When Should You Go to the ER for Vomiting? The Symptoms That Suggest You Shouldn’t Wait

Most people have experienced an upset stomach from time to time - nausea and vomiting is a pretty common symptom that can happen for lots of reasons. And in most cases, the symptoms get better on their own. But there are times when vomiting needs urgent attention.

Vomiting can be a sign of a dangerous medical condition. Or, if it has been going on for several days, it can lead to severe dehydration or low electrolyte levels. We'll help you figure out if it's time to head to the ER (emergency room) or hospital for treatment.

When should you get medical attention for vomiting?

There are two main reasons that vomiting can be a medical emergency:

• It's a symptom of a serious medical condition.

• Someone is vomiting so much that it causes complications.

We'll run through some of the different causes of vomiting in the next section. But first, here are the symptoms that may mean vomiting is caused by a life-threatening emergency:

• Intense abdominal pain

• Chest pain

• Trouble breathing

• New pain in the jaw, shoulder, or arm

• Intense headache, especially if it feels different than prior headaches

• New weakness on one side of the face

• Difficulty with speech

• Difficulty walking or staying awake

• Lightheadedness or dizziness

• Loss of consciousness

• Lip, tongue, or mouth swelling

• Rash or hives

• Blue lips

In most cases, vomiting isn't a symptom of a life-threatening condition. But it can still lead to a medical emergency if you become dangerously dehydrated. So here are the symptoms to watch for:

• Dizziness, or a feeling that you might faint

• Significant weakness or inability to stand

• Confusion or inability to think clearly

• Heart racing

• Intense thirst and dry mouth

• Urine that's dark or the color of tea

• Pale skin that doesn't quickly resolve

Some people focus on how many times they throw up - or for how many days - and wonder when it becomes too much. But your symptoms are a better indicator of how your body is holding up. This is because everyone has a different threshold for when they become dehydrated.

Someone who is young and healthy may do just fine with a few days of the stomach flu. But someone who is older with other medical conditions may feel the effects within hours. Regardless of the number of times that you throw up, if you have the above symptoms, you should go to the ER.

Does the color of vomit matter?

Sometimes people worry when their vomit appears bright green, or when it has streaks of blood in it. But that doesn't always mean something dangerous is going on.

Green vomit

Green vomit is usually a sign of bile in your stomach. This is a digestive juice that's naturally released into the gastrointestinal (GI) tract. Sometimes after you have thrown up several times, there may not be anything left in your stomach (other than bile). So when you vomit, you may notice greenish liquid. By itself, this probably isn't dangerous.

But green vomit can also be a sign of a blockage in your intestines. When this happens, more bile backs up into the stomach than normal. You should get medical attention if your green vomit occurs along with abdominal pain or fever. Another sign that you need to get care is if your first episode of vomiting is green.

Bloody vomit

Sometimes vomiting can cause mild irritation of the lining of the stomach or esophagus. So small streaks of blood in the vomit aren't necessarily cause for alarm.

But more severe bleeding needs immediate medical attention. You should go to the ER if you have:

• Large amounts of bright red blood in the vomit

• Increasing amounts of bright red blood

• Vomit that looks like it has coffee grounds in it

• Liver cirrhosis

• A condition that requires you take an anticoagulant (blood thinner)

• Symptoms of low blood counts (which are like the symptoms of dehydration mentioned above)

What are the different causes of vomiting?

Even though vomiting is a GI symptom, the cause isn't always a problem in the GI tract. Many different medical conditions can lead to nausea and vomiting. Let's take a look by category.

Digestive tract

Problems anywhere along the GI tract can lead to vomiting. This includes the stomach, small intestine, large intestine - even the liver, gallbladder, or pancreas. These GI issues include:

• Gastritis: This is irritation or inflammation of the lining of the stomach. Common causes include infection, acid reflux, alcohol, and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil).

• Gastroenteritis: Most people know this as the stomach flu. Usually a virus causes it, and it often leads to a lot of vomiting and diarrhea.

• Gastroparesis: This condition is a delay in stomach emptying. Diabetes and medications are common causes.

• Colitis: Inflammation of the colon can happen with autoimmune disease, such as Crohn's disease and ulcerative colitis. This also includes infections like C. diff.

• Bowel obstruction: This is when food is unable to pass through your intestines. It can be from scar tissue, hernias, twisted bowel, or illnesses like Crohn's disease.

• Appendicitis:Inflammation or infection of your appendix can cause abdominal pain as well as fever and vomiting.

• Problems with the gallbladder, liver, or pancreas: Inflammation of these organs (cholecystitis, hepatitis, and pancreatitis) can all cause vomiting.

Heart

People often think chest pain is the main symptom of a heart attack. But this is not always true - nausea and vomiting can also be someone's main symptoms. This is especially true for women and people with diabetes.

And heart attacks are not the only heart conditions that can lead to stomach symptoms. In fact, you can experience nausea and vomiting with any stress on the heart. Some examples include:

• Angina: This is a term for chest pain that occurs when your heart doesn't get enough oxygen from your blood.

• Arrhythmia: This is when your heart is out of its normal rhythm and beats abnormally, too fast or too slow.

• High or low blood pressure: Anytime your blood pressure gets too high or low, it can affect blood supply to the stomach and make you feel queasy.

• Heart failure: When your heart doesn't pump as well as it should, this can also affect blood flow to the stomach.

Brain

Some parts of the brain are responsible for sending and receiving signals that cause vomiting. So conditions that affect the brain can sometimes trigger nausea and vomiting. This includes:

• Headaches: This is especially true for migraines.

• Bleeding in the brain: This can be a result of trauma or head injury. But it can also happen spontaneously, like from a burst blood vessel or a brain tumor.

• Increased intracranial pressure: This is when the pressure inside the skull is abnormally high. It can happen with things like bleeding, swelling, infections like meningitis, tumors, and sometimes stroke.

• Vertigo or motion sickness: The inner ear communicates closely with the brain to control our balance. If these signals get interrupted, it can lead to vertigo, a sensation of spinning. This often causes people to have nausea and vomiting.

Hyperemesis

Hyperemesis is a general term that refers to repeated, uncontrollable vomiting. Scientists are still trying to understand exactly what signals in the body cause this to happen. But there are a few conditions that can do it:

• Pregnancy: Many women experience mild nausea and vomiting, especially early in their pregnancy. But some experience more serious symptoms, called hyperemesis gravidarum.

• Marijuana: Low-dose marijuana can help nausea, but high or repeated doses can cause severe vomiting. This is known as cannabinoid hyperemesis.

• Cyclic vomiting syndrome: Some people, both children and adults, experience repeated bouts of uncontrollable vomiting that come and go. It's similar to the way some people get migraines. Scientists aren't sure why this happens or what causes it, but there are clear descriptions of its pattern and symptoms.

Illnesses that affect the whole body

Anytime you're sick, you may have nausea and vomiting. But there are certain conditions that affect the entire body that are more likely to lead to vomiting than others:

• Toxic ingestions: If you take too much of a medication, or something that your body identifies as a toxin, you may start to vomit.

• Intoxication: Similar to the ingestion of something toxic, sometimes drinking too much alcohol can cause vomiting.

• Allergic reaction: Nausea, vomiting, and intestinal cramping can go alongside symptoms of a severe allergic reaction.

• Diabetic ketoacidosis: Sometimes, especially when sick, someone with diabetes may have persistently high blood sugars. This can cause them to develop ketoacidosis, a life-threatening complication of diabetes. Symptoms often include vomiting and abdominal pain.

• Kidney failure: When kidneys don't work properly, waste products build up in the blood. This is uremia, and it can often cause nausea and vomiting.

How can you treat vomiting at home?

Many people can recover from short-lived illnesses at home. If you don't have any of the concerning symptoms above and feel well enough to stay home, there are some ways you can take care of yourself.

The most important way to treat vomiting at home is to stay hydrated. It's important to replenish both fluids and key electrolytes that get lost when you vomit. So don't just try to hydrate with water alone. Instead, try one of these sources of hydration:

• Oral rehydration fluids: This includes drinks like Pedialyte, which you can actually make for yourself at home. It combines sugar, salt, and water. Try to avoid typical sports drinks if you can, which often contain too much sugar and not enough salt.

• Soup broth: This is a great way to get some salt into your system, which can help keep fluids in your body.

• Watered-down juice or popsicles: If you're having trouble drinking, popsicles can be a great and soothing way to get in some fluids. You can also try a juice that you find appetizing, and add some water to reduce the sugar content. Just avoid juice with pulp, like orange juice.

It also helps to take small, frequent sips rather than large gulps of fluids. This is less likely to upset your stomach and cause more vomiting. And keep drinking even if you're vomiting. It might feel like a lost cause, but your body will absorb more than you think.

There are also some medications for nausea that may help alleviate symptoms, and allow you to stay hydrated. Some over-the-counter (OTC) options include:

• Bismuth subsalicylate (Pepto-Bismol): Many people use bismuth subsalicylate for diarrhea, but it can help for nausea as well. It's not safe for children younger than 12 years.

• Dimenhydrinate (Dramamine) and Meclizine (Bonine): The antihistamines dimenhydrinate and meclizine can help with both motion sickness and nausea.

• Phosphorated carbohydrate solution (Emetrol): This is a liquid that can be taken as often as every 15 minutes. But it's important to note that it contains fructose, so it may not be a great option for people with diabetes.

And finally, be patient with yourself as you ease back into eating. Focus on fluids in the early part of recovery. And note that it will likely take time for your digestion to return to normal, even after the nausea and vomiting have improved. So, simple and bland carbohydrates may be a good place to start.

What to expect in the ER

In the ER, your medical team will have two main goals:

• Help you feel better

• Figure out why you're vomiting

To help you feel better, they'll likely place an intravenous catheter (IV) in your arm. There are many IV treatments that can help when you're vomiting:

• Medications that treat nausea

• Fluids to help with hydration

• Electrolyte supplements

The second goal is to figure out what's causing your vomiting. Sometimes the cause is obvious (like food poisoning or vertigo). Other times, your medical team may need to do some studies. These may include:

• Blood tests

• Urine tests

• Imaging tests, possibly an X-ray, ultrasound, or even a CT scan

• Electrocardiogram (ECG)