Vomiting

Vomiting is the expulsion of the contents of stomach through the mouth and can be voluntary or involuntary.

 

Common Causes of vomiting include: 

1. Infections: influenza, pertussis, urinary tract infection, food poisoning

2. Diseases of central nervous system: raised intracranial pressure, migraine

3. Metabolic causes: raised blood urea levels, diabetic ketoacidosis, delayed emptying of stomach (gastroparesis), increased blood calcium.

4. Drugs: levodopa, opiates, antibiotics, digoxin therapy, chemotherapy, immunotherapy.

5. Excess alcohol intake

6. Pregnancy related morning sickness

7. Sea sickness or motion sickness 

8. Severe pain due to kidney stone, gall stones, appendicitis

9. Injury to brain 

 

Vomiting can be an early symptom of other serious medical problems such as appendicitis, blockage of the intestines, cancer or a tumor, ulcers in the lining of the stomach or small intestine etc. Type of vomit can assist in diagnosing various conditions like large volumes of vomit suggest intestinal obstruction; vomit containing feces (feculent vomit) suggests lower intestinal obstruction or presence of fistula in gastrointestinal tract; early morning vomiting can be due to pregnancy, alcohol dependence and some metabolic disorders. 

 

If there have been just a few bouts of vomiting, investigations are generally not required. If the complaint persist then following routine tests are done:

(a) Lab tests include,

1. Complete blood count with differential counts

2. Blood electrolyte levels- sodium, chloride, potassium

3. Liver function tests

4. Complete urine examination  

(b) Imaging tests:

1. X-ray of the abdomen 

2. CT scan of the abdomen

 

Depending on the cause of vomiting, the treatment may differ. Homecare includes,
Sipping clear fluids
Gradually drinking larger quantities of clear liquids to prevent dehydration
Avoid solid food till the episodes of vomiting have subsided
Oral rehydration solution(ORS) is recommended to prevent chances of dehydration
Vomiting due to morning sickness in pregnant women can be prevented by eating some crackers before getting out of bed or having a high protein snack before sleeping.If vomiting is due to a bacterial infection, the doctor will prescribe antibiotics to clear the infection.

If vomiting persists, it may lead to following complications:

1. Entering of vomit into wind pipe an individual may choke and die or suffer from pneumonia.

2. Dehydration and electrolyte imbalance

3. Oral health  

4. Mallory- Weiss tear: Erosions in the esophagus or small tears in its mucosa 

5. Continuous vomiting during pregnancy can lead to a serious condition called hyperemesis gravidarum due to which the mother suffers from fluid and mineral imbalance that can endanger her life or of her unborn child.

 

Seek immediate medical help if:

1. Blood in vomit 

2. Vomit is after a head injury (even if the head injury didn’t seem serious) 

3. Severe headache or stiffness of neck, 

4. Severe abdominal pain, 

5. You cannot keep any fluids down for more than 12 hours or 

6. You have been vomiting longer than 24 hours.

 

Prognosis of vomiting is very good. Once the cause is treated, patients do not complain of it. Vomiting can be prevented by eating well cooked hygienic food. In case of nausea, drinking small amounts of clear, sweetened liquids such as soda or fruit juices can be helpful. However orange juice and grapefruit juice must be avoided , since  these are too acidic. Resting in sitting or in a propped position can also be helpful.