Monitoring Vomit Output: Vital Health Indicator?

Vomiting is the involuntary, forceful expulsion of stomach contents through the mouth and sometimes the nose. It is rarely painful but never pleasant.

Vomiting can be caused by a range of factors, including:

- Food poisoning

- Gastroenteritis

- Pregnancy

- Motion sickness

- Hangover

- Brain tumours

- Elevated intracranial pressure

- Overexposure to ionising radiation

- Self-induced vomiting, which can be a component of an eating disorder

- Infections, such as the flu or gastroenteritis

- Emotional stress

- Reactions to certain smells or odours

- Concussion or brain injury

- Some forms of cancer

- Bulimia or other psychological illnesses

- Ingestion of toxins or excessive amounts of alcohol

- Kidney infections and kidney stones

- Blockages in the bowel

- Chemotherapy and radiotherapy

- Inflamed gallbladder

Vomiting can be dangerous if gastric content enters the respiratory tract, which can lead to choking and asphyxiation. It can also lead to dehydration and electrolyte imbalance.

The causes of vomiting

Vomiting is rarely painful but is never pleasant. It is the body's way of getting rid of harmful substances from the stomach or a reaction to something that has irritated the gut. The feeling that one is about to vomit is called nausea.

There are many causes of vomiting, from infections to emotional stress, and in most cases, it is not a sign of anything serious. It is usually the result of an ailment like food poisoning, gastroenteritis, or hangover, or it can be an after-effect of a disease.

Infection

Infections such as influenza, gastroenteritis, and the "stomach flu" can cause vomiting. In most cases, these infections are self-limiting and will resolve within a few days.

Food Poisoning

Food poisoning caused by bacteria in contaminated food can also lead to vomiting.

Pregnancy

Pregnancy, particularly during the early stages, is a common cause of nausea and vomiting. This is often called "morning sickness" but can occur at any time of the day.

Motion Sickness

Motion sickness, which can occur while travelling, can also lead to vomiting.

Emotional Stress

Emotional stress, such as fear, can cause vomiting.

Ingestion of Toxins or Alcohol

The ingestion of toxins or excessive amounts of alcohol can irritate the gut and lead to vomiting.

Medical Conditions

Vomiting can also be caused by certain medical conditions, such as labyrinthitis, kidney infections, kidney stones, a blockage in the bowel, appendicitis, or an inflamed gallbladder.

Medication and Treatments

Additionally, certain medications and treatments, such as antibiotics, opioid painkillers, chemotherapy, and radiotherapy, can induce vomiting.

Psychiatric Disorders

Psychiatric disorders, such as anxiety and depression, can also lead to vomiting.

Brain-Related Causes

Vomiting can also be caused by conditions related to the brain, such as increased intracranial pressure, brain tumours, migraines, and head injuries.

Eating Disorders

In some cases, vomiting may be self-induced due to an eating disorder such as bulimia nervosa or anorexia nervosa.

While vomiting is usually harmless, it can lead to dangerous complications such as dehydration, malnutrition, and tooth enamel erosion. Therefore, it is important to monitor vomit output to identify any potential underlying causes and address them promptly.

The mechanism of vomiting

Nausea is an unpleasant sensation that often precedes vomiting but can also occur on its own. It is associated with decreased gastric motility, increased tone in the small intestine, and reverse peristalsis in the proximal small intestine. Retching, or dry heaves, refers to the strong involuntary effort to vomit, characterised by spasmodic respiratory movements with a closed glottis. During retching, the abdominal muscles, chest wall, and diaphragm contract without expelling any gastric contents.

The actual act of vomiting involves several steps. Firstly, a deep breath is taken, the glottis closes, and the larynx raises to open the upper oesophageal sphincter. The soft palate is also elevated to close off the posterior nares. The diaphragm then contracts sharply downward, creating negative pressure in the thorax, which facilitates the opening of the oesophagus and distal oesophageal sphincter. Simultaneously, the abdominal wall muscles contract vigorously, squeezing the stomach and increasing intragastric pressure. With the pylorus closed and the oesophagus relatively open, the route for expulsion is clear.

The vomiting act has two phases: the retching phase and the expulsive phase. In the retching phase, the abdominal muscles, diaphragm, and respiratory muscles undergo a few rounds of coordinated contractions. In the expulsive phase, intense pressure is formed in the stomach due to enormous shifts in the diaphragm and abdomen, resulting in vigorous and prolonged muscle contractions. The pressure is then suddenly released when the upper oesophageal sphincter relaxes, leading to the expulsion of gastric contents.

Vomiting can be voluntary or involuntary and is typically a protective mechanism to rid the body of noxious substances. However, it can also be self-induced, as seen in eating disorders such as bulimia nervosa.

The risks of vomiting

Vomiting is an involuntary reflex that forcefully expels the contents of the stomach through the mouth and sometimes the nose. While it is rarely painful, it can be dangerous and is never pleasant.

There are several risks associated with vomiting, and it is important to monitor vomit output to identify and address any potential complications. Here are some of the risks:

Dehydration and Electrolyte Imbalance

Prolonged and excessive vomiting can lead to dehydration, as the body loses a significant amount of water. Dehydration can be particularly dangerous for younger children and older adults. In severe cases, intravenous fluid administration may be required to rehydrate the body. Dehydration can also alter the electrolyte status, leading to hypochloremic metabolic alkalosis and hypokalemia (potassium depletion).

Esophageal Damage

Repeated or forceful vomiting can cause erosions in the esophagus or small tears in the esophageal mucosa, known as Mallory-Weiss tears. This can result in severe and life-threatening bleeding, known as Mallory-Weiss syndrome. Bright red blood in the vomit is a symptom of this condition.

Tooth Enamel Erosion

The high acidity of vomit can lead to the destruction of tooth enamel, especially with recurrent vomiting associated with certain eating disorders like bulimia nervosa.

Aspiration Pneumonia

Vomiting can become dangerous if gastric content enters the respiratory tract. Under the influence of certain substances, such as alcohol, the protective gag reflex and coughing reflexes may be compromised, leading to the risk of choking and aspiration pneumonia.

Nutritional Deficiencies and Weight Loss

Chronic vomiting can lead to malnutrition and dangerous weight loss, as the body is unable to retain nutrients from food. This is commonly seen in eating disorders such as bulimia nervosa.

Digestive Problems

Forceful vomiting can cause acid reflux, indigestion, and heartburn. It can also lead to other digestive issues, including constipation, diarrhea, and irritable bowel syndrome.

Hormonal Problems and Reproductive Issues

Chronic vomiting, as seen in eating disorders, can result in hormonal imbalances and reproductive issues, including irregular periods, missed periods, and fertility problems.

Mental Health Issues

Vomiting, particularly when associated with eating disorders, is often linked to mental health problems such as anxiety, depression, self-harm, obsessive-compulsive behaviors, and suicidal thoughts or actions.

It is important to seek medical attention if vomiting persists for more than a day, as it could indicate a more serious underlying condition and increase the risk of the complications mentioned above.

How to recover from vomiting

Monitoring vomit output can help determine the cause of vomiting and whether or not the person is dehydrated. Repeated or profuse vomiting may indicate erosions to the oesophagus or small tears in the oesophageal mucosa.

Immediate Actions

• Rinse your mouth with water and a little baking soda to get rid of the taste of vomit and neutralise the acid.
• Take sips of water or suck on ice chips to prevent dehydration.
• Avoid eating or drinking for 15 minutes to let your stomach rest.
• If you need to move around, go outside for fresh air to relieve nausea.
• Rest in an upright position to help your stomach settle.
• Avoid lying down flat, even if you vomit during the night, as this may cause you to vomit again.
• Place a cool compress over the back of your neck to soothe your nervous system and lower your body temperature.
• Avoid strong or unpleasant smells, as these can cause vomiting if you're already feeling nauseous.
• Avoid oral medications that may irritate your stomach, such as aspirin, ibuprofen, and some blood pressure medications.

After 8 Hours

• Start eating bland, soft, starchy foods. The BRAT diet is recommended: bananas, rice, applesauce, and toast.
• Eat small meals every 2-3 hours to slowly return to a normal diet.
• Focus on mashed potatoes, rice, cream soup, pretzels, and low-fat pudding.
• Avoid fried, greasy, acidic, and sweet foods until 48 hours after your last episode of vomiting.
• Avoid caffeine, tobacco, and alcohol until your stomach feels better, usually for at least 24-48 hours.
• If you are lactose intolerant, refrain from dairy products.

Ongoing Recovery

• Get plenty of rest and limit physical activity for at least 1-2 days.
• If you have frequent bouts of vomiting, consult your doctor for anti-nausea medication.
• Seek medical attention if your vomiting lasts for more than 24 hours, there is blood in your vomit, or you experience severe abdominal pain, lethargy, confusion, a high fever, or rapid breathing.

How to prevent vomiting

Monitoring vomit output can help identify the cause of vomiting, as well as assess the severity and potential complications. For example, the presence of blood in the vomit may indicate a cut or scrape in the esophagus or stomach, while yellow vomit suggests the presence of bile. Monitoring vomit output can also help identify dehydration, which is a common complication of prolonged or excessive vomiting.

• Rest and avoid activity: When feeling nauseous, it is recommended to rest either in a sitting position or in a propped lying position. Activity can worsen nausea and lead to vomiting.
• Modify your diet: Eat small meals throughout the day instead of large meals. Consume bland, light, and easily digestible foods such as crackers, plain bread, cereal, rice, and crackers. Avoid fatty, spicy, and salty foods that can irritate the stomach.
• Drink clear liquids: Sip small amounts of clear, sweetened liquids such as soda, fruit juices (except orange and grapefruit), ice pops, sports drinks, and Pedialyte. Avoid solid foods for up to 24 hours if vomiting is severe.
• Avoid triggers: Stay away from strong odors, including food and cooking smells, perfume, and smoke, that could trigger vomiting.
• Medications: Over-the-counter antiemetics such as dimenhydrinate (Dramamine) and meclizine can help prevent vomiting associated with motion sickness. For pregnancy-related nausea and vomiting, vitamin B6 supplements, and a combination of B6 and doxylamine (an antihistamine) can be effective. Always consult with a doctor before taking any medication.
• Natural remedies: Ginger, in the form of supplements, tea, root, or candies, is a well-studied remedy for nausea and vomiting. Aromatherapy with essential oils such as peppermint, ginger, spearmint, fennel, lavender, and chamomile may also help reduce nausea.
• Wrist acupressure: Applying pressure to the Neiguan (P-6) point on the wrist may help relieve nausea and vomiting.
• Intravenous fluids: In cases of severe dehydration due to vomiting, intravenous fluids may be administered by a healthcare provider.

Frequently asked questions