When to See a Doctor for Vomiting: 18 Red Flags

Key takeaways:

• There are numerous health conditions associated with vomiting. Many are not serious, but some require prompt or immediate medical care.
• Some symptoms that occur with vomiting may signal a medical emergency like a heart attack or meningitis.
• Even common conditions that result in vomiting can lead to dehydration and electrolyte imbalance. These often require medical care, particularly with older adults and people with other health conditions.

Vomiting is a common symptom of numerous conditions. Many cases are mild to moderate and resolve without medical treatment. Vomiting for days can cause dehydration and a loss of essential electrolytes like sodium and potassium. Still, in those cases, you may simply need to rest at home and drink plenty of fluids.

Sometimes, vomiting is a signal of a dangerous condition that requires emergency care. In this article, we’ll discuss these “red flag” symptoms that may indicate a serious medical condition and the need for immediate care. We’ll also help you understand when you need to see a doctor for vomiting.

When to go to the emergency room for vomiting

The following symptoms may signal a serious condition for which you should seek emergency medical treatment.

1. Chest pain

If you have vomiting and chest pain, you may be having a myocardial infarction (heart attack). The chest pain associated with heart attacks is often described as “crushing” or as though an elephant is sitting on the chest.

A myocardial infarction is caused by a blockage of blood flow in the arteries that supply the heart muscle. When the blood flow is blocked, the tissues do not get oxygen and will die. As time passes, the chances of permanent damage or further complications increase. In some cases, you may only experience nausea and vomiting when you have a heart attack.

2. Pain that radiates to your jaw, shoulder, or arm

New pain in the jaw, shoulder, or arm can also be a sign of a heart attack. It is critical to reach the hospital quickly to receive treatment.

Doctors will usually perform a procedure to open the blocked artery, which will let oxygen-rich blood reach the heart's tissues.

3. Shortness of breath

Shortness of breath or difficulty breathing with vomiting can signal heart trouble, like arrhythmia or heart failure.

Heart failure occurs when the heart is not pumping effectively. Both heart failure and arrhythmia can decrease blood flow to your digestive tract, which often causes vomiting.

4. Hives or rash

If you break out in a rash or hives while you are vomiting, you may be experiencing anaphylaxis.

Anaphylaxis is a severe allergic reaction that can cause loss of consciousness or death if not treated promptly.

5. Swelling in the lips or tongue

Swelling in your lips or tongue associated with vomiting can be caused by a reaction to medication or other allergens. If the swelling progresses, your airway may become blocked, making breathing difficult.

6. Blue lips

Blue lips are often a sign that you are not getting enough oxygen. Blue lips can signal anaphylaxis, a heart attack, or very low blood pressure. These conditions can prevent blood from carrying oxygen to your tissues and organs.

7. The worst headache of your life

People say the headache from bleeding in the brain is the worst they’ve ever experienced. It is different in quality and intensity from other headaches. If you are vomiting with this type of headache, go straight to the emergency room for evaluation and treatment.

8. Sudden onset of slurred speech

A stroke can cause slurred speech or trouble expressing your thoughts. Strokes can be caused by a brain hemorrhage or blocked arteries in the brain. If you have bleeding in the brain, you may need a neurosurgery procedure. Pressure can build up in the brain when blood fills the skull. This can cut off blood flow by compressing the blood vessels.

An ischemic stroke refers to a stroke caused by a blockage in an artery supplying the brain. If blood flow to the brain’s tissues is cut off, the tissues will die from lack of oxygen. Time is of the essence when you have a stroke. There is a small window of time, from three to four hours, during which treatment can relieve the obstruction before cell death occurs.

9. New weakness on one side

Weakness on one side of the face or body can also indicate a stroke. You should call 911 and get to the emergency department immediately if this happens.

10. Trouble with walking and coordination

Having difficulties with walking or coordination may be another sign of stroke. Getting to the hospital as soon as possible is essential. The use of thrombolytic drugs can relieve the blockage and save brain tissue.

11. Severe abdominal pain

If you are vomiting and experiencing severe abdominal pain, you may have a condition like appendicitis or pancreatitis. Both of these conditions necessitate emergency medical care.

12. Large amounts of blood in your vomit or coffee ground appearance

Some blood streaks in your vomit aren't necessarily worrisome. They can occur when your stomach is irritated, for instance. If you have a lot of bright red blood in your vomit, visit the emergency room for an evaluation. This is especially important if you take anticoagulants like warfarin or heparin.

If your vomit looks like coffee grounds, you may be experiencing bleeding in your digestive tract. If you are a heavy drinker or have cirrhosis, you may have bleeding from the blood vessels in your esophagus. You may also have a bleeding ulcer. Esophageal bleeding or a perforated ulcer is an emergency. Without care, it may require a blood transfusion or cause death.

13. Feeling lightheaded or dizzy

If you have been vomiting for hours and cannot hold any food or liquids down, you may be dehydrated. Dehydration can cause lightheadedness, especially when you stand up. You may need intravenous (IV) fluids if you cannot hold down oral liquids.

14. Loss of consciousness (fainting)

Fainting can occur if you are significantly dehydrated. You should go to the emergency room for evaluation if you or someone else has fainted.

15. Confusion

If you are vomiting and feel confused, you may have had a stroke or be dehydrated. It’s essential to see a doctor for evaluation.

16. Dark urine and dry mouth

These are signs of significant dehydration that can result from repeated vomiting. If you cannot hold down fluids to compensate for fluid loss, you might need to receive IV fluids in the emergency department. Other symptoms of dehydration include weakness and an increased heart rate.

17. High blood sugar and diabetes

If you are diabetic and are vomiting with high blood sugar readings, you may have diabetic ketoacidosis. This occurs in people with diabetes with very high blood glucose levels. It is associated with nausea, vomiting, and abdominal pain. If diabetic ketoacidosis is not treated at the emergency room, it can lead to coma and death.

18. High fever and headache or stiff neck

A fever over 101.3 degrees Fahrenheit, along with vomiting, headache, or stiff neck, may mean meningitis or encephalitis. These conditions require immediate medical care.

When to make a doctor’s appointment or see a specialist for vomiting

If you often vomit due to gastritis, gastroparesis, or inflammatory bowel disease (like Crohn's or ulcerative colitis), see your doctor or a gastroenterologist. Gastroenterologists are doctors who specialize in digestive diseases. Treating the chronic underlying condition can help reduce episodes of vomiting.

Here are some reasons to make a doctor’s appointment for your vomiting:

Vomiting lasting longer than 24 hours

If you don’t have red flag symptoms but have been vomiting for longer than 24 hours, you should see a doctor. Children aged 2 to 12 should see a doctor if they vomit for more than 12 hours. For infants, see a doctor after 4 hours of vomiting.

Frequent episodes of vomiting and right upper quadrant pain after eating

If you have been vomiting often with pain in the upper right abdomen after eating fatty foods, you may have cholecystitis (gallbladder inflammation). Cholecystitis is caused by bile collecting in the gallbladder. Bile is a digestive enzyme and can be blocked by gallstones or impaired drainage.

An ultrasound can usually make the diagnosis. If you have cholecystitis, you may have to undergo a cholecystectomy, which is the removal of the gallbladder. If your doctor thinks you have gallbladder disease, they will likely refer you to a general surgeon.

Exposure to hepatitis

If you have been exposed to a hepatitis virus, you should make an appointment with your doctor. Hepatitis A is transmitted through fecal-oral contact.

Hepatitis B and C are transmitted through blood and bodily fluids. Hepatitis C can be effectively treated before liver damage occurs. A vaccine exists to help prevent hepatitis B.

The room is spinning

If you experience bouts of nausea and vomiting along with a sensation that the room is spinning, you probably have vertigo. Various inner ear problems can cause vertigo. Your doctor can prescribe appropriate treatments depending on the cause.

Vomiting and constipation

Constipation and vomiting may mean you have a bowel obstruction. This occurs when a hernia or scar tissue traps your bowel. The bowel can also twist on itself, causing obstruction.

Diabetes and frequent vomiting

If you have diabetes and are vomiting persistently, see your doctor. It may be due to gastroparesis, a gut paralysis from damage to the autonomic nervous system.

Marijuana

You should see your doctor if you smoke a lot of marijuana or ingest THC and experience severe bouts of vomiting.

Doctors can help you with interventions like counseling to stop marijuana use, medications to help manage withdrawal symptoms, or an antiemetic medication for the disorder known as cannabinoid hyperemesis syndrome.

Migraine headaches

If you are having severe headaches with light sensitivity and vomiting, you may be having migraines. The appropriate treatment can help prevent migraine headaches. If you have a migraine, some medications can lessen the headache symptoms.

It can be difficult to know the difference between a migraine headache and a headache due to a brain bleed. The latter requires emergency medical care. Don’t be afraid to go to your local emergency department if you worry your headache is due to bleeding in the brain.

How a doctor can treat vomiting

A doctor can provide the following treatments in addition to diagnosing the underlying cause of your nausea:

• Intravenous (IV) fluids
• Electrolyte replacement
• Anti-nausea drugs (ondansetron, prochlorperazine, metoclopramide)
• Antihistamines to treat allergy symptoms (meclizine, diphenhydramine)

Questions to ask your doctor about vomiting

Asking questions can help you understand why you are vomiting and what to do if it occurs again. You may want to ask your doctor:

• What is causing my vomiting?
• How can I manage symptoms at home?
• When should I go to the emergency room?
• Is my condition contagious?

Frequently asked questions: When to see a doctor about vomiting

Here are a few questions people often ask when they’re wondering whether to see a doctor about vomiting:

How many times should you throw up before you see a doctor?

It is more important to focus on your symptoms rather than on the number of times you vomit.

What if you’re vomiting and you can’t keep water down?

If you cannot keep down water when vomiting, you may need to visit the emergency department to receive intravenous (IV) fluids. It is critical to stay hydrated after vomiting. It helps prevent complications of dehydration.

What if you have been vomiting for hours?

If you are a healthy young adult or teen, you may tolerate vomiting for hours. However, the elderly, very young, or those with medical conditions may need to see a doctor sooner. If you have been vomiting for 24 hours, you should consider seeing a doctor.

A child aged 2 to 12 should see a doctor after vomiting for 12 hours, especially if they can't keep down fluids. Children under the age of 2 are more likely to get dehydrated and should see a doctor after four hours of vomiting.

Final thoughts

Nausea and vomiting are common symptoms of digestive problems but can sometimes signal a serious underlying condition. If your nausea and vomiting come with red flag symptoms, you might be experiencing a neurological or cardiovascular condition. In those cases, you should go straight to the emergency room.

General Medicine follows a strict editorial process, including using real experts to write our articles, vetted primary sources, fact-checking, a secondary medical review, and updates as necessary. This article was medically reviewed and fact checked by Dr. Lane Thaut, DO.

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