amounts of vomit with no signs of gastric retention are consistent with decreased gastric capacity, caused by a tumour or external compression
• vomiting combined with increased abdominal girth and shortness of breath can indicate ascites
• position-dependent nausea and/or vomiting may be caused by fluid stasis in the stomach, infiltration of the mesenterium/peritoneum, or hypersensitivity of the vestibular apparatus (with neuritis vestibularis; as a rare side effect of opioids or as a result of a tumour of the inner or middle ear)
• vomiting (in the morning), (often without nausea; sometimes explosive), combined with a headache and/or neurological defects, indicates increased intracranial pressure in the case of, for example, a brain tumour or brain metastasis, leptomeningeal metastases or stroke
• vomiting combined with thirst, polyuria, constipation, drowsiness, and/or confusion may indicate hypercalcaemia or other electrolyte disorders
• vomiting and/or vomiting related to a particular sensation or association indicate a psychogenic cause

It is recommended (as long as the nausea and/or vomiting is not under control) that the patient scores his nausea and/or vomiting 1-2 times per day, for example, with a score on a scale of 0 to 10, in which 0 indicates the absence of nausea or vomiting and 10 the constant presence of intolerable nausea or vomiting.  The Edmonton Symptom Assesment Scale (ESAS) may be used for this purpose.