Monthly Medical Minute: Severe nausea can mean many things

Severe nausea can indicate a variety of health issues



How a UCM emergency medical provider figured out that a patient's middle-of-the-night vomiting wasn't food poisoning.

A week ago, Denise, a UCM patient, had a big agenda with a work meeting presentation that she just could not miss. However, she had been up all night nauseous and vomiting. She chalked it up to the sushi she’d eaten the night before. "Maybe the fish was bad," she thought. However, she reasoned, "My husband ate the same sushi and he's just fine."In any case, she just felt so sick that she knew she couldn't possibly function at work — and figured after feeling this sick, it was something more than she could handle on her own in the middle of the night and she needed a medical opinion right away.

So, she opened her UCMnow app and after selecting the the 'Consult Now' button, she filled out the few short questions and she selected the option for a video consult call.Within just a few minutes, the UCM emergency medical provider called and started the face-to-face interaction with Denise, and he could plainly see that she looked as miserable as she said she felt. He inquired about her general health and she reported that she was generally healthy and did not have any surgical history.As he inquired further about Denise's symptoms, he found that Denise had actually felt nauseous intermittently daily with exposure to certain foods for about a week, and that she'd had a general lack of appetite, but had noticed about a five-pound weight loss in one week.

As they talked, she also said she had a lighter than usual menstrual cycle three weeks prior, but that she did not have abdominal pain, diarrhea, or fever/chills. Additionally, Denise said she felt lightheaded and just couldn’t even think of eating something without vomiting.The UCM emergency medical provider outlined that Denise could have anything from food poisoning to gallstones to viral gastroenteritis to hyperemesis gravidarum.

AN UNEXPECTED DIAGNOSIS

Immediately, Denise questioned him, "What in the world is hyperemesis gravidarum?" After explaining that this was a condition of excessive vomiting that occurs during pregnancy and results in weight loss and dehydration, Denise fell silent for a short time. She then asked him if he would call her back within an hour. As they ended the video chat, he could hear Denise call for her husband. And, an hour later when the UCM emergency medical call connected with Denise, both she and her husband appeared on the video chat screen. Denise immediately disclosed that she tested positive for pregnancy with a home pregnancy test. She and her husband appeared joyfully tearful.

SETTING A PLAN FOR IMMEDIATE CARE

After congratulating Denise and her husband with their unexpected news, the UCM emergency medical provider suggested that Denise follow a plan to minimize her nausea and orally re-hydrate as soon as possible. Denise wanted to be as natural and safe as possible with supplements to minimize nausea prior to seeing her OBGYN doctor, so he suggested a regimen of vitamin B-6 supplements (pyridoxine), ginger and over-the-counter options such as doxylamine (Unisom) for management. Should these not suffice for Denise and she became more consistently lightheaded, fatigued, and could not tolerate fluids at all, the UCM emergency medical provider further directed her to call back for other anti-nausea medications or possibly needing intravenous hydration and nausea control at her local emergency department.

Learn more about hyperemesis gravidarum from the Mayo Clinic.