Why do many people have symptoms of nausea and vomiting after Covid-19?

People with Covid-19 weeks to months after being cured, they still face sequelae such as low-grade fever, shortness of breath, prolonged cough, fatigue, muscle pain, heart palpitations, etc. Among them, the patient shows confusion. Digestive disorders, especially nausea and vomiting account for a large number.

Why did the patient recover from Covid-19?

Nausea is a very unpleasant sensation (wanting to vomit) due to nerve stimulation of the vomiting center in the medulla oblongata. Nausea and vomiting are two symptoms that often go together.

First, the SARS-CoV-2 virus penetrates directly through the ACE2 receptor in the gastrointestinal epithelium. SARS-CoV-2 is usually localized to epithelial cells of the stomach, duodenum, and rectum. If the immune system is not strong enough to defeat the virus, SARS-CoV-2 will multiply rapidly. Thereby causing a decrease in the amount of ACE2 and destruction of the host’s cells. A decrease in ACE2 leads to a decreased ability to protect the organ. As a result, digestive function is compromised and inflammation accelerates, causing nausea and vomiting.

Second, the immune system response will produce proinflammatory cytokines and chemokines, and trigger a T-cell response to clear the virus in mild cases. In more severe cases, however, viral tissue damage can trigger monocytes, macrophages, and dendritic cells to overproduce proinflammatory cytokines, resulting in a “cytokine storm.” This systemic inflammatory response can damage many organs and systems in the body, including the digestive system.

The third may be due to side effects in the treatment of Covid-19 such as when taking remdesivir. Finally comes anxiety and psychological stress from Covid-19 – considered a common cause of nausea and vomiting. Prolonged social distancing coupled with an economic burden puts patients at high risk for health problems health mental health, especially for vulnerable people such as healthcare workers, children and the elderly.

Although there are no specific data on nausea and vomiting in anxious individuals, psychological factors play an important role in predisposing to persistent post-Covid-19 symptoms.

How to handle nausea and vomiting after Covid-19?

During Covid-19 infection, nausea and vomiting will be acute (high frequency) accompanied by other gastrointestinal symptoms, especially diarrhea, abdominal pain, loss of appetite, and these symptoms can be severe. may precede respiratory manifestations. However, in the post-Covid-19 situation, nausea and vomiting occur infrequently but still affect the patient’s quality of life. To correct this condition, treat it with standard medication. In addition, dietary and lifestyle interventions will also help increase effectiveness.

1. Treatment with antiemetics

Prochlorperazine: This is an antiemetic that partially relieves acute nausea and vomiting (eg, in acute gastroenteritis). It can cause side effects (anticholinergic) such as blurred vision, confusion, constipation, dry eyes, urinary retention, and heart rhythm disturbances. In addition, dizziness, orthostatic hypotension, somnolence and sedation may also occur. Pediatric patients are particularly sensitive to the sedative effects induced by prochlorperazine. Therefore, Prochlorperazine should not be used in pregnant women, patients with impaired liver and kidney function, epilepsy, children < 2 years old or weighing < 9 kg or with one of the above conditions.

Metoclopramide: The drug is used for the symptomatic treatment and prevention of nausea, and for the treatment of late (non-acute) vomiting. The drug is contraindicated in cases of mechanical obstruction, gastrointestinal perforation, gastrointestinal bleeding, history of epilepsy, Parkinson’s, pheochromocytoma and children under 1 year of age. Metoclopramide crosses the placenta and metoclopramide is POSSIBLY SAFE for pregnant women. However, when the drug is used in late pregnancy, extrapyramidal symptoms may appear in the neonate. Therefore, it is necessary to carefully monitor the baby after birth if the drug is used in the last 3 months of pregnancy. Metoclopramide is excreted in breast milk, so breast-feeding infants may experience undesirable effects due to the drug. Therefore, the use of metoclopramide during lactation is not recommended.

Domperidone: It is also an anti-dopamine drug, but with less ability to penetrate the blood-brain barrier. Therefore, there is much less sedation and dystonia than metoclopramide. Domperidone is indicated for the short-term treatment of severe nausea and vomiting and is rarely used with its antiemetic effect. The drug is contraindicated in patients with hepatic impairment (moderate and severe), heart disease, gastrointestinal bleeding or perforation, mechanical intestinal obstruction and pregnant women.

Non-drug treatment

Acupressure: Reflexology uses pressure to stimulate certain points on the body to relieve symptoms. Pressing on the Neiguan point on the palm of your hand can help relieve nausea and vomiting. To massage this point can be done in the following way:

· Place three fingers across the wrist.

· Place your thumb under the index finger.

· Rub the spot in a firm, circular motion for two to three minutes.

· Repeat on the other wrist.

Refined ginger juice: When the symptoms of nausea persist, using refined ginger water will be effective.

Eating: Eat easily digestible foods, divide them into several meals, avoid eating too much at one meal that can cause vomiting. Eat homemade foods and avoid processed foods.

Doctor’s Advice

– Only use anti-emetics when advised and prescribed by a doctor.

Watch out for other symptoms of post-Covid-19 syndrome. Consult a doctor if fatigue persists and tends to increase.

– Sit up, lean back slightly or move when feeling nauseous.

– Open a window or sit in front of a fan because the cool air will help reduce discomfort.

– Apply a cool compress with a warm towel on the back of your neck to stabilize the temperature and reduce discomfort.

– Breathe deeply, relax if nausea due to stress, excessive anxiety.

Dr. Dang Xuan Thang (University of Medicine and Pharmacy, Duy Tan University of Danang)