Nausea and Vomiting: When Should You See A Doctor?

Learn How to Treat at Home and When to See Your Doctor

Nausea and vomiting have many possible causes, some benign and some serious. No matter what the cause, nausea, and vomiting feel awful and can be debilitating—and a sudden episode can be very scary. The first step to getting better is narrowing down why you got sick in the first place.

Food poisoning, stomach viruses, pregnancy, overindulgence in alcohol, and migraines are some common, typically harmless causes of nausea and vomiting that can be treated with hydration, rest, and medications.

More serious causes of vomiting may include:

  • Appendicitis
  • Brain injury
  • Some forms of cancer
  • Heart attack
  • Inflammatory bowel disease
  • Intestinal obstruction
  • Kidney or liver disorders
  • Meningitis

Many cancer patients receiving chemotherapy also suffer from nausea and vomiting.

Children commonly experience vomiting due to viruses, motion sickness, overeating, and high fevers, but they may also vomit for more serious reasons. 

It's important to know whether to get medical attention or focus on nursing yourself back to health at home—or a combination of these. Prolonged vomiting can cause dehydration, which can become a medical issue on its own, so it's important to try to pin down why you're sick.

1
Ask Yourself These Questions First

How your vomiting started, and any additional symptoms you have, can provide clues to its causes. Here are some questions to ask yourself: 

Were you feeling fine and then suddenly started vomiting?

If you had no signs of being sick before you started vomiting, this could be a sign of a potentially serious problem, such as appendicitis or an intestinal obstruction. 

Are you experiencing severe abdominal pain?

Vomiting that occurs with abdominal pain (not just nausea) may be a sign of appendicitis. Contact your healthcare provider.

Do you have a severe headache without other symptoms of a stomach bug?

Vomiting that occurs with a severe headache can be a sign of some very serious illnesses such as meningitis. If you are experiencing a severe headache and vomiting, seek medical attention right away. If you have had diarrhea and vomiting and then develop a bad headache, it could be due to dehydration. If you believe this may be the cause of your headache, contact your healthcare provider to determine if you need treatment.

Were you nauseated or experiencing diarrhea prior to vomiting?

These are reassuring signs that your vomiting is most likely due to a stomach bug. It could be a virus such as gastroenteritis or a bacteria such as E. coli or salmonella. While most cases get better on their own, children and those with weak immune systems can develop complications. 

Do you have a fever? 

A fever is another common symptom of a stomach virus. When it occurs with diarrhea and vomiting and you have no other symptoms, you can probably take steps to treat yourself at home unless you believe you are dehydrated.

However, if you have a high fever and vomiting without diarrhea, this could be an indication of a more serious illness. Determine if you have any other symptoms and check with your healthcare provider.

Have you had a head injury in the past 24 hours?

If you or your child has had a head injury in the past 24 hours and has started vomiting, seek medical attention. This could be a sign of a concussion or increased pressure on the brain.

Are you traveling/moving?

Many people experience nausea and vomiting when they get motion sick. Motion sickness is very common when traveling in cars, airplanes, and boats.

Do you have painful urination?

Fever, vomiting, and pain when urinating are all symptoms of a urinary tract infection. If you believe you might have a urinary tract infection, you will need to see your health care provider to be tested and treated with antibiotics.

Do you also have signs of the flu?

If you or your child is congested and are also vomiting, these can be symptoms of influenza (the flu). Vomiting is not common with the flu for adults but occurs more frequently in children. If you believe you or your child may have the flu, contact your healthcare provider. If your symptoms have started within the past 48 hours, you may be a candidate for antiviral medications that might help you feel better a little faster.

2
Look Before You Flush

Gross as it may be, the consistency of your vomit can tell you some information about its cause. Take a look and see if it is: 

Food you recently ate

Most vomiting starts out looking like whatever it was you ate last. If you just vomit a few times and it consists of food, it could be a stomach virus, food poisoning or something completely different, such as pregnancy.

Bright green   

Vomit that is dark green is typically bile. For children, this can signal a serious illness that requires immediate medical attention. It can also occur when a person has vomited so much that there is no food or liquid left in their stomach. In this case, it may be an indication of dehydration.

Bright red

If you are vomiting bright red, it could be blood. Other causes of red vomit can be recently eating or drinking something red or a recent nosebleed. If you know you have not recently had anything red to eat or drink, and have not had a nosebleed, then the presence of bright red vomit indicates a medical emergency.

Coffee grounds 

Black vomit that looks like coffee grounds may also be blood. If it is not fresh blood, it will often turn very dark and look black when you vomit. Although there may not be active internal bleeding, vomit that looks like coffee grounds is still considered a medical emergency.

3
When to See a Doctor for Vomiting

Usually vomiting is caused by a stomach virus and will resolve on its own in 24 hours. As long as you don't get dehydrated, there is no reason to see a doctor for vomiting if you have a stomach virus.

However, as noted above, some illnesses that cause vomiting require urgent or immediate medical attention. 

To recap, signs that you may need to see your healthcare provider for vomiting include:

  • Dehydration (if you repeatedly vomit even small amounts of liquids, you need to see a doctor; other signs of dehydration include no urination for 12 hours especially in young children, dry mouth or eyes, and fatigue)
  • Very severe headache associated with vomiting and/or stiff neck
  • Severe abdominal pain
  • Confusion
  • Fever
  • History of head injury in past 24 hours

4
Home Remedies for Vomiting

If you have a stomach bug or any other more benign cause of vomiting, treatment will most often include rest and small sips of liquid, progressing to a BRAT diet.

Rest

This includes resting your body and your stomach. Do not try to eat or drink anything for 15 to 20 minutes after you vomit.

Lay down and do not attempt to participate in any physical activities while you are sick.

Clear Liquids

If you do not vomit for a period of 15 to 20 minutes, you can try to introduce clear liquids. Take a small sip of water or an electrolyte drink (such as Gatorade or Pedialyte) every 5 or 10 minutes.

As you are able to tolerate the clear liquids, you can slowly increase the amount that you drink each time.

Continue clear liquids for at least 6 hours before proceeding to Step 3.

If you start vomiting again, go back to Step 1.

BRAT Diet

BRAT stands for Bananas, Rice, Applesauce, and Toast.

If you are able to keep clear liquids down for 6 hours or more, you can progress to the BRAT diet. All of these foods are good to eat if you have had a stomach virus. They are bland and easy to digest. You can eat other foods as long as they are also bland and easy to digest. Some other good options include mashed potatoes, dry crackers, and pretzels.

If vomiting returns after you have started the BRAT diet, go back to Step 1.

5
Medications for Vomiting

There are a few medications available to treat nausea and vomiting. Over-the-counter medications for vomiting are typically ineffective, but may help with nausea or an "upset stomach."

Some common OTC medications include:

  • Pepto Bismol, Kaopectate (bismuth subsalicylate). Works by protecting the stomach lining. Do not use this medication if you are allergic to it. Do not combine with aspirin. Also, it should never be given to someone under the age of 12 or to someone under the age of 18 who has the chickenpox or the flu, due to the risk of developing Reye's Syndrome.
  • Dramamine. Although it is an antihistamine (anti-allergy medication), Dramamine is commonly used to treat nausea and vomiting that is caused by motion sickness.

A few prescription medications are available to help with severe nausea and vomiting.

These include:

  • Zofran (ondansetron). Originally developed and used to treat severe nausea and vomiting due to chemotherapy, Zofran is used to treat uncontrolled vomiting in adults and children.
  • Phenergan (promethazine). Phenergan is also an antihistamine, but is frequently used to treat nausea and vomiting. It may also be used as a pain reliever or to make a person fall asleep prior to surgery.

Both of these medications are available by prescription only. Most health care providers will not prescribe them over the phone. It is important to be seen by your healthcare provider before taking one of these medications. Only they can determine if the medication is appropriate for you and your illness. They will also be able to rule out more serious causes of your vomiting.

Sources:

"Nausea and Vomiting." Medline Plus 28 Mar 11. National Library of Medicine. National Institutes of Health. 22 Jun 11.

Cleveland Clinic. Nausea and Vomiting. 

"Antiemetic Medicines: OTC Relief for Nausea and Vomiting." FamilyDoctor.org Jan 11. American Academy of Family Physicians. 23 Jun 11.

"Infant Vomiting." Healthy Children 11 Aug 10. American Academy of Pediatrics. 23 Jun 11.

"Nausea and Vomiting." Mayo Foundation for Medical Education and Research 14 May 11. 23 Jun 11.

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