- Vomiting is the forceful emptying (throwing up) of a large portion of the stomach's contents through the mouth
- Nausea and abdominal discomfort usually precede each bout of vomiting
- Vomiting can occur in many types of illnesses.
- Nausea and abdominal discomfort usually precede each bout of vomiting.
- Vomiting occurring with diarrhea is suggestive of gastroenteritis (stomach flu) or some type of food poisoning. Most such patients can be managed at home.
- Maintaining hydration is the cornerstone of treatment of adults with acute vomiting. In general, an adult who is alert, feels well, and who is not thirsty or dizzy: is NOT dehydrated. Patients with moderate to severe dehydration will require medical evaluation, usually in an emergency department or urgent care setting.
Causes of Vomiting
- Bowel obstruction
- CNS: Increased intracranial pressure may lead to vomiting.
- Diabetic ketoacidosis (DKA): This is seen in diabetics who are taking insulin. Vomiting in insulin-dependent diabetics should be taken seriously and usually requires an emergency department disposition.
- Emotional response to certain smells
- Food allergy
- Foodborne illness ("food poisoning"): Food poisoning is caused by toxins produced by bacteria growing in poorly refrigerated foods (e.g. Staphylococcus toxin in egg salad or Bacillus cereus toxin in rice dishes). Foodborne illnesses usually present with gastrointestinal symptoms of vomiting, diarrhea and/or abdominal pain. The symptoms and their duration depend on the type of infection.
- Gastritis and Gastroenteritis ("stomach flu"): There are many viral and bacterial causes. This is a common cause.
- Labyrinthine disorders: This grouping includes labyrinthitis and motion sickness. Typical symptoms are episodes of vertigo with nausea and vomiting.
- Medications: This may be the most common cause in adults, and certainly should be considered in elderly adults. Some examples include digoxin, narcotics, erythromycin, NSAIDS, and anticancer drugs.
- Migraine headaches: Vomiting occurs commonly in some patients with migraine or cluster headaches.
- Neurologic disease: meningitis, encephalitis, Reye’s syndrome, blocked V-P shunt, head trauma, and other causes of increased intracranial pressure.
- Postoperative vomiting
- Renal colic (kidney stone attack): Nausea and vomiting commonly accompany the flank pain of a kidney stone attack.
- Vomiting in first trimester of pregnancy (i.e., Morning Sickness)
When to call your doctor
Call 911 Now (you may need an ambulance) If
- Very weak (can't stand)
Call Your Doctor Now (night or day) If
- You feel weak or very sick
- Signs of dehydration (e.g., no urine in more than 12 hours, very dry mouth, very lightheaded, etc.)
- Vomiting blood or black (coffee-grounds)
- Vomiting more than once and you
- Are over 60 years of age OR
- Have diabetes mellitus OR
- Are bedridden (e.g., nursing home patient, stroke, chronic illness) OR
- Have other risks (e.g., brain tumor, chemotherapy, inguinal hernia, recovering from surgery)
- Severe abdominal pain
- Constant abdominal pain for more than 2 hours
- Abdomen is more swollen than usual
- Fever of 103° F (39.4° C) or higher
- Recent abdominal or head injury (within 3 days)
- Severe headache
- Severe pain in one eye
- Taking any of the following medications: digoxin (Lanoxin), lithium, theophylline, phenytoin (Dilantin)
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
- You think you need to be seen
- Fever present for more than 3 days
- Vomiting for more than 48 hours
- Vomiting a prescribed medication or recently started on a new medication
Call Your Doctor During Weekday Office Hours If
- You have other questions or concerns
- Vomiting is a recurrent problem
Self Care at Home If
- Mild vomiting (possibly gastritis) and you don't think you need to be seen
HOME CARE ADVICE FOR MILD VOMITING
- For Continuous Vomiting, Try Sleeping:
- Try to go to sleep (Reason: sleep often empties the stomach and relieves the need to vomit).
- When you awaken, resume drinking liquids. Water works best initially.
- Clear Liquids: Try to sip small amounts (1 tablespoon) of liquid frequently (every 5 minutes) for 8 hours, rather than trying to drink a lot of liquid all at one time.
- Sip water or a rehydration drink (e.g., Gatorade or Powerade).
- Other options: 1/2 strength flat lemon-lime soda or ginger ale.
- After 4 hours without vomiting, increase the amount.
- Solid Food:
- You may begin eating bland foods after eight hours without vomiting. Start with saltine crackers, white bread, rice, mashed potatoes, cereal, applesauce, etc.
- After 48 hours on a bland diet, you may resume a normal diet.
- Avoid Medicines:
- Discontinue all non-prescription medicines for 24 hours (Reason: they may make vomiting worse).
- Call your doctor if vomiting a prescription medicine.
- Contagiousness: You can return to work or school after vomiting and fever are gone.
- Expected Course: Vomiting from viral gastritis usually stops in 12 to 48 hours. If diarrhea is present, it usually continues for several days.
- Call Your Doctor If:
- Vomiting persists for 48 hours
- Signs of dehydration occur
- You become worse
Author: David A. Thompson, M.D.
Last reviewed: 9/15/2011
Last revised: 4/17/2010 2:34:14 PM