Do You Know When to Visit the ER for Vomiting?

How to treat vomiting at home and when to see a doctor

Sick Chid Vomiting

If you call your doctor because of vomiting issues, there’s no way that he or she can diagnose the problem over the phone. However, your symptoms can suggest possible remedies, including whether you need to take a trip to the emergency room, says gastroenterologist Brian Kirsh, MD.

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“There’s no way to determine the diagnosis,” he says. “I wish there was a better way to triage over the phone. There’s no way to look into a crystal ball and say, ‘This will get better in an hour.’ If we knew those things, we would be clairvoyant.”

How to treat vomiting at home

Vomiting is often a harmless symptom of an infection (stomach flu) or a mild case of food poisoning.

To treat it:

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  • Drink clear liquids.
  • Avoid solid food until the vomiting ends.
  • Get extra rest.
  • Temporarily stop taking all oral medications, which may irritate the stomach and make vomiting worse.

However, if the vomiting continues, you may need to seek medical help. With extended bouts of vomiting, dehydration is a concern.

When to visit the ER

For the most part, patients with uncontrolled vomiting for more than four or five hours — meaning they can’t keep down even clear fluids — should go to the ER, especially young children or elderly adults. Doctors can give them intravenous fluids and possibly nausea medication to make them more comfortable, Dr. Kirsh says.

“The young and the old are more susceptible to becoming ill more quickly, in terms of dehydration,” he says. “Those are patients you’re going to think about directing to the emergency department earlier rather than later, as opposed to a healthy 45-year-old.”

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There are several questions a doctor on call will ask (and patients can ask themselves) in determining what the cause might be, as well as the most prudent course of action, Dr. Kirsh says.

Among them:

  1. Are you vomiting blood? In that case he instructs them to go immediately to the ER, “even if it’s just a little bit, because there’s no way to know if it’s a ‘tip of the iceberg’ phenomenon.”
  2. Are you also experiencing diarrhea, and what about bloody diarrhea? That makes an ER trip more likely and can sometimes indicate an outbreak of food poisoning, which typically lasts longer than 24 hours. “Salmonella, e coli, the Jack in the Box outbreaks and those sorts of things can be more serious and prolonged,” Dr. Kirsh says.
  3. Was it something you ate? There’s no way to know for certain, but if you have friends or family members you recently saw who are also ill “that lends itself to an infectious cause,” he says. “We all ate at a picnic, and I know three other people who are sick.”
  4. Can you keep down clear fluids? If not, “there’s no way to rehydrate without an IV,” Dr. Kirsh says.
  5. Do you have a fever? That makes doctors think it’s probably an infection, although certain illnesses such as Crohn’s disease can bring bouts of fever due to inflammatory reactions. Fevers are less likely to happen if the cause is acid reflux, ulcer disease or bowel obstruction, although not having a fever doesn’t change the calculation about going to the emergency room.
  6. Do you have other significant symptoms? Dr. Kirsh says other red flags include severe abdominal pain, lethargy and mental confusion (the latter two symptoms are easier to decipher over the phone if someone other than the patient calls). “Those are big red flags,” he says, “and they should come in.”

Use these questions to help you identify red flags — reasons to visit an ER for vomiting rather than riding it out. If you are ever in doubt, call your doctor.