I feel like I need to throw up but nothing comes out

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What Is Vomiting?

If you feel nauseous, resting either in a sitting position or in a propped lying position can help; activity may worsen nausea and may lead to vomiting.

Vomiting is rarely painful but never pleasant. Vomiting, also known scientifically as “emesis” and colloquially as throwing up, retching, heaving, hurling, puking, tossing, or being sick, is the forcible voluntary or involuntary emptying of stomach contents through the mouth or, less often, the nose.

A person with nausea has the sensation that vomiting may occur. Other signs that you are about to vomit include gagging, retching, choking, involuntary stomach reflexes, the mouth filling with saliva (to protect the teeth from stomach acid), and the need to move or bend over.

Pregnant women experiencing morning sickness can eat some crackers before getting out of bed or eat a high protein snack before going to bed (lean meat or cheese).

If you feel nauseous, resting either in a sitting position or in a propped lying position can help; activity may worsen nausea and may lead to vomiting.

Drinking small amounts of clear, sweetened liquids such as soda or fruit juices (except orange and grapefruit juices, because these are too acidic) can also help. You should avoid solid food until the vomiting episode has passed.

Vomiting associated with cancer treatments can often be treated with another type of drug therapy. There are also prescription and nonprescription drugs that can be used to control vomiting associated with pregnancy, motion sickness, and some forms of dizziness. However, consult with a doctor before using any of these treatments.

The gag reflex during vomiting prevents the liquid contents of your stomach from entering your respiratory tract and suffocating you. People who vomit under the influence of drugs or alcohol, or who vomit while on their backs, are at risk of choking on their own vomit because this gag reflex is not intact.

There are many different types of vomit. Some people get the dry-heaves, where you retch and feel like vomiting but nothing comes out of your stomach. The dry-heaves are also called non-productive emesis.

Blood streaked or bloody vomit usually means usually indicates a cut or scrape to the esophagus or stomach. Some vomit resembles coffee grounds. Vomit that looks like coffee-grounds occurs when stomach acids and blood congeal. Coffee ground vomit can be a sign of ulcer, GERD, cancer of the stomach or liver, or other abdominal conditions.

Yellow vomit indicates the presence of bile, which usually happens after a meal.

Rarely, people with abnormal intestinal function vomit up partially digested food or feces.

Vomiting often brings relief from nausea and induces relaxation and sleepiness. In most cases, you won’t need any specific treatment after vomiting and can take care of yourself at home until you feel better.

If vomiting and diarrhea last more than 24 hours, an oral rehydrating solution such as Pedialyte should be used to prevent and treat dehydration.

Symptoms

Nausea and vomiting commonly occur in those with infections ranging from influenza to gastroenteritis. Symptoms that occur with nausea and vomiting include:

  • abdominal pain
  • diarrhea
  • fever
  • lightheadedness
  • vertigo
  • rapid pulse
  • excessive sweating
  • dry mouth
  • decreased urination
  • chest pain
  • fainting
  • confusion
  • excessive sleepiness
  • vomiting blood

Causes

Vomiting is an involuntary reflex that empties the stomach forcefully. Causes for nausea and vomiting include:

  • Motion sickness or seasickness
  • Early stages of pregnancy
  • Medication-induced vomiting
  • Intense pain
  • Emotional stress (such as fear)
  • Gallbladder disease
  • Food poisoning
  • Infections (such as the “stomach flu”)
  • Overeating
  • A reaction to certain smells or odors
  • Heart attack
  • Concussion or brain injury
  • Brain tumor
  • Ulcers
  • Some forms of cancer
  • Bulimia or other psychological illnesses
  • Gastroparesis or slow stomach emptying (a condition that can be seen in people with diabetes)
  • Ingestion of toxins or excessive amounts of alcohol
  • Migraines
  • Labyrinthitis – which also causes dizziness and a feeling of spinning (vertigo)
  • Motion sickness – nausea and vomiting associated with travelling
  • Certain medicines, such as antibiotics and opioid painkillers
  • Drinking too much alcohol
  • Kidney infections and kidney stones
  • A blockage in your bowel, which may be caused by a hernia or gallstones
  • Chemotherapy and radiotherapy
  • An inflamed gallbladder (acute cholecystitis)

Treatment

Treatment for nausea and vomiting depends on the underlying cause. Treatment for vomiting may include plenty of fluids, a clear liquid diet to rest the stomach, and medications to control nausea. Severe dehydration caused by vomiting may require treatment with intravenous fluids.

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with stomach cancer may experience the following symptoms or signs. Sometimes, people with stomach cancer do not have any of these changes. Or, the cause may be a different medical condition that is not cancer.

Stomach cancer is usually not found at an early stage because it often does not cause specific symptoms. When symptoms do occur, they may be vague and can include those listed below. It is important to remember that these symptoms can also be caused by many other illnesses, such as a stomach virus or an ulcer.

  • Indigestion or heartburn

  • Pain or discomfort in the abdomen

  • Nausea and vomiting, particularly vomiting up solid food shortly after eating

  • Diarrhea or constipation

  • Bloating of the stomach after meals

  • Loss of appetite

  • Sensation of food getting stuck in the throat while eating

Symptoms of advanced stomach cancer may include:

  • Weakness and fatigue

  • Vomiting blood or having blood in the stool

  • Unexplained weight loss

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. It is often started soon after diagnosis and continued throughout treatment. This may be called palliative care or supportive care. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

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Emetophobia is the abnormal and persistent fear of vomiting, thought to be the fifth-most common phobia in the world. The most extreme sufferers devote their lives to avoiding anything that might bring on illness — including seemingly innocuous everyday occurrences like a catered office lunch, an alcoholic drink, oyster happy hour, or a child in line at the supermarket complaining of a sore stomach. And those avoidance strategies can get extreme: Some sufferers will refuse to leave the house, eat, take medicine, get in a moving vehicle, or have children (according to a 2008 study, almost half of female emetophobes will delay pregnancy or bypass it completely).

Some studies indicate that a fear of losing control underpins emetophobia, which, like other anxiety disorders, tends to impact women more than men. The interview below — with a 23-year-old from Mt. Vernon, Ohio — was only one of a number of conversations I’ve had over the past several months with emetophobes, an overwhelming majority of whom grew up taking care of a chronically sick parent, though not typically one who suffered excessively from vomiting per se.

Is vomiting your biggest fear?
I would rather face death than vomit. I recently had a cancer scare and throughout the whole process all I was thinking was, I’m going to have to have surgery and chemo and these treatments are going to make me throw up. What am I going to do? Most people would say, “You’re crazy! You’re going to throw up, and you’ll get over it!” But to me it’s worse than hearing I have cancer, that’s how bad it is.

How much time do you spend thinking about vomiting?
My main focus in life is to not get sick. It’s in my head every single minute of the day, especially when I’m alone.

When was the last time you vomited?
It was in 2012 and I went into full melt-down mode. My mom had to hold me because I was so upset I made myself pass out. It’s a horrible experience for me. Before that, I hadn’t thrown up for six or seven years. People say it’s just a way for toxins to escape your body, but I never feel better afterward. I can still clearly remember that last time and when I’m nauseous I think about it and I picture myself over the toilet and it scares me even more.
Can you pinpoint when this fear began?
When I was in kindergarten I saw someone else throw up for the first time. It was this little kid called Kenny. He came out of a tiny playhouse and sat in the middle of the floor and just puked. I saw all these chewed-up pretzels, which we had been snacking on, and I got so upset. Everyone was running away from him, and I got really shaky and hid and plugged my ears. It happened again in fourth grade and that time I ran into the supply closet.
My dad was also really sick when I was growing up. He was in and out of the hospital, and he had nurses, but I don’t think I ever saw him puke. He passed away from an overdose when I was 10 years old. He was really ill (mentally and physically) and had numerous open-heart surgeries. His cardiologist gave him Oxycontin right before he was scheduled to have his latest surgery to repair his sternum, and he overdosed. I was the one who found him. I currently live with my mother, who has a lung condition. She’s on oxygen and also has stomach and bowel issues. Because her esophagus is herniated into her chest, when she eats a big meal and gets full she gets nauseous, and when she says she feels nauseous I freak out. It’s not an everyday thing but it is often, and I’ll never get used to it.
Do you remember a moment at which your fear got truly extreme?
The turning point was when I was about 15. I got tonsillitis and the stomach flu, and I’d never felt so sick in my life. That’s when I stopped eating when I feel sick, sometimes for days on end. Everyone thought I had an eating disorder and that I wanted to be skinny, and nobody would believe that I was just scared of vomiting. And then because you aren’t eating you feel even more anxious — it’s a vicious cycle. When you try to eat, your body is like, No! What are you doing? I don’t want that. It never ends. I’m always focused on my stomach. I think about my stomach constantly.
I tried to kill myself when I was 14 and following that I was hospitalized, and they overdosed me on lithium and I spent four days vomiting foam. That was one of the scariest experiences of my life. I was terrified. But I wasn’t anxious about vomiting — it just wasn’t on my mind. It was when I got tonsillitis and the stomach bug that the whole throwing-up fear began.
What’s a typical day like for you? Can you talk me through your routine?
After I wake up, I take my morning meds (Prilosec, propranolol for my heart, and some aspirin) then I spend the first hour of the day analyzing my body. Even before I get out of bed I’m thinking, “How’s my stomach today? Does it feel okay? Is it growling? If it is, is that because it’s hungry?” If I feel hungry then I know I’m not sick. I’ll smoke a cigarette while I gauge how my body is feeling. I’m on the lookout for pain, nausea, or anything weird. I don’t eat for at least three hours after I wake up and I’ll only eat if I know my stomach is okay and that everything is okay with everybody around me.

After I’ve eaten I wait for a couple more hours to see how it affects my stomach. In the meantime, I clean up the house, disinfect everything, take my dog out, check the mail, and try to stay busy. If I’m having a good day, I’ll eat more and more throughout the day, and some days I get brave and say, “Fuck it! I’m gonna eat whatever.” In the evening, I spend time with my fiancé, clean up after dinner, shower, and we lay in bed and watch Netflix until we fall asleep.
If that’s a good day, what’s a bad one like?
On a bad day, after my normal routine of taking my meds, I’ll realize I feel like crap and come to the conclusion it’s going to be an anxiety-fueled day. I’ll spend the day worrying about my stomach. I won’t eat in case it makes me sick. I’ll sip on water and chew gum or suck on peppermint candies. I’m usually in a bad mood. I just sit in a recliner with a heating pad and some ibuprofen and Sprite. I don’t get up, and I don’t talk to anybody. I make something quick and easy for my mom and fiancé to eat for dinner (but I won’t eat it), then I might try to take a shower and go to bed. I lie down, but my mind won’t allow me to sleep because I’m scared I’ll wake up in the middle of the night and vomit. So I usually just lie there until 4 or 5 a.m., fighting sleep, worrying, and trying to calm my stomach.
What other sorts of things do you avoid because of your fear?
I don’t work, and I opted to be homeschooled because I was scared of germs at school and of the thought of other students throwing up around me. I hate car rides with other people, as a lot of my friends get carsick, so I avoid that. Children are dirty and constantly sick, so I will avoid them at all costs. Waiting rooms of any sort are hard for me, whether it’s the DMV or a doctor’s office, because people are constantly coughing and sneezing, touching every surface, and they never wash their hands and I almost pass out from the panic. I hate going to crowded parties because people don’t wash their hands and that spreads germs like wildfire. I will not ride buses. I wash my hands much more than I should. I follow the 20-second scrubbing rule, and I have hand sanitizer. I never put my hands to my mouth, and I try to steer clear of anyone who is sick. When people tell me they think they just had food poisoning, I dwell on it, thinking, “But what if it’s not food poisoning? What if it’s a stomach virus and I was just talking to them?” I get incredibly antsy and immediately think, “When was the last time I ate? Do I have anything in my stomach that I might throw up?”
If I’ve been around someone who has a stomach bug I won’t eat until the incubation period has passed and I sanitize even more than usual and I make sure I keep washing my hands and I’m a wreck during that window of time — I watch for symptoms to show up and I just shut down. After I’ve cleared the incubation period, I calm down and get back into my routine. But I think about it nonstop and usually make myself feel sick, which then convinces me that I’ve caught it.

What about sex, or other intimate situations?
Sex and intimate situations with my fiancé (I’ve only ever had sex with two people) are no problem for me. He usually washes his hands as he should, and is a particularly clean person. If he’s sick, I will take care of him, all whilst taking any precaution I can to avoid contamination.

How has your phobia impacted your social life?
I’m scared of food, and I don’t drink alcohol. And when you’re out with people there’s always food and alcohol around, so I can’t really hang out with friends. Even watching a movie at a friend’s house is a risk because there will be snacks or someone will decide to order a pizza, and I go, “Oh no! Here we go again. Here’s food. It might make me sick.” I question my fiancé a lot and monitor how he’s feeling. I ask him: “Are you going to throw up? Is your stomach okay?”
So what sort of food do you eat?
I have a list of foods I consider safe.
What’s a “safe food”?
Things that haven’t ever made me sick or things prepared by me, this is the only food I will eat. My safe foods are pretzels, Cheez-It crackers, toast, boiled chicken, homemade beefs and noodles or homemade chicken noodle soup, steamed or boiled carrots, potatoes and noodles, cheesy poofs, and these little things we have here in Ohio called smiley fries, which are smiley-face-shaped fries with mashed potatoes inside — I nuke them or bake them.
What sort of foods do you consider unsafe?
Seafood, shellfish, and sushi are definite no-goes: They terrify me. Ground beef freaks me out (a few states around here recently had a contamination scare. There were no reported illnesses, but I won’t touch it. If I hear news about a recall I won’t touch whatever was recalled ever again) and so does anything spicy or with barbecue sauce. I don’t eat Chinese food. I stay away from butter, red pasta sauces, spaghetti, pizza, Hot Pockets, pizza rolls, or anything like that because they are heavy on my stomach. I never, ever, drink regular soda or tea (only caffeine-free stuff) and onions scare me. I eat chicken but I have a hard time with it, so I constantly check to make sure it’s fully cooked, and I’ll freak out for a while after eating it. I do not eat at buffets. I won’t eat salads unless they are prepared by me. When I cook I burn everything. I don’t mean to but I worry about getting sick from undercooked meat. I won’t ingest raw egg, and I don’t eat cookie dough. Even if the expiration date is still good, I’ll put eggs in water to see if they float.
Do you ever eat out?
No, never. The last time I went out to eat was over a year ago when my cousin was visiting, and we went to a steakhouse. I had a Reuben sandwich, fries, breadsticks, deep-fried mushrooms, and tons of other appetizers. I miss it so much; it was so much fun.
So do you ever eat food that’s prepared by someone else?
I’ll do drive-through at Burger King or Arby’s, but I’m really funny about eating stuff I haven’t made. At Burger King, I get chicken tenders or nuggets with French fries and a water or Sprite, and at Arby’s I get either a turkey sandwich or roast-beef sandwich with fries or mozzarella sticks and a Sprite or water. I order the same thing every time. I’d never, ever, eat anything fresh and never, ever, a sandwich. I’ll only eat food that I know has been thoroughly cooked and that I haven’t had a bad experience with.
Do you have any rituals or crutches that you depend on to calm you down?
I pace a lot and sometimes, I’ll chain smoke. Sipping on ice water helps me if I’m nauseous or if someone around me feels sick or if I’m dealing with the possibility that I’ve been exposed to germs. I chew a lot of gum, and I have hard candies. When I start to panic I try to distract myself; sometimes I’ll clean. I have Xanax but I don’t like to rely on anything like that, and I keep antiemetics with me to help calm me down and help settle down my stomach, but I try not to take them too often because I’ve taken so much I was in danger of paralyzing my stomach muscles. I drink ginger ale and Sprite and stuff like that. Sometimes I can breathe in through my mouth and zone out into space, but I usually don’t have a warning before I’m in full-blown panic mode, and then I have to bring myself down.
Do you think your fear will stop you from having children?
I’ve been with my fiancé for eight years and we are not ready for kids, but I’ve thought about pregnancy and the morning sickness and the prospect of caring for a sick child and it all scares me. When little kids vomit it’s worse than an adult vomiting. They’re upset and messy, and they get it everywhere. I couldn’t deal with that as a mother. Even when my dog gets sick I freak out and have to leave the room. I don’t think I’d be suited to having kids if I can’t even take care of them when they’re sick.

What happens when someone close to you gets sick?
It happened on Saturday. My best friend got hammered and threw up in my car. I pulled over and I just plugged my ears and hummed, and I was just shaking. My heart was racing.
What’s the hardest part of the day?
Nighttime. If I get nauseous before bed I get my mom to stay up with me rubbing my back until about 7 or 8 a.m. I hate nighttime. It always seems to hit me then. I always take at least half an antiemetic before I go to bed so I’m not as freaked out in the morning. That’s the only time I take it. My thing is worrying about waking up in the middle of the night and feeling sick. Every time I’ve woken up in the middle of the night it’s because I felt like I was going to puke. So whenever I startle awake I’m like, “Oh my God! Why am I awake? Am I nauseous? Am I going to get nauseous? Am I going to puke?” My mom is the one who usually calms me down. I’ll let her know I’m freaking out because my stomach feels funny or I’ve been around someone who is sick, and she’ll try and talk to me about other things and take my mind off it. We’ll watch a movie, or she’ll rub my back.
What’s the worst panic attack you’ve had?
I had a nervous breakdown in a hospital bed. I hadn’t eaten for over a week, and the doctor told me that I had starvation-induced metabolic acidosis and if I didn’t eat my organs would shut down. My fiancé and our friends were there and I was crying and snot was running out of my nose. I was hooked up to a heart monitor and IVs and they were like, “Please! Just eat something!” And I was like, “No, because it’s going to make me vomit.” I felt like the world was ending. I was screaming so loud doctors and nurses came rushing in from other rooms. I was scared because I knew what was going to happen, I was going to be forced to eat, and I just wanted it all to end; I wanted to go home and just wake myself up from this nightmare.
Eventually the doctor sat with me and just asked what was going on. He came to the conclusion that I’d had a nervous breakdown and loaded me up on so much anxiety medication I couldn’t stand. I eventually came out of the acidosis and was able to go home, but I didn’t start eating. It still took a few months to come back from all of it and get my body where it needed to be.
Have you ever spent a night alone? Do you think you could?
No. I’ve spent nights alone in hospital, but that’s the most alone I’ve been. The thought of it scares me so much: If something were to happen and there wasn’t anyone there to comfort me or take care of me what would happen to me?
Does your fear prevent you from working?
I’m not doing anything right now. I do plan on going back to work, but I’m not sure what I’ll do. I don’t want to do anything too public, where I have to be around a lot of people or handle money. I’m still freaked out about that but I don’t plan on staying a recluse for the rest of my life. Looking back on it, I really don’t think I would go back to being a nursing assistant. I did really well with it, but I couldn’t physically be there when patients were vomiting. I thought about nursing school and that just freaks me out too much. I’ve never been a cashier but I know how dirty money and people are.
Have you ever sat down and analyzed what’s at the bottom of this? Have you come up with a grand theory about your phobia?
Yes, the last time I was in the hospital I really wanted to try and figure it out for myself. I came to the conclusion that for me, it’s about not having control. I was always the person who took care of everybody else. When I would get sick I would get right back up and take care of everything and everybody, waiting on them hand and foot. I loved that, it just felt like what I’m here to do. When I was growing up, with my mom being sick and my dad’s death, everyone would always tell me, “You’re so strong! You’re so strong! I don’t know how you do it!” But when I’m sick, I’m so vulnerable and all of that goes out the window. I have no control and I think, “What if I get so sick I die?” “What if this is it?” “What if I can’t quit throwing up and this is going to be the rest of my life?”

This interview has been edited and condensed.

Nausea and Vomiting

Nausea and vomiting may occur together or separately. They can be caused by a number of physical and psychological conditions.

The most common causes of nausea are intense pain — usually from an injury or illness — and the first trimester of pregnancy. There are also a number of other relatively common causes, including:

  • motion sickness
  • emotional stress
  • indigestion
  • food poisoning
  • viruses
  • exposure to chemical toxins

If you have gallstones, you’re also likely to feel nauseated.

You may find that certain smells bring on the feeling of nausea. This is a very common symptom during the first trimester of pregnancy, although it can also occur in people who aren’t pregnant. Pregnancy-induced nausea usually goes away by the second or third trimester.

Vomiting in children

The most common causes of vomiting in children are viral infections and food poisoning. However, vomiting can also be caused by:

  • severe motion sickness
  • coughing
  • high fevers
  • overeating

In very young infants, blocked intestines can also cause persistent vomiting. The intestines may become blocked by abnormal muscular thickening, hernia, gallstones, or tumors. This is uncommon, but should be investigated if unexplained vomiting occurs in an infant.

Vomiting in adults

Most adults rarely vomit. When it does occur, a bacterial or viral infection or a type of food poisoning usually causes vomiting. In some cases, vomiting can also be the result of other illnesses, especially if they lead to a headache or high fever.

Chronic stomach conditions

Chronic, or long-term, stomach conditions can often cause nausea and vomiting. These conditions can come along with other symptoms, such as diarrhea, constipation, and stomach pain. These chronic conditions include food intolerances, such as celiac disease and dairy protein and lactose intolerance.

Irritable bowel syndrome (IBS) is a common stomach condition that causes bloating, nausea, vomiting, heartburn, fatigue, and cramping. It occurs when parts of the gut become overactive. Doctors usually diagnose IBS by identifying symptoms and ruling out other stomach and bowel conditions.

Crohn’s disease is an inflammatory bowel disease that commonly affects the intestines, though it can occur anywhere in the digestive tract. Crohn’s disease is an autoimmune condition in which the body attacks its own healthy gut tissue, causing inflammation, nausea, vomiting, and pain.

Doctors usually diagnose Crohn’s disease using a colonoscopy, a procedure that uses a small camera to explore the colon. Sometimes they also need a stool sample to help diagnose the condition.

Lifestyle choices

Certain lifestyle choices can increase your chance of experiencing nausea and vomiting.

Consuming a large amount of alcohol can cause damage to the lining of the gut. Alcohol can also react with stomach acid. Both of these will cause nausea and vomiting. In some cases, excessive alcohol consumption can also cause bleeding in the digestive tract.

Eating disorders

An eating disorder is when a person adjusts their eating habits and behaviors based on an unhealthy body image. It can cause nausea and vomiting.

Bulimia is an eating disorder in which a person induces vomiting deliberately to purge the stomach of any consumed food. People with anorexia may also feel nausea due to starvation and excess stomach acid.

Serious conditions

Though rare, vomiting can sometimes occur as a symptom of a more serious condition, including:

  • meningitis
  • appendicitis
  • concussion
  • a brain tumor
  • migraines

If you’re persistently vomiting, go see your doctor.

What happens in my body when I vomit?

Your body vomits when it senses various different threats. These threats can take the form of toxic chemicals or stress hormones in the blood, swaying motions, or an upset stomach. Chemicals and hormones are detected by the brain’s chemoreceptor trigger zone (CTZ), swaying motions are detected by the inner ear, while an upset stomach is identified by the vagus nerve. Once the signal for a need to vomit arrives at the CTZ, it sets off a chain reaction.

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1. Brainstem

© Raja Lockey

The chemoreceptor trigger zone (CTZ) receives a stimulus that might warrant vomiting. The vomiting centre begins a choreographed sequence of actions.

2. Salivary glands

© Raja Lockey

Your mouth suddenly begins producing extra saliva. This is slightly alkaline and forms a buffer to protect your mouth and teeth from incoming stomach acid.

3. Diaphragm

© Raja Lockey

You take a deep breath to avoid getting vomit in your lungs, then the diaphragm contracts in a few short pulses, squeezing the stomach to create pressure.

4. Glottis

© Raja Lockey

The glottis closes, sealing the airway. Nothing enters or leaves the lungs. Diaphragm contractions without vomiting cause dry heaves.

5. Abdominal muscles

© Raja Lockey

The abdominal muscles contract to further increase pressure. The pyloric sphincter at the bottom of the stomach is held closed. The only way out is upwards.

6. Skin

© Raja Lockey

The sympathetic nervous system raises your heart rate and makes you sweat across your whole body, to shed the heat from this sudden exertion.

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Spewing 101: Why am I vomiting?

Whether it was a bout of gastro, morning sickness, a migraine, the dreaded hangover, or something more serious, we have all experienced vomiting in our lives. Vomiting is a common symptom and can be caused by dietary or lifestyle factors, or the body’s reaction to infections, stomach irritations and medications. Vomiting can also be caused by long-term conditions such as diabetes or cancer-related treatments.

While vomiting can be relieving for the body, it may cause some adverse reactions. Let’s take a look at why you vomit and how it affects your body, what steps to take that will help get you back on your feet and when to seek medical help.

What is vomiting?

Vomiting is the body’s way of protecting you from threats. When it detects a harmful substance or something irritating, your body actually thinks you’re being poisoned. The body’s natural reaction is to rid the body of that threat, causing it to expel the contents of the stomach.

There are many causes of vomiting. From the effects of a rough night with your mates, to pregnancy, motion sickness, and all the infections, viruses and medications in between. Vomiting can be a one-off caused by something you ate or something you did, while acute vomiting for conditions like food poisoning or gastro can last a few hours to a few days. Vomiting for more than a few days, or experiencing other symptoms alongside the vomiting, could mean there is a serious underlying condition and you may need medical assistance.

How does vomiting affect my body?

Before

When a vomit is looming, a signal is sent to an area of the brain called the chemoreceptor trigger zone, or CTZ. The CTZ receives this information and determines if the threat warrants vomiting. The CTZ then communicates to other areas of the body to start the domino effect for vomiting.

Before you vomit you may feel nauseous, become pale, have a cold sweat, and have an increased heart rate. Your mouth will also produce extra saliva to protect your teeth from the incoming stomach acid.

During

As your body prepares to vomit, the major muscles in between the neck and abdomen – the diaphragm, chest wall and the abdominal muscles – all contract at the same time. This puts pressure on the stomach, forcing the contents in the stomach up the throat and through your mouth.

Generally, a few contractions occur before vomiting, causing dry heaving. As the contractions continue, the stomach contents are up, up and away! To protect you from choking, the throat has a flap called the epiglottis which closes to stop any vomit getting into the windpipe and lungs.

After

Vomiting causes the body to lose fluids that contain salts and minerals called electrolytes. While one vomit alone is not likely to cause adverse reactions, multiple vomits in a short period of time can quickly lead to dehydration, particularly in babies and children, and an electrolyte imbalance. Electrolytes are vital for your body to perform normal functions like regulating your heartbeat, signalling your nerves, and moving your muscles. When the balance is disturbed, you’ll usually feel miserable until the electrolytes are replaced with fluids.

Prolonged vomiting can also cause damage to enamel on your teeth because the strength of stomach acid. Additionally, it can be difficult to replace essential nutrients when you’re continuously vomiting, which can cause malnourishment. Over time, this can lead to your body not functioning properly, lowered immunity and unintended weight loss.

What should I do to look after myself after vomiting?

There are some things you can do to help you feel better after vomiting:

  • neutralise any stomach acid left in your mouth – rinse with water or fluoridated mouth wash (don’t brush your teeth as this can damage enamel)
  • replace fluids and electrolytes at the first sign of vomiting – mixing oral rehydration solutions in water will help replace the lost electrolytes
  • try eating bland foods, like crackers, rice or dry toast
  • avoid sugary, alcoholic or caffeinated drinks – these will only make your symptoms worse
  • rest.

When should I seek help for vomiting?

Vomiting is a symptom so it’s important to treat the underlying condition that is causing it. For one-off and acute vomiting, the illness will usually resolve itself without medical treatment. If you have other symptoms with your vomiting, it could mean something more serious.

Call Triple Zero (000) if you are vomiting and also have:

  • chest pain
  • severe abdominal pain or cramping
  • high fever and stiff neck
  • blurred vision
  • confusion
  • poo in the vomit
  • bleeding from your rectum
  • swallowed something poisonous.

See your doctor if you have:

  • been vomiting for more than two days
  • a severe headache
  • dehydration
  • green or blood in the vomit
  • stomach pain
  • diabetes, especially if you take insulin.

Babies and children must be monitored closely while they are unwell as their condition can go downhill quickly if dehydration occurs.

If you are concerned about your health or the health of a loved one, call 13 HEALTH (13 43 25 84) to speak with a registered nurse or see your doctor.

Related information

How to look after your kids when gastro strikes

Why am I vomiting green or yellow bile?

Sometimes, determining the cause of throwing up bile is simple. For example, if a person has been drinking heavily and threw up bile afterward, the cause is likely to be excessive alcohol consumption.

However, looking at other symptoms can help determine the cause of throwing up bile in cases where the reason is less obvious.

Bile reflux

Share on PinterestA doctor should be consulted to diagnose the cause of vomiting bile.

Bile reflux is not the same as acid reflux, though their symptoms are similar. Bile reflux occurs when bile backs up into a person’s stomach and esophagus.

Bile reflux often occurs after surgery, such as a gastric bypass or gallbladder removal, or because of peptic ulcers.

If a person vomits bile due to bile reflux, several other symptoms will likely occur, including:

  • severe pain in the upper abdomen
  • sour taste in the mouth
  • frequent heartburn
  • cough or hoarseness in the throat
  • nausea
  • weight loss

A person with symptoms of bile reflux should talk to a doctor. A doctor may be able to diagnose reflux based on a description of the symptoms alone. But they can also order further testing to determine whether it is bile reflux or acid reflux.

Proper diagnosis is crucial for treating bile reflux, as acid reflux treatments do not work for this condition.

Intestinal blockages

Intestinal blockages are a common cause of someone throwing up bile, but it may not be obvious to them that an intestinal blockage is to blame.

An intestinal blockage is serious and requires urgent medical attention to prevent complications, including sepsis, tissue death, and malnutrition.

A person who is throwing up bile should visit a doctor if they experience any of the following symptoms:

  • waves of abdominal pain and cramps
  • constipation
  • loss of appetite
  • swelling of the abdomen
  • inability to pass gas

Symptoms of intestinal blockages may vary, depending on the underlying cause.

Intestinal blockages may be caused by any of the following:

  • colorectal cancer
  • other cancerous tumors
  • a hernia
  • diverticulitis or infection in the digestive tract
  • gallstones
  • impacted stool
  • adhesions and scar tissue from surgery
  • volvulus, otherwise known as twisted intestines
  • inflammatory bowel disease (IBD)
  • ileus, a condition that causes bowel problems

For adults, the two most common causes of bowel obstructions are colon cancer and adhesions or scar tissues that form in the intestines after abdominal or pelvic surgery.

A doctor can diagnose an intestinal blockage or obstruction by a physical exam and additional tests. Tests used to diagnose the cause of vomiting bile include:

  • ultrasound
  • CT scan
  • air or barium enemas
  • X-rays

For children under 3 years of age, the most common cause of intestinal blockage is a serious condition known as intussusception.

Intussusception happens when one part of the intestine slides into an adjacent section, similarly to the retraction of a telescope.

The condition causes pain that comes and goes at first before turning constant. The child may look very pale, tired, and limp, and may be vomiting.

7 Possible Clear Vomit Conditions

The list below shows results from the use of our quiz by Buoy users who experienced clear vomit. This list does not constitute medical advice and may not accurately represent what you have.

Non-specific nausea and vomiting

Nausea and vomiting with no recognizable cause.

Rarity: Common

Top Symptoms: nausea, vomiting

Symptoms that always occur with non-specific nausea and vomiting: nausea, vomiting

Symptoms that never occur with non-specific nausea and vomiting: diarrhea, fever, headache

Urgency: Self-treatment

Indigestion (dyspepsia)

Indigestion, also called upset stomach, dyspepsia, or functional dyspepsia, is not a disease but a collection of very common symptoms. Note: Heartburn is a separate condition.

Common causes are eating too much or too rapidly; greasy or spicy foods; overdoing caffeine, alcohol, or carbonated beverages; smoking; and anxiety. Some antibiotics, pain relievers, and vitamin/mineral supplements can cause indigestion.

The most common symptoms are pain, discomfort, and bloating in the upper abdomen soon after eating.

Indigestion that lasts longer than two weeks, and does not respond to simple treatment, may indicate a more serious condition. Upper abdominal pain that radiates to the jaw, neck, or arm is a medical emergency.

Diagnosis is made through patient history and physical examination. If the symptoms began suddenly, laboratory tests on blood, breath, and stool may be ordered. Upper endoscopy or abdominal x-ray may be done.

For functional dyspepsia – “ordinary” indigestion – treatment and prevention are the same. Eating five or six smaller meals per day with lighter, simpler food; managing stress; and finding alternatives for some medications will provide relief.

Rarity: Common

Top Symptoms: nausea, stomach bloating, dyspeptic symptoms, bloating after meals, vomiting

Symptoms that always occur with indigestion (dyspepsia): dyspeptic symptoms

Symptoms that never occur with indigestion (dyspepsia): vomiting (old) blood or passing tarry stools, rectal bleeding, bloody diarrhea, fever

Urgency: Self-treatment

Viral (norovirus) infection

If you ever heard of an entire cruise ship of people coming down with the same “stomach bug,” chances are that was norovirus. Fortunately, norovirus usually goes away on its own after a few days, but is pretty unpleasant and can spread extremely easily. The …

Clear Vomit Symptom Checker

Take a quiz to find out what might be causing your clear vomit

Food poisoning

Food poisoning, also called foodborne illness or “stomach flu,” is an acute infection of the digestive tract from food contaminated with bacteria, viruses, parasites, or other toxins. It actually has no relation to influenza.

Any food can become contaminated if not prepared under clean conditions, cooked thoroughly, or stored at cold temperatures. Meat, fish, dairy products, and fresh fruits and vegetables are some of the most easily contaminated foods.

Symptoms include nausea, vomiting, diarrhea, and abdominal pain, and sometimes fever and chills.

Most people recover on their own with supportive care, meaning rest, fluids, and over-the-counter pain relievers and fever reducers.

However, dehydration can result if the vomiting and/or diarrhea are not controlled and IV fluids may be needed.

If there is also blurred vision, dizziness, or paralysis, the nervous system may be affected due to botulism. This is a medical emergency. Take the patient to the emergency room or call 9-1-1.

Proper food preparation and storage, along with frequent and thorough handwashing, is the best prevention.

Rarity: Common

Top Symptoms: nausea, abdominal pain (stomach ache), headache, abdominal cramps (stomach cramps), dizziness

Symptoms that never occur with food poisoning: severe fever, being severely ill, bloody diarrhea

Urgency: Self-treatment

Functional dyspepsia/indigestion

Indigestion, also known as dyspepsia, is a condition that causes pain or discomfort in the stomach after eating. In some cases, indigestion also causes heartburn, burping, and nausea. Indigestion or dyspepsia is a very common complaint and in most cases there is no serious underlying cause. This is when doctors call it ‘functional’.

Rarity: Common

Top Symptoms: stomach bloating, nausea, dyspeptic symptoms, bloating after meals, vomiting

Symptoms that always occur with functional dyspepsia/indigestion: dyspeptic symptoms

Symptoms that never occur with functional dyspepsia/indigestion: vomiting (old) blood or passing tarry stools, rectal bleeding, bloody diarrhea, fever

Urgency: Primary care doctor

Acute gastritis

When something interferes with the protective mechanisms of the stomach, a range of problems can occur from mild indigestion to deadly bleeding ulcers. Gastritis is an umbrella term for one of the most common problems, inflammation of the stomach lining.

Symptoms include nausea or vomiting,…

Cyclic vomiting syndrome

Cyclic vomiting syndrome is characterized by episodes of severe vomiting that have no apparent cause. Episodes can last for hours or days and alternate with relatively symptom-free periods of time.

Rarity: Rare

Top Symptoms: fatigue, nausea, headache, abdominal pain (stomach ache), trouble sleeping

Symptoms that always occur with cyclic vomiting syndrome: episodic vomiting

Urgency: Primary care doctor

Vomiting in adults

When to contact your GP

Contact your GP if:

  • you’ve been vomiting repeatedly for more than a day or two
  • you’re unable to keep down any fluids because you are vomiting repeatedly
  • your vomit is green (this could mean you are bringing up a fluid called bile, which suggests you may have a blockage in your bowel – see below)
  • you have signs of severe dehydration, such as confusion, a rapid heartbeat, sunken eyes and passing little or no urine
  • you’ve lost a lot of weight since you became ill
  • you experience episodes of vomiting frequently

Your GP may want to investigate the cause of your vomiting or prescribe treatment.

You should also see your GP if you have diabetes and have been vomiting persistently, particularly if you need to take insulin. This is because prolonged vomiting can affect your blood sugar level.

When to seek emergency medical help

Occasionally, vomiting can be a sign of a more serious problem.

You should call 999 for an ambulance, or go to your nearest accident and emergency (A&E) department if you also have:

  • sudden, severe abdominal (tummy) pain
  • severe chest pain
  • blood in your vomit or what looks like coffee granules
  • a stiff neck and high temperature (fever)
  • a sudden, severe headache that’s unlike any headache you’ve had before

You should also seek emergency medical help if you think you have swallowed something poisonous.

Common causes of vomiting in adults

If you have diarrhoea as well as vomiting, it’s likely you have gastroenteritis. This is one of the most common causes of vomiting in adults.

It’s often the result of a virus picked up from someone who’s ill, such as the norovirus, or food poisoning caused by bacteria found in contaminated food.

Your immune system will usually fight off the infection after a few days and the self-care measures described above can help in the meantime. Read more about treating gastroenteritis.

Pregnant women typically experience repeated episodes of nausea and vomiting, particularly during the early stages of pregnancy. This is often called “morning sickness”, although it can occur throughout the day.

In most cases, morning sickness will develop at some point during the first 3 months of pregnancy and will pass by about weeks 16-20. Read more about morning sickness, including things you can do to help reduce your symptoms.

Migraines

If you have recurrent episodes of vomiting along with intense, throbbing headaches that last for a few hours to days at a time, you may be experiencing migraines.

Conventional painkillers, such as paracetamol and ibuprofen, can sometimes help control the pain and your GP can prescribe anti-sickness medicine to help prevent vomiting. Read more about treating migraines.

Labyrinthitis

If your vomiting is accompanied by dizziness and a feeling of spinning (vertigo), it may be caused by an inner ear infection called labyrinthitis.

Labyrinthitis will usually improve over a few days, and your GP can prescribe medication to reduce your symptoms if necessary.

Motion sickness

Nausea and vomiting associated with travelling could be a sign of motion sickness.

These symptoms can sometimes be improved using techniques such as fixing your eyes on the horizon or distracting yourself by listening to music, although medication to prevent and treat motion sickness is also available.

Appendicitis

As well as vomiting, appendicitis can cause severe pain in your abdomen (tummy). You should call 999 for an ambulance if you experience pain that suddenly becomes worse and spreads across your abdomen. These are signs that your appendix may have burst.

If you have appendicitis, you will often need surgery to remove your appendix. Read more about treating appendicitis.

Other causes of vomiting in adults

Vomiting in adults can also be caused by a number of other things, including:

  • certain medicines, such as antibiotics and opioid painkillers
  • drinking too much alcohol
  • kidney infections and kidney stones
  • a blockage in your bowel, which may be caused by a hernia or gallstones
  • chemotherapy and radiotherapy
  • acute cholecystitis (inflammation of the gallbladder)

Clink on the links above for more information about these conditions and treatments.

Looking after yourself at home

In most cases, you won’t need any specific treatment and can take care of yourself at home until you feel better.

The most important thing you can do is to keep taking small sips of water frequently so you don’t become dehydrated.

A sweet drink such as fruit juice can be useful for replacing lost sugar, although you should avoid sweet drinks if they make you feel sick. Salty snacks, such as crisps, can help replace lost salt.

You may also find ginger helps to relieve your nausea and vomiting. This is available as supplements, or can be found in ginger biscuits and ginger tea. Check with your pharmacist or GP before using ginger supplements.

Vomiting Without Diarrhea

Is this your child’s symptom?

  • Vomiting (throwing up) stomach contents
  • It’s normal for nausea (upset stomach) to come before each bout of vomiting
  • Other names for vomiting are puking, barfing and heaving

Causes of Vomiting

  • Viral Gastritis. Stomach infection from a stomach virus is the most common cause. Also called stomach flu. A common cause is the Rotavirus. The illness starts with vomiting. Watery loose stools may follow within 12-24 hours.
  • Food Poisoning. This causes rapid vomiting within hours after eating the bad food. Diarrhea may follow. Caused by toxins from germs growing in foods left out too long. An example is Staph toxin in egg salad.
  • Ibuprofen. Ibuprofen products (such as Advil) can be a stomach irritant. If taken on an empty stomach, it can cause vomiting.
  • Food Allergy. Vomiting can be the only symptom of a food reaction. The vomiting comes on quickly after eating the food. Common foods are peanuts, tree nuts, fish and shellfish (such as shrimp).
  • Coughing. Hard coughing can also cause your child to throw up. This is more common in children with reflux.
  • Motion Sickness. Vomiting and dizziness are triggered by motion. Sea sickness or fun-park ride sickness are the most common types. Strongly genetic.
  • Migraine Headaches. In children, most migraine headaches also have vomiting.
  • Serious Causes. Vomiting alone (without diarrhea) should stop within about 24 hours. If it lasts over 24 hours, you must think about more serious causes. Examples are appendicitis, a kidney infection, diabetes and head injury. A serious cause in young babies is pyloric stenosis. See below for more on this.
  • Cyclic Vomiting. Cyclic vomiting is the most common cause of recurrent attacks of vomiting. Attacks have a sudden onset and offset. Often occur in children who later develop migraine headaches.

Pyloric Stenosis (Serious Cause)

  • The most common cause of true vomiting in young babies.
  • Onset of vomiting is age 2 weeks to 2 months
  • Vomiting is forceful. It becomes projectile and shoots out.
  • Right after vomiting, the baby is hungry and wants to feed. (“hungry vomiter”)
  • Cause: the pylorus is the channel between the stomach and the gut. In these babies, it becomes narrow and tight.
  • Risk: weight loss or dehydration
  • Treatment: cured by surgery.

Vomiting Scale

  • Mild: 1 – 2 times/day
  • Moderate: 3 – 7 times/day
  • Severe: vomits everything, nearly everything or 8 or more times/day
  • Severity relates even more to how long the vomiting goes on for. At the start of the illness, it’s common for a child to vomit everything. This can last for 3 or 4 hours. Children then often become stable and change to mild vomiting.
  • The main risk of vomiting is dehydration. Dehydration means the body has lost too much fluid.
  • The younger the child, the greater the risk for dehydration.

Dehydration: How to Tell

  • The main risk of vomiting is dehydration. Dehydration means the body has lost too much water.
  • Vomiting with watery diarrhea is the most common cause of dehydration.
  • Dehydration is a reason to see a doctor right away.
  • Your child may have dehydration if not drinking much fluid and:
  • The urine is dark yellow and has not passed any in over 8 hours.
  • Inside of the mouth and tongue are very dry.
  • No tears if your child cries.
  • Slow blood refill test: longer than 2 seconds. First, press on the thumbnail and make it pale. Then let go. Count the seconds it takes for the nail to turn pink again. Ask your doctor to teach you how to do this test.
  • A child with severe dehydration becomes too weak to stand. They can also be very dizzy when trying to stand.

When to Call for Vomiting Without Diarrhea

Call 911 Now

  • Can’t wake up
  • Not moving or too weak to stand
  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Headache
  • Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
  • Stomach pain when not vomiting. Exception: stomach pain or crying just before vomiting is quite common.
  • Diabetes suspected (drinking lots, frequent urine, weight loss)
  • Kidney infection suspected (side or back pain, fever, painful to pass urine)
  • Age less than 12 weeks old with vomiting 2 or more times. Exception: normal spitting up.
  • Severe vomiting (vomits everything) more than 8 hours while getting clear fluids
  • High-risk child (such as diabetes, stomach or head injury)
  • Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
  • Vomiting a prescription medicine
  • Fever over 104° F (40° C)
  • Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen.
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Age less than 1 year with vomiting
  • Vomits for more than 24 hours
  • Fever lasts more than 3 days
  • Fever returns after being gone more than 24 hours
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Vomiting is a frequent problem
  • You have other questions or concerns

Self Care at Home

  • Mild or moderate vomiting (most likely viral gastritis)

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice for Vomiting without Diarrhea

  1. What You Should Know About Vomiting Without Diarrhea:
    • Most vomiting is caused by a viral infection of the stomach. Sometimes, mild food poisoning is the cause.
    • Vomiting is the body’s way of protecting the lower gut.
    • The good news is that stomach illnesses last only a short time.
    • The main risk of vomiting is dehydration. Dehydration means the body has lost too much fluid.
    • Here is some care advice that should help.
  2. Formula Fed Babies – Give Oral Rehydration Solution (ORS) for 8 Hours:
    • If your child vomits more than once, offer ORS for 8 hours. If you don’t have ORS, use formula until you can get some.
    • ORS is a special fluid that can help your child stay hydrated. You can use Pedialyte or the store brand of ORS. It can be bought in food stores or drugstores.
    • Spoon or syringe feed small amounts. Give 1-2 teaspoons (5-10 mL) every 5 minutes.
    • After 4 hours without throwing up, double the amount.
    • Return to Formula. After 8 hours without throwing up, go back to regular formula.
  3. Breastfed Babies – Reduce the Amount Per Feeding:
    • If vomits more than once, nurse for 5 minutes every 30 to 60 minutes. After 4 hours without throwing up, return to regular nursing.
    • If continues to vomit, switch to pumped breastmilk. ORS is rarely needed in breastfed babies. It can be used if vomiting becomes worse.
    • Spoon or syringe feed small amounts of pumped milk. Give 1-2 teaspoons (5-10 mL) every 5 minutes.
    • After 4 hours without throwing up, return to regular feeding at the breast. Start with small feedings of 5 minutes every 30 minutes. As your baby keeps down the smaller amounts, slowly give more.
  4. Older Children (over 1 Year Old) – Offer Small Amounts of Clear Fluids For 8 Hours:
    • Water or ice chips are best for older children. Reason: Water is easily absorbed in the stomach.
    • Other clear fluids: Use half-strength Gatorade. Make it by mixing equal amounts of Gatorade and water. Can mix apple juice the same way. ORS (such as Pedialyte) is usually not needed in older children. Popsicles work great for some kids.
    • The key to success is giving small amounts of fluid. Offer 2-3 teaspoons (10-15 mL) every 5 minutes. Older kids can just slowly sip a clear fluid.
    • After 4 hours without throwing up, increase the amount.
    • After 8 hours without throwing up, return to regular fluids.
    • Caution: If vomits over 12 hours, switch to ORS or half-strength Gatorade.
  5. Stop All Solid Foods:
    • Avoid all solid foods and baby foods in kids who are vomiting.
    • After 8 hours without throwing up, gradually add them back.
    • Start with starchy foods that are easy to digest. Examples are cereals, crackers and bread.
  6. Do Not Give Medicines:
    • Stop using any drug that is over-the-counter for 8 hours. Reason: Some of these can make vomiting worse.
    • Fever. Mild fevers don’t need to be treated with any drugs. For higher fevers, you can use an acetaminophen suppository (such as FeverAll). This is a form of the drug you put in the rectum (bottom). Ask a pharmacist for help finding this product. Do not use ibuprofen. It can upset the stomach.
    • Call your doctor if: Your child vomits a drug ordered by your doctor.
  7. Try to Sleep:
    • Help your child go to sleep for a few hours.
    • Reason: Sleep often empties the stomach and removes the need to vomit.
    • Your child doesn’t have to drink anything if his stomach feels upset and he doesn’t have any diarrhea.
  8. Return to School:
    • Your child can return to school after the vomiting and fever are gone.
  9. What to Expect:
    • For the first 3 or 4 hours, your child may vomit everything. Then the stomach settles down.
    • Vomiting from a viral illness often stops in 12 to 24 hours.
    • Mild vomiting and nausea may last up to 3 days.
  10. Call Your Doctor If:
    • Vomits clear fluids for more than 8 hours
    • Vomiting lasts more than 24 hours
    • Blood or bile (green color) in the vomit
    • Stomach ache present when not vomiting
    • Dehydration suspected (no urine in over 8 hours, dark urine, very dry mouth, and no tears)
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 02/01/2020

Last Revised: 03/14/2019

Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.

The possible diagnoses for a patient presenting with persistent nausea and/or vomiting are many and varied but can often be considered under five main headings:

  • Pregnancy.
  • Visceral disease.
  • Toxic substance effects/metabolic conditions.
  • Central nervous system disease.
  • Psychiatric illness.

Assessment of the patient

Assessment of the patient with persistent nausea and vomiting should fall into two categories:

  • Assessment of the physical state of the patient, which has occurred as a consequence of the nausea/vomiting.
  • Look for evidence of:
    • Poor nutritional state
    • Dehydration
    • Electrolyte imbalance
  • Assessment of the patient with regard to the potential underlying cause.
  • Nausea and vomiting of pregnancy affects nearly 75% of pregnant women.
  • About 1% of women develop hyperemesis gravidarum, which may result in adverse outcomes for the mother and fetus.
  • Also consider the following:
    • Morning sickness.
    • Urinary tract infection.
    • Reflux oesophagitis.
    • Mechanical pressure from the gravid uterus.

Common causes of persistent nausea and vomiting

Underlying cause Examples Mechanisms leading to
nausea and vomiting
Irritation or stretching of the meninges. Raised intracranial pressure caused by intracranial tumour. Not known, may involve
meningeal mechanoreceptors.
Pelvic or abdominal tumour.
  • Mesenteric metastases.
  • Metastases of liver.
  • Ureteric obstruction.
  • Retroperitoneal cancer.
Stretching of mechanoreceptors.
Bowel obstruction secondary to malignancy.
  • Mechanical – intrinsic or extrinsic by tumour.
  • Functional – disorders of intestinal motility secondary to malignant involvement of
    nerves, bowel muscle or blood supply.
  • Paraneoplastic neuropathy.
Stretching of mechanoreceptors.
Gastric stasis.
  • Drugs (anticholinergics, opioids).
  • Mechanical obstruction to gastric emptying: tumour, gastritis, peptic ulcer, hepatomegaly.
  • Autonomic failure – eg, in advanced diabetes.
Gastric mechanoreceptors.
Chemical/metabolic.
  • Drugs – anti-epileptics, opioids, antibiotics, cytotoxics, digoxin.
  • Metabolic – hypercalcaemia: consider if drowsiness, confusion, thirst occur, particularly if of sudden onset.
  • Toxins – eg, tumour necrosis, bacterial toxins.
Chemoreceptors in the trigger zone.
Anxiety-induced. Concern about diagnosis, treatment, symptomatology, social issues, anticipatory emesis with cytotoxics. Multiple receptors in the cerebral cortex.
Movement-related.
  • Abdominal tumours.
  • Opioids.
  • Disease affecting vestibular system.
  • Accentuates stretch of
    mechanoreceptors by tumours.
  • Vestibular sensitivity is increased.
  • Vestibular function is disturbed.

Visceral disease

  • Reflux oesophagitis or gastro-oesophageal reflux disease (GORD).
  • Obstruction – eg, due to malignancy or chronic constipation.
  • Cholecystitis.
  • Hepatitis.
  • Urinary tract infection.
  • Gastroparesis – delayed gastric emptying.

Toxic substance effects/metabolic conditions

  • Drugs, eg cytotoxic agents, erythromycin, digoxin toxicity, theophylline.
  • Alcohol.
  • Hypercalcaemia.
  • Uraemia.
  • Diabetic ketoacidosis.

Central nervous system disease

  • Cyclical vomiting syndrome – this is characterised by recurrent, discrete episodes of vomiting in an otherwise healthy person, usually a child.It can also be associated with episodes of abdominal pain and there is often a family history of migraines.
  • Vestibular labyrinthitis and Ménière’s disease.
  • Raised intracranial pressure – eg, due to a space-occupying lesion, intracranial bleed.

Psychiatric disease

  • Bulimia nervosa.
  • Functional.
  • Psychogenic.

Investigations

Full history

It is important to pay particular attention to duration, severity, aggravating and relieving factors, associated features, drug and occupational history, social history, last menstrual period, previous medical history and recent trauma.

Full examination

In particular, assess hydration and nutritional state, examine the abdomen, sclera and optic discs and check for nystagmus.

The following tests may be appropriate:

  • Urine dipstick – for protein, blood, glucose, pH, bilirubin, urobilinogen.
  • Serum urea.
  • Serum calcium.
  • LFTs.
  • FBC.
  • Pregnancy test.
  • Abdominal X-ray.
  • Abdominal ultrasound.
  • Endoscopy.
  • Abdominal CT/MRI scan.
  • CT or MRI of the brain if there is suspicion of raised intracranial pressure.

Management

General measures

  • Patients with persistent nausea and/or vomiting should be given appropriate dietary advice and advice on fluid intake.
  • Patients with severe dehydration may require treatment with intravenous fluids.
  • Psychiatric or psychology referral may be appropriate for those thought to have an underlying psychiatric/psychological cause.
  • Pregnant women should be given emotional support, advice concerning diet and adequate nutritional intake and be advised to avoid large-volume meals and tight clothing. See the separate Nausea and Vomiting in Pregnancy article for more information.
  • There is some evidence for the use of acupuncture for the symptomatic relief of nausea and vomiting and this may be an option for some patients. It can be particularly efficacious for the prevention of postoperative nausea and vomiting.

Pharmacological

  • Once the cause of vomiting has been established, symptomatic relief may be given (if appropriate) in the form of antiemetic therapy.
  • Many classes of drugs exhibit antiemetic properties – eg, antihistamines, phenothiazines (such as prochlorperazine) and antipsychotic drugs (such as haloperidol).
  • Metoclopramide acts directly on the gastrointestinal tract. However, there is a risk of potentially serious neurological adverse effects with this drug, such as extrapyramidal disorders and tardive dyskinesia.
  • In view of these potential adverse effects, the following restrictions to indications, dose and duration of use of metoclopramide have been made:
    • In adults over 18 years, metoclopramide should only be used for prevention of postoperative nausea and vomiting, radiotherapy-induced nausea and vomiting, delayed (but not acute) chemotherapy-induced nausea and vomiting, and symptomatic treatment of nausea and vomiting, including that associated with acute migraine (where it may also be used to improve absorption of oral analgesics).
    • It should only be prescribed for short-term use (up to five days).
    • Oral liquid formulations should be given via an appropriately designed, graduated oral syringe to ensure dose accuracy.
  • Medications including cyclizine and metoclopramide have been shown to be safe and effective treatments in pregnancy.
  • Domperidone acts at the chemoreceptor trigger zone and is especially useful for nausea and vomiting associated with chemotherapy.
  • Prokinetic agents such as domperidone can also be beneficial in the management of those with gastroparesis.
  • Gastro-electrical stimulation is an option for treating chronic, intractable nausea and vomiting secondary to gastroparesis.
  • Granisetron and ondansetron are specific 5HT3 antagonists and, as such, are particularly useful for postoperative nausea and vomiting and that associated with cytotoxic therapy. They can also be beneficial in children.
  • Dexamethasone and nabilone (a synthetic cannabinoid) may be useful for patients on cytotoxic drugs, with nausea that is resistant to other therapy.

Surgical

Surgery may be required to treat some underlying causes of nausea and vomiting – eg, raised intracranial pressure and some forms of obstruction.

Complications

Recurrent vomiting may result in:

  • Dehydration
  • Electrolyte disturbance
  • Oesophagitis/gastritis
  • Mallory-Weiss syndrome

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