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Vomiting, also known as emesis and throwing up, among other terms, is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose.^[1]

Vomiting can be caused by a wide variety of conditions; it may present as a specific response to ailments like gastritis or poisoning, or as a non-specific sequela of disorders ranging from brain tumors and elevated intracranial pressure to overexposure to ionizing radiation. The feeling that one is about to vomit is called nausea, which often precedes, but does not always lead to, vomiting. Antiemetics are sometimes necessary to suppress nausea and vomiting. In severe cases, where dehydration develops, intravenous fluid may be required.

Vomiting is different from regurgitation, although the two terms are often used interchangeably. Regurgitation is the return of undigested food back up the esophagus to the mouth, without the force and displeasure associated with vomiting. The causes of vomiting and regurgitation are generally different.

1 Complications
- 1.1 Aspiration of vomit
- 1.2 Dehydration and electrolyte imbalance
- 1.3 Mallory–Weiss tear
- 1.4 Dentistry
2 Pathophysiology
- 2.1 Phases
- 2.2 Contents
3 Differential diagnosis
- 3.1 Digestive tract
- 3.2 Sensory system and brain
- 3.3 Emetics
- 3.4 Social cues
- 3.5 Miscellanea
- 3.6 Other types
4 Treatment
5 Epidemiology
6 See also
7 References
8 External links

Complications

Aspiration of vomit

Vomiting can be dangerous if the gastric content enters the respiratory tract. Under normal circumstances the gag reflex and coughing prevent this from occurring; however, these protective reflexes are compromised in persons under the influences of certain substances such as alcohol or anesthesia. The individual may choke and asphyxiate or suffer an aspiration pneumonia.^{[citation needed]}

Dehydration and electrolyte imbalance

Prolonged and excessive vomiting depletes the body of water (dehydration), and may alter the electrolyte status. Gastric vomiting leads to the loss of acid (protons) and chloride directly. Combined with the resulting alkaline tide, this leads to hypochloremic metabolic alkalosis (low chloride levels together with high HCO−
3 and CO
2 and increased blood pH) and often hypokalemia (potassium depletion). The hypokalemia is an indirect result of the kidney compensating for the loss of acid. With the loss of intake of food the individual may eventually become cachectic. A less frequent occurrence results from a vomiting of intestinal contents, including bile acids and HCO−
3, which can cause metabolic acidosis.^{[citation needed]}

Mallory–Weiss tear

Repeated or profuse vomiting may cause erosions to the esophagus or small tears in the esophageal mucosa (Mallory–Weiss tear). This may become apparent if fresh red blood is mixed with vomit after several episodes.^{[citation needed]}

Dentistry

Recurrent vomiting, such as observed in bulimia nervosa, may lead to destruction of the tooth enamel due to the acidity of the vomit. Digestive enzymes can also have a negative effect on oral health, by degrading the tissue of the gums.^{[citation needed]}

Pathophysiology

14th-century illustration of vomiting from the Casanatense Tacuinum Sanitatis

Receptors on the floor of the fourth ventricle of the brain represent a chemoreceptor trigger zone, known as the area postrema, stimulation of which can lead to vomiting. The area postrema is a circumventricular organ and as such lies outside the blood–brain barrier; it can therefore be stimulated by blood-borne drugs that can stimulate vomiting or inhibit it.^[2]

There are various sources of input to the vomiting center:

The chemoreceptor trigger zone at the base of the fourth ventricle has numerous dopamine D₂ receptors, serotonin 5-HT₃ receptors, opioid receptors, acetylcholine receptors, and receptors for substance P. Stimulation of different receptors are involved in different pathways leading to emesis, in the final common pathway substance P appears involved.^[3]^[4]
The vestibular system, which sends information to the brain via cranial nerve VIII (vestibulocochlear nerve), plays a major role in motion sickness, and is rich in muscarinic receptors and histamine H₁ receptors.^[5]^[6]
The cranial nerve X (vagus nerve) is activated when the pharynx is irritated, leading to a gag reflex.
The vagal and enteric nervous system inputs transmit information regarding the state of the gastrointestinal system. Irritation of the GI mucosa by chemotherapy, radiation, distention, or acute infectious gastroenteritis activates the 5-HT₃ receptors of these inputs.
The CNS mediates vomiting that arises from psychiatric disorders and stress from higher brain centers.^[7]

The vomiting act encompasses three types of outputs initiated by the chemoreceptor trigger zone: Motor, parasympathetic nervous system (PNS), and sympathetic nervous system (SNS). They are as follows:^{[citation needed]}

Increased salivation to protect tooth enamel from stomach acids. (Excessive vomiting leads to dental erosion). This is part of the PNS output.
The body takes a deep breath to avoid aspirating vomit.
Retroperistalsis starts from the middle of the small intestine and sweeps up digestive tract contents into the stomach, through the relaxed pyloric sphincter.
Intrathoracic pressure lowers (by inspiration against a closed glottis), coupled with an increase in abdominal pressure as the abdominal muscles contract, propels stomach contents into the esophagus as the lower esophageal sphincter relaxes. The stomach itself does not contract in the process of vomiting except for at the angular notch, nor is there any retroperistalsis in the esophagus.
Vomiting is ordinarily preceded by retching.
Vomiting also initiates an SNS response causing both sweating and increased heart rate.

The neurotransmitters that regulate vomiting are poorly understood, but inhibitors of dopamine, histamine, and serotonin are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. Vasopressin and neurokinin may also participate.^{[citation needed]}

Phases

The vomiting act has two phases. In the retching phase, the abdominal muscles undergo a few rounds of coordinated contractions together with the diaphragm and the muscles used in respiratory inspiration. For this reason, an individual may confuse this phase with an episode of violent hiccups. In this retching phase nothing has yet been expelled. In the next phase, also termed the expulsive phase, intense pressure is formed in the stomach brought about by enormous shifts in both the diaphragm and the abdomen. These shifts are, in essence, vigorous contractions of these muscles that last for extended periods of time - much longer than a normal period of muscular contraction. The pressure is then suddenly released when the upper esophageal sphincter relaxes resulting in the expulsion of gastric contents. Individuals who do not regularly exercise their abdominal muscles may experience pain in those muscles for a few days. The relief of pressure and the release of endorphins into the bloodstream after the expulsion causes the vomiter to feel better.^{[citation needed]}

The content of the vomitus (vomit) may be of medical interest. Fresh blood in the vomit is termed hematemesis ("blood vomiting"). Altered blood bears resemblance to coffee grounds (as the iron in the blood is oxidized) and, when this matter is identified, the term coffee-ground vomiting is used. Bile can enter the vomit during subsequent heaves due to duodenal contraction if the vomiting is severe. Fecal vomiting is often a consequence of intestinal obstruction or a gastrocolic fistula and is treated as a warning sign of this potentially serious problem (signum mali ominis).^{[citation needed]}

If the vomiting reflex continues for an extended period with no appreciable vomitus, the condition is known as non-productive emesis or "dry heaves", which can be painful and debilitating.^{[citation needed]}

Color of vomit^{[citation needed]}

Bright red in the vomit suggests bleeding from the esophagus
Dark red vomit with liver-like clots suggests profuse bleeding in the stomach, such as from a perforated ulcer
Coffee-ground-like vomit suggests less severe bleeding in the stomach, because the gastric acid has had time to change the composition of the blood
Yellow vomit suggests bile, indicating that the pyloric valve is open and bile is flowing into the stomach from the duodenum (this is more common in older people)

Differential diagnosis

Vomiting may be due to a large number of causes, and protracted vomiting has a long differential diagnosis.^{[citation needed]}

Digestive tract

Causes in the digestive tract

Gastritis (inflammation of the gastric wall)
Gastroenteritis
Gastroesophageal reflux disease
Pyloric stenosis (in babies, this typically causes a very forceful "projectile vomiting" and is an indication for urgent surgery)
Bowel obstruction
Overeating
Acute abdomen and/or peritonitis
Ileus
Food allergies (often in conjunction with hives or swelling)
Cholecystitis, pancreatitis, appendicitis, hepatitis
Food poisoning
In children, it can be caused by an allergic reaction to cow's milk proteins (Milk allergy or lactose intolerance)

Sensory system and brain

An intoxicated woman vomiting

Causes in the sensory system:^{[citation needed]}

Movement: motion sickness (which is caused by overstimulation of the labyrinthine canals of the ear)^{[citation needed]}
Ménière's disease

Causes in the brain:^{[citation needed]}

Concussion
Cerebral hemorrhage
Migraine
Brain tumors, which can cause the chemoreceptors to malfunction
Benign intracranial hypertension and hydrocephalus

Metabolic disturbances (these may irritate both the stomach and the parts of the brain that coordinate vomiting):^{[citation needed]}

Hypercalcemia (high calcium levels)
Uremia (urea accumulation, usually due to renal failure)
Adrenal insufficiency
Hypoglycemia
Hyperglycemia

Pregnancy:^{[citation needed]}

Hyperemesis, morning sickness

Drug reaction (vomiting may occur as an acute somatic response to):^{[citation needed]}

alcohol (being sick while being drunk or being sick the next morning, suffering from the after-effects, i.e., the hangover)
opioids
selective serotonin reuptake inhibitors
many chemotherapy drugs
some entheogens (such as peyote or ayahuasca)

Illness (sometimes colloquially known as "stomach flu"—a broad name that refers to gastric inflammation caused by a range of viruses and bacteria):^{[citation needed]}

Norovirus (formerly Norwalk virus or Norwalk agent)
Swine influenza

Emetics

An emetic, such as syrup of ipecac, is a substance that induces vomiting when administered orally or by injection. An emetic is used medically when a substance has been ingested and must be expelled from the body immediately (for this reason, many toxic and easily digestible products such as rat poison contain an emetic). Inducing vomiting can remove the substance before it is absorbed into the body. Ipecac abuse can cause detrimental health effects.^{[citation needed]}

Salt water and mustard water have been used since ancient times as emetics.^[8] Care must be taken with salt, as excessive intake can potentially be harmful.^[9]^[10]

Copper sulfate was also used in the past as an emetic.^[11]^[12] It is now considered too toxic for this use.^[13]

Hydrogen peroxide is used as an emetic in veterinary practice.^[14]^[15]

Social cues

A drunk man vomiting, while a young slave is holding his forehead. Brygos Painter, 500–470 BC

It is quite common that, when one person vomits, others nearby become nauseated, particularly when smelling the vomit of others, often to the point of vomiting themselves. It is believed that this is an evolved trait among primates. Many primates in the wild tend to browse for food in small groups. Should one member of the party react adversely to some ingested food, it may be advantageous (in a survival sense) for other members of the party to also vomit. This tendency in human populations has been observed at drinking parties, where excessive consumption of alcoholic beverages may cause a number of party members to vomit nearly simultaneously, this being triggered by the initial vomiting of a single member of the party. This phenomenon has been touched on in popular culture: notorious instances appear in the films Monty Python's The Meaning of Life (1983) and Stand By Me (1986).^[16]

Intense vomiting in ayahuasca ceremonies is a common phenomenon. However, people who experience "la purga" after drinking ayahuasca, in general, regard the practice as both a physical and spiritual cleanse and often come to welcome it.^[17] It has been suggested that the consistent emetic effects of ayahuasca—in addition to its many other therapeutic properties—was of medicinal benefit to indigenous peoples of the Amazon, in helping to clear parasites from the gastrointestinal system.^[18]

There have also been documented cases of a single ill and vomiting individual inadvertently causing others to vomit, when they are especially fearful of also becoming ill, through a form of mass hysteria.^{[citation needed]}

Special bags are often supplied on boats for sick passengers to vomit into.

Most people try to contain their vomit by vomiting into a sink, toilet, or trash can, as vomit is difficult and unpleasant to clean. On airplanes and boats, special bags are supplied for sick passengers to vomit into. A special disposable bag (leakproof, puncture-resistant, odorless) containing absorbent material that solidifies the vomit quickly is also available, making it convenient and safe to store until there is an opportunity to dispose of it conveniently.^{[citation needed]}

People who vomit chronically (e.g., as part of an eating disorder such as bulimia nervosa) may devise various ways to hide this disorder.^{[citation needed]}

An online study of people's responses to "horrible sounds" found vomiting "the most disgusting". Professor Trevor Cox of the University of Salford's Acoustic Research Centre said that "We are pre-programmed to be repulsed by horrible things such as vomiting, as it is fundamental to staying alive to avoid nasty stuff." It is thought that disgust is triggered by the sound of vomiting to protect those nearby from possibly diseased food.^[19]

Miscellanea

Self-induced
- Eating disorders (anorexia nervosa or bulimia nervosa)
- To eliminate an ingested poison (some poisons should not be vomited as they may be more toxic when inhaled or aspirated; it is better to ask for help before inducing vomiting)
- Some people who engage in binge drinking induce vomiting to make room in their stomachs for more alcohol consumption.
- People suffering from nausea may induce vomiting in hopes of feeling better.
After surgery (postoperative nausea and vomiting)
Disagreeable sights or disgust, smells or thoughts (such as decayed matter, others' vomit, thinking of vomiting), etc.
Extreme pain, such as intense headache or myocardial infarction (heart attack)
Violent emotions
Cyclic vomiting syndrome (a poorly understood condition with attacks of vomiting)
High doses of ionizing radiation sometimes trigger a vomit reflex.
Violent fits of coughing, hiccups, or asthma
Anxiety
Depression
Overexertion (doing too much strenuous exercise can lead to vomiting shortly afterwards).
Rumination syndrome, an underdiagnosed and poorly understood disorder that causes sufferers to regurgitate food shortly after ingestion.

Other types

Projectile vomiting refers to vomiting that ejects the gastric contents with great force.^[20] It is a classic symptom of infantile hypertrophic pyloric stenosis, in which it typically follows feeding and can be so forceful that some material exits through the nose.^[21]

Treatment

An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of medications such as opioids and chemotherapy.^{[citation needed]}

Antiemetics act by inhibiting the receptor sites associated with emesis. Hence, anticholinergics, antihistamines, dopamine antagonists, serotonin antagonists, and cannabinoids are used as antiemetics.^[22]

Evidence to support the use of antiemetics for nausea and vomiting among adults in the emergency department is poor.^[23] It is unclear if any medication is better than another or better than no active treatment.^[23]

Epidemiology

Nausea and/or vomiting are the main complaints in 1.6% of visits to family physicians in Australia.^[24]

References

^ Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill Companies. p. 830. ISBN 0-07-148480-9.
^ Holland, James F.; Kufe, Donald W.; Weichselbaum, Ralph R.; Pollock, Raphael E.; Frei III, Emil; Gansler, Ted S.; Bast Jr., Robert C. (2003). Cancer medicine (6. [ed.]. ed.). Hamilton, Ontario [u.a.]: Decker. ISBN 9781550092134.
^ Hornby, PJ (2001). "Central neurocircuitry associated with emesis". The American Journal of Medicine. 111 Suppl 8A (8): 106S–112S. doi:10.1016/S0002-9343(01)00849-X. PMID 11749934.
^ Naylor, RJ; Inall, FC (January 1994). "The physiology and pharmacology of postoperative nausea and vomiting.". Anaesthesia. 49 Suppl: 2–5. doi:10.1111/j.1365-2044.1994.tb03575.x. PMID 8129158.
^ Matsuoka, I; Ito, J; Takahashi, H; Sasa, M; Takaori, S (1984). "Experimental vestibular pharmacology: a minireview with special reference to neuroactive substances and antivertigo drugs.". Acta oto-laryngologica. Supplementum 419: 62–70. PMID 6399658.
^ Li–gui, Huang; En–tong, Wang; Wei, Chen; Wei–xi, Gong (June 2011). "Role of Histamine H1 Receptors in Vestibular Nucleus in Motion Sickness". Journal of Otology 6 (1): 20–25. doi:10.1016/S1672-2930(11)50003-0.
^ Ray Andrew P., Chebolu Seetha, Ramirez Juan, Darmani Nissar A (2009). "Ablation of Least Shrew Central Neurokinin NK1 Receptors Reduces GR73632-Induced Vomiting". Behavioural Neuroscience 123 (3): 701–706. doi:10.1037/a0015733.
^ Decker, W. J. (1971). "In Quest of Emesis: Fact, Fable, and Fancy". Clinical Toxicology 4 (3): 383–387. doi:10.3109/15563657108990490. PMID 4151103.
^ Moder, K. G.; Hurley, D. L. (1991). "Fatal hypernatremia from exogenous salt intake: report of a case and review of the literature". Mayo Clin Proc. 65 (12): 1587–94. doi:10.1016/S0025-6196(12)62194-6. PMID 2255221.
^ Salt: a natural antidepressant? The Scotsman. April 6, 2009.
^ Holtzmann NA, Haslam RH (July 1968). "Elevation of serum copper following copper sulfate as an emetic". Pediatrics 42 (1): 189–93. PMID 4385403.
^ Wang, S. C.; Borison, Herbert L. (1951). "Copper Sulphate Emesis: A Study of Afferent Pathways from the Gastrointestinal Tract". Am J Physiol - Legacy Content 164 (2): 520–526.
^ Olson, Kent C. (2004). Poisoning & drug overdose. New York: Lange Medical Mooks/McGraw-Hill. p. 175. ISBN 0-8385-8172-2.
^ "Drugs to Control or Stimulate Vomiting". Merck Veterinary manual. Merck & Co., Inc. 2006.
^ "How to Induce Vomiting (Emesis) in Dogs". Petplace.com. Retrieved 2014-05-03.
^ 9 Best Vomit Scenes On Film, screenjunkies.com
^ Shanon, B. (2002). The antipodes of the mind: Charting the phenomenology of the ayahuasca experience. Oxford: Oxford University Press.
^ Andritzky, W. (1989). "Sociopsychotherapeutic functions of ayahuasca healing in Amazonia". Journal of Psychoactive Drugs 21 (1): 77–89. doi:10.1080/02791072.1989.10472145. PMID 2656954.
^ [1] University of Salford. January 28, 2007. Archived February 24, 2009, at the Wayback Machine.
^ "vomiting - definition of vomiting in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia". Medical-dictionary.thefreedictionary.com. Retrieved 2014-05-03.
^ Sleisenger, edited by Mark Feldman, Lawrence S. Friedman, Lawrence J. Brandt; consulting editor, Marvin H. (2009). Sleisenger & Fordtran's gastrointestinal and liver disease pathophysiology, diagnosis, management (PDF) (9th ed.). St. Louis, Mo.: MD Consult. p. 783. ISBN 1-4160-6189-4.
^ Mitchelson, F (March 1992). "Pharmacological agents affecting emesis. A review (Part I).". Drugs 43 (3): 295–315. doi:10.2165/00003495-199243030-00002. PMID 1374316.
^ ^a ^b Furyk, JS; Meek, RA; Egerton-Warburton, D (28 September 2015). "Drugs for the treatment of nausea and vomiting in adults in the emergency department setting.". The Cochrane database of systematic reviews 9: CD010106. doi:10.1002/14651858.CD010106.pub2. PMID 26411330.
^ Helena Britt; Fahridin, S (September 2007). "Presentations of nausea and vomiting" (PDF). Aust Fam Physician 36 (9): 673–784. PMID 17885697.

External links

Cyclical Vomiting Syndrome
"Emetics". The American Cyclopædia. 1879.

‹ The template below (Digestive system and abdomen symptoms and signs) is being considered for merging. See templates for discussion to help reach a consensus.›

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 悪心および嘔吐を呈する幼児または小児に対するアプローチ approach to the infant or child with nausea and vomiting
2. 悪心および嘔吐を伴う成人に対するアプローチ approach to the adult with nausea and vomiting
3. 周期性嘔吐症候群 cyclic vomiting syndrome
4. 化学療法誘発性悪心および嘔吐の予防および治療 prevention and treatment of chemotherapy induced nausea and vomiting
5. 妊娠の悪心および嘔吐の臨床的特徴および評価 clinical features and evaluation of nausea and vomiting of pregnancy

English Journal

[Diagnosis and results of treatment of congenital pyloric stenosis in children].

Bodnar BM, Shestobuz SV, Brozhyk VL.
Klinichna khirurhiia / Ministerstvo okhorony zdorov'ia Ukraïny, Naukove tovarystvo khirurhiv Ukraïny.Klin Khir.2002 Nov-Dec;(11-12):108-9.
Results of treatment of congenital pylorostenosis in children during last 15 years were studied. There was established, that degree of hypotrophy increases proportionally to duration of vomitive period. Changes of clinical signs of illness due to depression of immune defence, observation by division
PMID 12549320

[Sociocultural aspects of rheumatological practices in Sub-Saharan Africa].

Mijiyawa M.
Histoire des sciences médicales.Hist Sci Med.1995;29(2):175-9.
Conceived by the patient as the result of a surnatural origin, rheumatism, as most diseases in Black Africa, justifies the consultation of a witch or a quack. This consultation occurring upstream or downstream that of the modern physician aims to determine the exact cause of the disease in order to
PMID 11640472

[Re-evaluation of the vomitive action of the rhizome of ginseng].

Li LZ.
Zhong yao tong bao (Beijing, China : 1981).Zhong Yao Tong Bao.1987 Jun;12(6):46-8.
PMID 3446404

Related Pictures

Bulimia and Depression Health Consequences of Bulimia Nervosa: Was du heute auf den Lippen hast, hast du Tumblr. - xxhybrid Fan Art binge_eating Leggi l'articolo: Bulimia nervosa: sintomi Vomitive sábado, 14 de abril de 2012

★リンクテーブル★

リンク元

「催吐薬」

Vomiting
	Miracle of Marco Spagnolo by Giorgio Bonola (Quadroni of St. Charles)
Classification and external resources
Specialty	Gastroenterology
ICD-10	R11
ICD-9-CM	787
MeSH	D014839
	[edit on Wikidata]

　　[★]

英: emetics emetic, vomitive
ラ: emetica, vomitiva
同: 吐剤
関

[1] Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill Companies. p. 830. ISBN 0-07-148480-9.

[2] Holland, James F.; Kufe, Donald W.; Weichselbaum, Ralph R.; Pollock, Raphael E.; Frei III, Emil; Gansler, Ted S.; Bast Jr., Robert C. (2003). Cancer medicine (6. [ed.]. ed.). Hamilton, Ontario [u.a.]: Decker. ISBN 9781550092134.

[3] Hornby, PJ (2001). "Central neurocircuitry associated with emesis". The American Journal of Medicine. 111 Suppl 8A (8): 106S–112S. doi:10.1016/S0002-9343(01)00849-X. PMID 11749934.

[pmid8129158-4] Naylor, RJ; Inall, FC (January 1994). "The physiology and pharmacology of postoperative nausea and vomiting.". Anaesthesia. 49 Suppl: 2–5. doi:10.1111/j.1365-2044.1994.tb03575.x. PMID 8129158.

[pmid6399658-5] Matsuoka, I; Ito, J; Takahashi, H; Sasa, M; Takaori, S (1984). "Experimental vestibular pharmacology: a minireview with special reference to neuroactive substances and antivertigo drugs.". Acta oto-laryngologica. Supplementum 419: 62–70. PMID 6399658.

[6] Li–gui, Huang; En–tong, Wang; Wei, Chen; Wei–xi, Gong (June 2011). "Role of Histamine H1 Receptors in Vestibular Nucleus in Motion Sickness". Journal of Otology 6 (1): 20–25. doi:10.1016/S1672-2930(11)50003-0.

[7] Ray Andrew P., Chebolu Seetha, Ramirez Juan, Darmani Nissar A (2009). "Ablation of Least Shrew Central Neurokinin NK1 Receptors Reduces GR73632-Induced Vomiting". Behavioural Neuroscience 123 (3): 701–706. doi:10.1037/a0015733.

[8] Decker, W. J. (1971). "In Quest of Emesis: Fact, Fable, and Fancy". Clinical Toxicology 4 (3): 383–387. doi:10.3109/15563657108990490. PMID 4151103.

[9] Moder, K. G.; Hurley, D. L. (1991). "Fatal hypernatremia from exogenous salt intake: report of a case and review of the literature". Mayo Clin Proc. 65 (12): 1587–94. doi:10.1016/S0025-6196(12)62194-6. PMID 2255221.

[10] Salt: a natural antidepressant? The Scotsman. April 6, 2009.

[pmid4385403-11] Holtzmann NA, Haslam RH (July 1968). "Elevation of serum copper following copper sulfate as an emetic". Pediatrics 42 (1): 189–93. PMID 4385403.

[12] Wang, S. C.; Borison, Herbert L. (1951). "Copper Sulphate Emesis: A Study of Afferent Pathways from the Gastrointestinal Tract". Am J Physiol - Legacy Content 164 (2): 520–526.

[isbn0-8385-8172-2-13] Olson, Kent C. (2004). Poisoning & drug overdose. New York: Lange Medical Mooks/McGraw-Hill. p. 175. ISBN 0-8385-8172-2.

[14] "Drugs to Control or Stimulate Vomiting". Merck Veterinary manual. Merck & Co., Inc. 2006.

[15] "How to Induce Vomiting (Emesis) in Dogs". Petplace.com. Retrieved 2014-05-03.

[16] 9 Best Vomit Scenes On Film, screenjunkies.com

[17] Shanon, B. (2002). The antipodes of the mind: Charting the phenomenology of the ayahuasca experience. Oxford: Oxford University Press.

[18] Andritzky, W. (1989). "Sociopsychotherapeutic functions of ayahuasca healing in Amazonia". Journal of Psychoactive Drugs 21 (1): 77–89. doi:10.1080/02791072.1989.10472145. PMID 2656954.

[19] [1] University of Salford. January 28, 2007. Archived February 24, 2009, at the Wayback Machine.

[med_dict-20] "vomiting - definition of vomiting in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia". Medical-dictionary.thefreedictionary.com. Retrieved 2014-05-03.

[Sleisenger783-21] Sleisenger, edited by Mark Feldman, Lawrence S. Friedman, Lawrence J. Brandt; consulting editor, Marvin H. (2009). Sleisenger & Fordtran's gastrointestinal and liver disease pathophysiology, diagnosis, management (PDF) (9th ed.). St. Louis, Mo.: MD Consult. p. 783. ISBN 1-4160-6189-4.

[22] Mitchelson, F (March 1992). "Pharmacological agents affecting emesis. A review (Part I).". Drugs 43 (3): 295–315. doi:10.2165/00003495-199243030-00002. PMID 1374316.

[Fur2015-23] Furyk, JS; Meek, RA; Egerton-Warburton, D (28 September 2015). "Drugs for the treatment of nausea and vomiting in adults in the emergency department setting.". The Cochrane database of systematic reviews 9: CD010106. doi:10.1002/14651858.CD010106.pub2. PMID 26411330.

[24] Helena Britt; Fahridin, S (September 2007). "Presentations of nausea and vomiting" (PDF). Aust Fam Physician 36 (9): 673–784. PMID 17885697.

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