Vomiting is emptying of stomach content through the mouth; it can be either voluntary or involuntary. It can cause dehydration and electrolyte imbalance which if untreated can be fatal. Vomiting can be due to various causes and usually does not present as an isolated finding. Mostly it can be gastro-intestinal system related cause but disorders in other systems can cause vomiting as a presenting cause.
Causes
- Related to the gastro-intestinal system
- Acute gastroenteritis
- Gastritis
- Gastro-esophageal reflux disease
- Pyloric stenosis
- Intestinal obstruction
- Food allergies
- Food poisoning
- Cholecystitis – inflammation of the gall bladder
- Pancreatitis – inflammation of the pancreas
- Appendicitis
- Hepatitis
2. Related to brain and higher functions
- Motion sickness
- Meniere’s disease ( triad of vertigo, tinnitus and hearing loss )
- Migraine
- Brain tumors
- Hydrocephalus
- Cerebral hemorrhage
3. Pregnancy
4. Metabolic disturbances
- Hypoglycemia
- Hyperglycemia
- Calcium abnormalities
- Uremia and renal failure
5. Other
- Alcohol
- Most of the medications/drugs
- Psychological
Simple vomiting is harmless but it may be the first sign of the serious illness.
But most important fact to consider about is the dehydration caused by which can even kill the patient. Children have more risk of dehydration comparing to adults. Prolonged and excessive vomiting depletes body fluids and alters the electrolyte composition of blood. Also vomiting can lead to serious complications like aspiration of vomitus and cause aspiration pneumonia. Prolonged vomiting can lead to destruction of tooth enamel and forceful vomiting may lead to esophageal tears called as Mallory -Weiss syndrome resulting in vomiting of blood.
First Aid Management
1) Reassure the patient, help him to clean his mouth and remove cloths.
2) Keep in a comfortable position.
3) Give small amount of clear water, if patient vomited again give fluids few minutes later.
4) If it is a breast feeding child, continue Brest feeding.
5) Give much fluid to prevent dehydration. Can give lemon juice, clear fruit juices or rehydration solutions available in market. But do not give dairy products which can induce vomiting in some people.
6) Keep eye on signs of dehydration like crying without tears, dry eyes, dry lips, shrunken skin, passing small amount of darker urine and if severe drowsiness, lethargy, confusion and altered level of consciousness.
7) Over the counter anti-emetics can be administered if available.
8) If possible keep notes about fluid input and output by measuring the drinks as well as vomitus, urine and stool; their amounts and time.
9) Contact your doctor in following situations
- Continuous and profuse vomiting
- Suspected poisoning
- Suspected gall bladder, pancreatic, hepatic diseases
- Suspected appendicitis
- Blood or dark coffee color vomitus
- Dehydration
- Severe abdominal pain
- Headache and neck stiffness
Oral Rehydration Fluid at Home
Homemade drinks like lime juice, salted rice water, salted vegetable or chicken soup can be used instead of water.
WHO new ORS(oral rehydration solution) formula can be used for rehydration a patient with vomiting much effectively than water as it replenishes lost water as well as electrolytes from the body in optimal concentrations.
The basic oral rehydration solute should contain water, sugar, salt in a standard ratio.
- 1 liter of water: 30 ml of sugar: 2.5 ml salt
In 2003 WHO changed the ORS formula to reduced osmolality new formula. The new version is having few added advantages including decrease stool output, reduces vomiting, and reduces the need of unscheduled intravenous therapy.
New ORS formula
| mmol/l | |
| Sodium | 75 |
| Chloride | 65 |
| Glucose ,anhydrous | 75 |
| Potassium | 20 |
| Citrate | 10 |
| Total osmolarity | 245 |
Preparation of ORS
Dissolve the contents of the sachet in 1 liter of boiled and cooled/ or clean water and store in a clean bottle. This can be used for 24hrs and then discard the remaining fluid.