Vomiting

Vomiting, medically known as emesis, is the involuntary, forceful expulsion of stomach contents through the mouth. While often associated with gastrointestinal infections, vomiting can result from a wide array of health issues including motion sickness, pregnancy, food poisoning, migraines, or more severe conditions such as brain injury or cancer. It is usually a symptom of an underlying condition and not a disease itself.

Vomiting is a reflex action controlled by the brain’s vomiting centre. It serves as a protective mechanism to rid the body of harmful substances or irritants in the stomach or intestines. Vomiting may be acute (lasting less than a week) or chronic (persisting for weeks or longer), and it can be triggered by both physical and psychological stimuli.

The vomiting process involves several steps: nausea, retching, and finally the expulsion of contents. It is regulated by the medulla oblongata and influenced by inputs from the gastrointestinal tract, vestibular system, cerebral cortex, and chemoreceptor trigger zone (CTZ).

Vomiting is a global symptom experienced by people across all age groups. It is one of the most common symptoms leading individuals to seek medical attention. In India, vomiting is frequently observed in cases of foodborne illnesses and gastrointestinal infections, especially in rural areas with poor sanitation.

Globally, vomiting is commonly reported in hospital emergency departments, especially among children and pregnant women. According to WHO, foodborne diseases affect 600 million people globally every year, with vomiting being one of the leading symptoms.

In India, diarrhoeal and gastrointestinal diseases continue to be a significant public health issue, contributing to 13% of all child deaths under age 5, with vomiting as a key symptom.

Vomiting can be categorised based on its cause or presentation:

• Projectile Vomiting: Forceful ejection, often due to neurological conditions or pyloric stenosis in infants.
• Bilious Vomiting: Green or yellow vomit due to bile, indicating obstruction or gastrointestinal reflux.
• Coffee-ground Vomitus: Resembles ground coffee, often indicating gastrointestinal bleeding or ulcer.
• Non-bilious Vomiting: Usually seen in simple infections or motion sickness.
• Cyclic Vomiting Syndrome (CVS): Chronic condition with repeated vomiting episodes, often triggered by stress or infections.

Vomiting can occur due to numerous triggers:

• Infections: Viral gastroenteritis, food poisoning, hepatitis, meningitis
• Pregnancy: Morning sickness, especially in the first trimester
• Motion Sickness: Travel by car, boat, or plane due to vestibular system disturbance
• Medications: Chemotherapy, antibiotics, opioids
• Surgery/Medical Procedures: Anaesthesia, post-operative nausea
• Brain Disorders: Concussion, migraines, brain tumours, increased intracranial pressure
• Metabolic Disorders: Diabetic ketoacidosis, uremia, Addison’s disease
• Psychological Factors: Anxiety, stress, eating disorders like bulimia nervosa
• Food Allergies or Intolerances: Lactose intolerance, gluten sensitivity

Vomiting is often accompanied by other symptoms, depending on the underlying cause:

• Nausea (feeling of queasiness)
• Sweating
• Pallor (pale skin)
• Abdominal pain or cramping
• Dizziness or light-headedness
• Headache
• Loss of appetite
• Fever (in infections)
• Dehydration signs: dry mouth, low urine output, fatigue, sunken eyes, increased thirst

In infants: sunken fontanelle, listlessness, dry nappies, and persistent crying may be indicators.
 

Diagnosis involves identifying the root cause behind vomiting through:

• Medical History: Detailed questioning on symptoms, diet, medication, travel, and family history
• Physical Examination: Checking for signs of dehydration, abdominal tenderness
• Laboratory Tests:
  
  • Blood tests (CBC, electrolytes, liver/kidney function)
  • Urinalysis
  • Pregnancy test
  • Stool tests (for infection or parasites)
• Imaging Tests:
  
  • Ultrasound (for gallbladder, pregnancy, or bowel obstruction)
  • CT scan or MRI (for brain or abdominal issues)
• Endoscopy: To inspect the gastrointestinal tract for ulcers, tumours, or gastritis

Treatment focuses on the cause and symptom relief:

• Hydration: Oral rehydration salts (ORS), intravenous fluids in severe cases
• Medications:
  
  • Antiemetics: Ondansetron (Anset 4mg tablet), metoclopramide (Metvo 10mg tablet), domperidone
  • Antibiotics: If caused by bacterial infection
  • Proton pump inhibitors (PPIs): For acid-related disorders. (PPI 40mg tablet)
  • Antihistamines or anticholinergics: For motion sickness
• Dietary Management:
  
  • Start with clear fluids (water, broths, electrolyte drinks)
  • Gradually introduce bland foods like rice, bananas, toast, and applesauce (BRAT diet)
• Hospitalisation: In cases of severe dehydration, persistent vomiting, or serious underlying illness

While not a substitute for medical treatment, some therapies may provide relief:

• Ginger Tea or Capsules: Natural anti-nausea properties; useful in pregnancy and chemotherapy-induced nausea
• Peppermint Oil: Helps settle the stomach and reduce spasms
• Acupressure: Wristbands targeting the P6 point (Neiguan) may reduce nausea
• Aromatherapy: Using essential oils like lemon, lavender, or ginger for calming effects

Always consult a healthcare professional before trying alternative remedies.

Several factors can increase the risk of vomiting:

• Age: Infants and elderly are more vulnerable
• Pregnancy: Especially in the first trimester
• Travel: Motion sickness susceptibility
• Medications: Chemotherapy, anaesthesia
• Medical Conditions: Migraines, gastrointestinal disorders
• Stress: Psychological factors
• Previous surgeries involving gastrointestinal tract
• Infections and immunocompromised states
   

Untreated or severe vomiting can lead to:

• Dehydration: Loss of fluids and electrolytes
• Electrolyte Imbalance: Affecting heart and muscle function
• Mallory-Weiss Tear: Tear in the oesophagus lining due to forceful vomiting
• Aspiration Pneumonia: Inhalation of vomit into lungs
• Nutritional Deficiencies: In chronic conditions
• Esophagitis: Inflammation from recurring acid exposure
• Weight Loss and Fatigue: In prolonged episodes

• Rest and avoid physical activity post-vomiting
• Sip clear fluids regularly to stay hydrated
• Avoid solid food until nausea subsides
• Stay in a well-ventilated room
• Use cold compresses on the neck or forehead for comfort
• Keep a symptom diary to track potential triggers or patterns
• Inform your doctor of any new or unusual symptoms

• Myth: Vomiting always means food poisoning
  
  • Fact: It can result from many non-infectious causes
• Myth: You should eat immediately after vomiting
  
  • Fact: Wait until nausea completely subsides
• Myth: Vomiting is harmless
  
  • Fact: Severe vomiting can cause dangerous dehydration or electrolyte loss
• Myth: Vomiting is only a stomach issue
• Fact: It can be related to brain disorders, medications, and even psychological triggers
   

Seek immediate medical help if:

• Vomiting persists for more than 24 hours
• There is blood or a coffee-ground appearance in vomit
• Severe abdominal pain or headache occurs
• High fever accompanies vomiting
• Signs of dehydration appear (dry mouth, sunken eyes, no urination)
• The patient is a young child, elderly, or immunocompromised individual
• Vomiting occurs after head injury or new medication
   

• What is causing my vomiting?
• Do I need any tests or imaging?
• Should I stop eating or drinking?
• When should I go to the hospital?
• Are there medications that can help?
• Is this condition contagious?
• How can I prevent this in the future?

• Offer small sips of water or ORS
• Keep the environment quiet and calm
• Help them lie on their side to avoid choking
• Avoid offering food until advised
• Keep track of frequency and type of vomiting to inform doctors
• Encourage rest and avoid unnecessary movement

Vomiting, while often harmless and self-limiting, can be a symptom of serious underlying health issues. Early diagnosis and appropriate care are key to avoiding complications. With proper treatment, lifestyle adjustments, and support, most individuals recover quickly. It’s vital to stay informed and consult a healthcare provider when needed. Especially in vulnerable populations like children and the elderly, vigilance can prevent serious outcomes.