Vomiting (Emesis)

What is vomiting?

Vomiting is when your body expels what’s in your stomach, sending it upward through your esophagus and then out of your mouth. It’s a key symptom of several diseases and medical conditions. But it can also happen for mostly harmless reasons.

Vomiting is a three-step process:

• Nausea: This is the feeling of being sick to your stomach or needing to throw up.
• Retching (dry heaving): This is a precursor of vomiting. You do some of the movements, but don’t actually vomit.
• Vomiting: This means the muscles of your upper digestive tract reverse their usual motion. They work together to push what’s in your stomach out, forcefully propelling it up your esophagus and out of your mouth.

What are the most common causes of vomiting?

Vomiting can happen for many reasons. Some of the most common include:

• Chronic conditions like cyclic vomiting syndrome or gastroparesis
• Digestive issues like indigestion
• Head injuries like concussions or skull fractures
• Infectious diseases like Salmonella or Norovirus
• Medication side effects, like with chemotherapy for cancer
• Migraine headaches
• Motion sickness
• Poisoning-type effects, like from something you ate (botulism) or alcohol poisoning
• Pregnancy-related effects, like morning sickness or hyperemesis gravidarum
• Pressure inside your skull from brain injuries or brain bleeds
• Psychological reasons, like seeing or thinking about something nauseating, or mental health conditions ranging from anxiety to eating disorders like bulimia
• Significant strains on your body, like extremely strenuous physical activity or severe pain
• Unpleasant odors or tastes

How is vomiting treated?

Vomiting treatments aim to stop the vomiting, first and foremost. That typically starts with preventing nausea that comes before vomiting. Preventing nausea and treating vomiting can involve many strategies, including:

• Behavior changes: Modifying things like how and what you eat or other parts of your daily routine can help you avoid nausea that leads to vomiting.
• Managing chronic conditions: If you have a condition that can cause nausea, managing that condition may help. A healthcare provider can help you manage your condition and find ways to prevent nausea from happening or at least limit how severe it is.
• Medications: Antinausea and antiemetic drugs may stop or prevent vomiting from happening. These are available in multiple ways, including over the counter or with a prescription.

If you’re repeatedly vomiting, it’s important to prevent related complications like dehydration. Depending on how severe it is, treatment for that can range from drinking extra fluids to receiving intravenous (IV) fluids.

Depending on why you’re vomiting, you might need other treatments. Your healthcare provider can tell you if an underlying condition is causing or contributing to your vomiting. They can also recommend treatment options.

What are the possible complications or risks of not treating vomiting?

Isolated vomiting usually isn’t dangerous. But when vomiting is severe and keeps happening over and over, it can easily turn into a serious issue. Dehydration is one of the first potential complications. Over time, repeated vomiting can lead to malnutrition and unexpected weight loss.

It can also cause especially severe or dangerous conditions, like:

• Barrett’s esophagus
• Esophageal rupture or Boerhaave syndrome
• Mallory Weiss tear
• Tooth erosion

Your healthcare provider is the best person to tell you more about the potential complications for your situation.

When should vomiting be treated by a doctor or healthcare provider?

Vomiting needs medical care when it happens repeatedly for too long or when it causes dehydration. It also needs medical care when it happens with certain symptoms or other conditions.

You should call or see a healthcare provider for vomiting in children under 6 years old if:

• It lasts more than a few hours
• It happens along with diarrhea
• They show signs of dehydration
• They have a fever of 100 degrees Fahrenheit (37.8 degrees Celsius) or higher
• They haven’t peed (urinated) for at least six hours

You should call or see a healthcare provider for vomiting in children over 6 years old if:

• It lasts at least a day
• It happens along with diarrhea for more than 24 hours
• They show signs of dehydration
• They have a fever of 102 degrees F (38.9 degrees C)
• They haven’t urinated for six hours

You should call or see a healthcare provider for an adult with vomiting if:

• It lasts more than a day
• You also have diarrhea, and both last more than 24 hours
• You have signs of moderate dehydration
• You have a swollen or tender abdomen
• You have constant abdominal pain, or the pain is very severe

Danger symptoms and conditions

Vomiting needs emergency medical attention if any of the following apply:

• It happens after a head injury
• You also have light sensitivity, severe headache, neck stiffness, confusion or show signs of lethargy
• You’re vomiting blood (it may be noticeably red or look like coffee grounds)
• You have heart attack symptoms like chest pain or shortness of breath
• You also have severe abdominal pain, especially towards the lower right of your belly (which can signal appendicitis)