Persistent Vomiting: Causes and Solutions

Vomiting

Hello doctor, my girlfriend has been vomiting continuously since midnight the day before yesterday.
She has vomited everything she ate and has not had a fever or diarrhea.
She has vomited to the point of expelling bile.
She is afraid to eat because of the vomiting and has only been drinking fluids to replenish electrolytes.
She has received antiemetic injections and has taken medication, but there has been no improvement.
What could be the cause? Thank you, doctor.

Niming, 10~19 year old female. Ask Date: 2019/08/23

Dr. Hong Yuanbin reply Internal Medicine

Based on your description, it seems to be acute gastroenteritis.
Acute gastroenteritis typically presents with persistent vomiting and diarrhea for the first 2-3 days.
It is recommended to avoid solid foods initially and to consume clear liquids, such as sports drinks or diluted fruit juice (1:1 with water).
After 2-3 days, once the acute phase has passed, you can start eating soft foods, such as congee.
If you continue to have a high fever or feel very unwell after 2-3 days, it is important to visit a larger hospital for evaluation to check for any complications.
Thank you for your inquiry.

Reply Date: 2019/08/23

More Info

Persistent vomiting can be a distressing and concerning symptom, especially when it leads to the expulsion of bile, which indicates that the stomach is empty. In your girlfriend's case, the absence of fever and diarrhea suggests that this may not be a typical case of gastroenteritis, which is often accompanied by these symptoms. There are several potential causes for her condition, and understanding these can help guide appropriate treatment and management.

Potential Causes of Persistent Vomiting
1. Gastrointestinal Obstruction: This can occur due to various reasons, such as adhesions from previous surgeries, tumors, or hernias. An obstruction can prevent food from moving through the digestive tract, leading to vomiting.

2. Acute Gastritis or Gastroenteritis: While she may not have diarrhea, acute gastritis (inflammation of the stomach lining) can still cause severe nausea and vomiting. This can be triggered by factors such as alcohol consumption, certain medications (like NSAIDs), or infections.

3. Migraine-associated Nausea: Some individuals experience nausea and vomiting as a part of their migraine symptoms, even without the typical headache.

4. Metabolic or Endocrine Disorders: Conditions such as diabetic ketoacidosis or adrenal insufficiency can lead to vomiting. If she has any underlying health conditions, this could be a contributing factor.

5. Psychogenic Causes: Stress, anxiety, or other psychological factors can sometimes manifest as physical symptoms, including nausea and vomiting.

6. Medication Side Effects: Certain medications can cause nausea and vomiting as side effects. If she has recently started any new medications, this could be a factor.

7. Food Intolerance or Allergies: Sometimes, the body reacts negatively to certain foods, leading to vomiting. This can occur even if the food was consumed hours or days prior.

Management and Solutions
Given that she has already received anti-nausea medication and has been hydrating, here are some additional steps you can take:
1. Seek Medical Attention: If her vomiting persists, it is crucial to seek medical attention. A healthcare provider may recommend further diagnostic tests, such as blood tests, imaging studies (like an ultrasound or CT scan), or an endoscopy, to determine the underlying cause.

2. Hydration: Continue to ensure she stays hydrated. Electrolyte solutions (like Pedialyte) can help replenish lost electrolytes. Small sips of clear fluids may be more tolerable than larger amounts.

3. Dietary Adjustments: Once she feels ready to eat, start with bland foods that are easy on the stomach, such as crackers, toast, or rice. Gradually reintroduce other foods as tolerated.

4. Rest: Encourage her to rest as much as possible. Sometimes, lying down in a comfortable position can help alleviate nausea.

5. Avoid Strong Odors: Strong smells can exacerbate nausea, so keeping her environment free from cooking odors or strong perfumes can be beneficial.

6. Monitor Symptoms: Keep a close watch on her symptoms. If she develops a fever, severe abdominal pain, or if the vomiting worsens, it is essential to seek immediate medical care.

7. Follow-Up Care: After the acute episode resolves, consider a follow-up appointment with a healthcare provider to discuss any potential underlying issues and to prevent future occurrences.

In conclusion, persistent vomiting can have various underlying causes, and while some may resolve on their own, others may require medical intervention. It is essential to monitor her condition closely and seek medical advice if symptoms do not improve or worsen.

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