Vomiting

Vomiting is the forceful expulsion of stomach contents through the mouth. While often a protective mechanism to rid the body of harmful substances, persistent or severe vomiting can lead to dehydration and may signal serious underlying conditions requiring immediate medical attention.

Quick Facts

  • Common symptom
  • Many possible causes
  • Can cause dehydration
  • Often with nausea
  • May need emergency care

⚠️ Seek Emergency Care Immediately For:

  • Blood in vomit (red or coffee-ground appearance)
  • Severe dehydration (dizziness, dry mouth, little/no urination)
  • Signs of shock (rapid pulse, cold skin, confusion)
  • Severe abdominal pain with vomiting
  • Head injury followed by vomiting
  • Vomiting with severe headache and stiff neck
  • Chest pain with vomiting
  • Persistent vomiting preventing fluid intake
  • Projectile vomiting in infants
  • Green bile vomit (may indicate bowel obstruction)
  • Vomiting with high fever (>103°F/39.4°C)
  • Vomiting after ingesting poison or medication overdose

These symptoms may indicate life-threatening conditions requiring immediate treatment.

Understanding Vomiting

Vomiting is a complex reflex coordinated by the brain's vomiting center in response to various triggers. It involves forceful contraction of abdominal muscles, reversal of normal digestive movements, and opening of the gastroesophageal sphincter to expel stomach contents.

While vomiting can be a protective mechanism helping the body eliminate toxins or irritants, it can also result from various medical conditions affecting the digestive system, brain, or other organs. The pattern, timing, and associated symptoms often provide clues to the underlying cause.

Persistent vomiting can lead to serious complications including dehydration, electrolyte imbalances, malnutrition, and aspiration pneumonia. Understanding when vomiting requires medical attention and how to manage it effectively is crucial for preventing these complications.

Types and Patterns of Vomiting

Projectile Vomiting

  • Forceful expulsion
  • Travels several feet
  • Often without nausea
  • May indicate obstruction
  • Common in pyloric stenosis
  • Can suggest increased pressure

Bilious Vomiting

  • Green or yellow color
  • Contains bile
  • May indicate obstruction
  • Below duodenum level
  • Bitter taste
  • Requires evaluation

Coffee-Ground Vomitus

  • Dark, grainy appearance
  • Indicates old blood
  • From upper GI bleeding
  • Medical emergency
  • Needs immediate care
  • Often with melena

Cyclic Vomiting

  • Recurring episodes
  • Intense vomiting periods
  • Symptom-free intervals
  • Often in children
  • Can last hours to days
  • Triggers vary

Common Causes of Vomiting

Gastrointestinal Causes

  • Food poisoning: Contaminated food or water
  • Viral gastroenteritis: Stomach flu, norovirus, rotavirus
  • Bacterial infections: Salmonella, E. coli
  • GERD: Severe acid reflux
  • Appendicitis: Inflamed appendix
  • Bowel obstruction: Blockage in intestines
  • Gallstones: Blocking bile ducts
  • Pancreatitis: Inflamed pancreas
  • Peptic ulcers: Stomach or duodenal ulcers
  • Gastroparesis: Delayed stomach emptying

Central Nervous System

  • Migraines: Severe headaches with nausea
  • Concussion: Brain injury from trauma
  • Meningitis: Brain/spinal cord inflammation
  • Brain tumors: Increased intracranial pressure
  • Vertigo: Inner ear disorders
  • Motion sickness: Travel-related nausea

Metabolic and Hormonal

  • Pregnancy: Morning sickness, hyperemesis gravidarum
  • Diabetic ketoacidosis: Diabetes complication
  • Kidney failure: Uremia buildup
  • Hypercalcemia: High calcium levels
  • Addison's disease: Adrenal insufficiency
  • Thyrotoxicosis: Overactive thyroid

Medications and Toxins

  • Chemotherapy: Cancer treatment side effect
  • Antibiotics: GI side effects
  • Pain medications: Especially opioids
  • Alcohol: Intoxication or withdrawal
  • Food allergies: Immune reactions
  • Poisoning: Various toxic substances

Other Causes

  • Heart attack: Can present with vomiting
  • Severe pain: Any source
  • Psychological: Anxiety, bulimia
  • Post-operative: Anesthesia effects
  • Radiation therapy: Treatment side effect

Associated Symptoms

Vomiting often occurs with other symptoms that help identify the cause:

  • Nausea: Usually precedes vomiting
  • Abdominal pain: Location and type vary by cause
  • Diarrhea: Common with gastroenteritis
  • Fever: Suggests infection
  • Headache: With migraines or increased pressure
  • Dizziness: From dehydration or inner ear
  • Sweating: Autonomic response
  • Pale skin: From vasovagal response
  • Rapid heartbeat: Dehydration or anxiety
  • Muscle aches: With viral infections
  • Loss of appetite: Common with GI issues
  • Weight loss: With chronic vomiting

Potential Complications

Dehydration

  • Loss of fluids
  • Electrolyte imbalance
  • Dizziness
  • Dry mouth
  • Decreased urination
  • Can be severe

Mallory-Weiss Tear

  • Esophageal tear
  • From forceful vomiting
  • Causes bleeding
  • Blood in vomit
  • Usually heals itself
  • May need treatment

Aspiration

  • Vomit enters lungs
  • Can cause pneumonia
  • Risk when unconscious
  • Elderly at higher risk
  • Can be serious
  • Needs antibiotics

Metabolic Alkalosis

  • Loss of stomach acid
  • pH imbalance
  • Muscle cramps
  • Confusion
  • Breathing changes
  • Needs IV treatment

Diagnosis and Evaluation

Medical History

  • Onset and duration of vomiting
  • Frequency and amount
  • Appearance of vomitus
  • Associated symptoms
  • Recent food intake
  • Medication history
  • Travel history
  • Pregnancy possibility

Physical Examination

  • Vital signs check
  • Dehydration assessment
  • Abdominal examination
  • Neurological evaluation
  • Ear examination (vertigo)
  • Skin turgor test

Diagnostic Tests

  • Blood tests: Electrolytes, kidney function, liver enzymes
  • Urine tests: Pregnancy, infection, ketones
  • Imaging: X-ray, CT scan, ultrasound
  • Endoscopy: For persistent vomiting
  • ECG: If cardiac cause suspected

Treatment Options

Immediate Care

  • Rest in comfortable position
  • Small sips of clear fluids
  • Avoid solid foods initially
  • Fresh air helps
  • Cool compress on forehead
  • Rinse mouth after vomiting

Rehydration

  • Oral rehydration solutions
  • Clear liquids: water, broth
  • Electrolyte drinks
  • Ice chips or popsicles
  • Avoid caffeine/alcohol
  • IV fluids if severe

Medications

  • Ondansetron (Zofran)
  • Promethazine (Phenergan)
  • Metoclopramide (Reglan)
  • Dimenhydrinate (Dramamine)
  • Meclizine for vertigo
  • Prescription based on cause

Dietary Management

  • BRAT diet when ready
  • Small, frequent meals
  • Avoid fatty foods
  • No spicy foods
  • Room temperature foods
  • Gradual reintroduction

Home Remedies and Natural Treatments

  • Ginger: Tea, candies, or supplements for nausea
  • Peppermint: Tea or aromatherapy
  • Acupressure: P6 point on wrist
  • Deep breathing: Slow, controlled breaths
  • Lemon: Scent or in water
  • Cool environment: Reduces nausea
  • Crackers: Plain, dry foods
  • Apple cider vinegar: Diluted in water
  • Fennel seeds: Chew or tea
  • Chamomile tea: Soothing effect

Prevention Strategies

  • Food safety: Proper storage and cooking
  • Hand hygiene: Regular washing
  • Avoid triggers: Known foods or smells
  • Eat slowly: Don't overeat
  • Stay hydrated: Regular fluid intake
  • Motion sickness: Prevention medications
  • Manage stress: Reduces nausea
  • Avoid alcohol excess: Know limits
  • Medication timing: With food if needed
  • Pregnancy: Small, frequent meals

When to See a Doctor

See a Doctor Soon For:

  • Vomiting lasting more than 24 hours
  • Unable to keep fluids down for 12 hours
  • Signs of dehydration
  • Vomiting with severe headache
  • Persistent abdominal pain
  • Vomiting after head injury
  • Recurrent vomiting episodes
  • Weight loss from vomiting
  • Vomiting with no apparent cause
  • Pregnancy with severe vomiting

Special Considerations

  • Infants: Any persistent vomiting
  • Elderly: Higher dehydration risk
  • Diabetics: Blood sugar concerns
  • Heart patients: Electrolyte risks
  • Pregnant women: Hyperemesis evaluation

Related Conditions

GERD

Chronic acid reflux can cause nausea and occasional vomiting.

Migraine

Severe headaches often accompanied by nausea and vomiting.

Appendicitis

Inflamed appendix causes severe pain with nausea and vomiting.

Nausea

The queasy feeling that often precedes vomiting.