Vomiting

Vomiting may occur with other symptoms depending on the underlying disease, disorder or condition. Symptoms that frequently affect the digestive tract may also involve other body systems.

Vomiting may occur with other symptoms affecting the digestive tract including:

• Abdominal pain

• Belching

• Diarrhea

• Gas

• Heartburn and indigestion

• Nausea

• Poor appetite

• Retching

Vomiting can also be caused by problems in body systems other than the digestive tract including:

• Body aches and flu-like symptoms

• Dizziness

• Fatigue

• Fever and chills

• Headache

• Malaise

• Referred shoulder pain

• Weakness

In some cases, vomiting may occur with other symptoms that might indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting. Get immediate help (call 911) for these symptoms:

• Bloody or black stools

• Change in level of consciousness

• Chest pain or pressure

• Confusion and disorientation

• Difficulty breathing

• Fainting or change in level of consciousness or lethargy

• High fever (higher than 101°F)

• Rapid pulse or rapid breathing

• Severe abdominal pain

• Severe dizziness and weakness

• Vomiting blood or black material (resembling coffee grounds)

• Yellow skin and eyes (jaundice)

Conditions known to cause vomiting include infection, poisoning, mental health illnesses, malignancy (cancer), inflammation, trauma, obstruction, and other abnormal processes within the digestive system, nervous system, reproductive system, cardiovascular system, or endocrine system. A part of the brain called the chemoreceptor trigger zone (CTZ) controls and coordinates the vomiting process, which is why conditions and certain drugs that affect the nervous system can induce vomiting.

Vomiting may arise from problems in the digestive tract including:

• Acute gastritis

• Appendicitis

• Diverticulitis

• Food intolerances or allergies

• Food poisoning

• Gallstones

• Gastroesophageal reflux disease (GERD)

• Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)

• Intestinal obstruction

• Liver disease (hepatitis, cirrhosis of the liver)

• Overeating or eating a high-fat meal

• Pancreatitis

• Peptic ulcer and H. pylori infection

• Perforated bowel

• Peritonitis

• Viral gastroenteritis (stomach flu), the most common cause of vomiting overall

Vomiting can also be caused by problems in body systems other than the digestive tract. Causes include:

• Altitude sickness or motion sickness

• Brain tumor or brain swelling

• Bulimia

• Cancer and chemotherapy medications

• Concussion

• Cyclic vomiting syndrome, a genetic disorder marked by recurring cycles of nausea, vomiting and fatigue

• Exposure to smoke or toxic fumes or substances

• General anesthesia

• Kidney stone

• Medication side effects

• Migraine

• Pregnancy and morning sickness

• Vertigo and labyrinthitis

In some cases, vomiting may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. Call your doctor or poison-control hotline (1-800-222-1222) immediately or take the person to an emergency care facility if you suspect poisoning or drug ingestion.

Life-threatening causes of vomiting include:

• Appendicitis

• Bleeding peptic ulcer

• Bowel obstruction

• Brain hemorrhage

• Diabetic ketoacidosis

• Heart attack

• Heat exhaustion

• Increased intracranial pressure (high pressure inside the skull, usually from brain swelling)

• Intestinal ischemia (loss of blood supply to the intestines)

• Kidney or liver failure

• Meningitis (infection or inflammation of the sac around the brain and spinal cord)

• Peritonitis (infection or inflammation in the abdominal cavity)

• Poisoning

• Severe pain

• Uremia (buildup of urea and other toxins in the blood)

In most cases, the cause of vomiting is not serious and it usually resolves with home treatment. However, there are times when seeing a doctor is best. See a doctor promptly when:

• Unexplained weight loss accompanies vomiting episodes

• Vomiting episodes occur on and off for more than a month 

• Vomiting has occurred three or more times in one day

• Vomiting, as opposed to spitting up, occurs in a baby less than 2 months old

• Vomiting lasts for more than 12 hours in infants, 24 hours in older children, and 48 hours in adults

Call 911 or go to your nearest emergency room for throwing up when:

• You are vomiting blood, bile (a yellow-green vomitus), or coffee ground-like material. Any of these symptoms may signal a bleeding ulcer.

• You have been unable to keep fluids down for 12 hours.

• You have had a recent head injury or the vomiting could be due to a toxin or poison.

• You have other symptoms, including abdominal pain, blurred vision, chest pain, confusion, high fever, severe headache, stiff neck, or rectal bleeding.

• You have signs of dehydration, including excessive thirst, dark-colored urine, urinating less than normal, headache, skin that remains raised after pinching it, or dizziness, lightheadedness or fainting.

• Your child has signs of dehydration, including dry mouth and tongue, irritability, no tears with crying, no wet diapers for three hours, skin that stays tented when pinched, or sunken eyes cheeks, or soft spots.

To diagnose the cause of vomiting, your doctor may ask you several questions including:

• When did the vomiting start?

• How long have you been vomiting? How often does it occur?

• Have you been able to eat or drink in the last 12 hours?

• Are you nauseated?

• What, if anything, seems to make the vomiting better or worse?

• Do you have any other symptoms, such as fever, diarrhea or headache?

• Have you lost weight?

• Have you recently traveled outside the country or been around anyone who is sick?

• What other medical conditions do you have?

• What medications do you take?

Your doctor will perform a physical exam, which may include feeling your abdomen. Your doctor will also look for signs of dehydration. Depending on what your doctor finds, testing may be necessary. This could include blood tests, urinalysis, or imaging exams of the abdomen, such as ultrasound or CT (computed tomography) scan. Women of childbearing age may need a pregnancy test.

It is not always possible to diagnose an underlying cause or condition. If the problem persists and your provider is unable to determine a cause, seeking a second opinion may give you more information and answers.

Vomiting treatment is not always necessary. The need for treatment will depend on the cause, the severity, and your comfort. Simple causes of vomiting, such as viral gastroenteritis (stomach flu), will resolve on their own with home remedies. If an underlying medical condition is responsible, treating it should help resolve the vomiting.

There are also medicines to treat vomiting. For motion sickness, over-the-counter antihistamines are often useful. Prescription medicines are available to treat more severe causes of vomiting, such as cancer chemotherapy.

There are several home remedies to help manage vomiting and prevent it when nausea occurs. Strategies include:

• Avoiding alcohol, caffeinated drinks, and spicy, fatty or fried foods

• Avoiding strong odors, including cooking smells

• Drinking frequent sips of clear, cold, sweet liquids, such as ginger ale and non-citrus juices. Popsicles and rehydration solutions are also options.

• Eating small meals of cold or room temperature, bland foods, such as crackers, plain bread, rice, or chicken soup, slowly and frequently

• Sitting or reclining instead of lying flat and avoiding physical activity

If your motion sickness causes you to vomit, talk with your doctor about ways to prevent it and manage it.

Alternative and complementary treatments can help prevent and control nausea and vomiting. This is especially true for certain conditions, such as early pregnancy, postoperative nausea and vomiting, and cancer treatments. Many of these therapies do not use drugs at all, but focus on a mind-body connection instead. Alternative treatments include:

• Acupuncture

• Biofeedback, in which you learn how to gain conscious control over physical processes

• Music therapy

• Relaxation techniques, such as breathing exercises, guided imagery, meditation, and progressive muscle relaxation

• Supplements, including ginger and vitamin B₆ (pyridoxine)

• Systematic desensitization, which teaches you how to reduce anxiety-related problems, such as nausea and vomiting

There are also essential oils and some herbs and plants that may help manage nausea and vomiting. Examples include ginger, peppermint, lemon and chamomile. Teas and aromatherapy with essential oils are generally safe, but talk with your doctor before using a supplement to treat nausea and vomiting.

Left untreated, vomiting can lead to serious complications, especially if the vomiting is severe, continues for days, or the underlying disease or condition is untreated or poorly managed. Complications include:

• Anemia and shock caused by vomiting of blood

• Aspiration of stomach contents into the airway and lungs

• Dehydration due to a decreased desire to drink or ability to hold fluids

• Electrolyte imbalance

• Gum disease

• Mallory-Weiss tear (tear of the lower esophagus resulting in severe bleeding)

• Poor nutrition due to a decreased desire to eat

• Tooth decay