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January 31, 2005

Prolonged Vomiting Can Be Life Threatening. If this occurs observe yourself closely.
M.J. McKeown, MD, FACOG, FACS


It is safe to say that almost all, if not all, persons have had episodes of vomiting in their lives. These can be associated with childhood illnesses, eating occasional bad food, associated with viral or bacterial illnesses as an adult, or associated with more severe and perhaps life threatening illnesses.

The body has a trigger center for vomiting in the brain. This has the somewhat catchy name of the, emetic chemoreceptor trigger center of Borrison and Wang located in the area postrema of the medulla oblongata. This trigger center can be stimulated by motion sickness, chemical imbalance, exposure to certain chemicals and many other specific causes. The drugs used to treat nausea and vomiting act to suppress this center or in some cases act to suppress the mechanisms that stimulate this center. This short discussion is not meant to elucidate these mechanisms or the suppression of them.

The purpose of this discussion is to alert persons to the very real dangerous health threats that can occur with prolonged and or expulsive or projectile vomiting.

The mechanics of vomiting have been extensively studied and still there is not a one agreed upon simple mechanistic system of the act of vomiting. However the exact mechanism is not important to this discussion. The important aspects of the act of vomiting that can produce severe or fatal consequences are the result of the passage of acidic stomach contents over the mucosa of the esophagus which is not designed to withstand that and the sudden pressure surges on the esophageal muscle tube.

Anyone who has suffered severe vomiting well remembers the irritating substances coming from the mouth and frequently out the nose. Part of the irritation can be due to the nature of the ingested substance that comes back up. A major source of irritation of the esophagus and the mucosa of the mouth and nose is the gastric acid that comes up with vomiting. This acidic substance can be seriously corrosive on the mucosa of the esophagus and persons with GERD or Gastric Esophageal Reflux Disease can develop severe changes in that mucosa. This disease is one that should not be ignored and requires serious medical therapy. If the disease is associated with the mechanics of a hiatal hernia then surgical repair may be necessary. If one thinks they suffer from chronic acid reflux into the esophagus they should see a specialist who will look down the esophagus and into the stomach with a special, flexible optic scope to look for changes in the mucosa of the stomach or esophagus and for possible causes of the problem.

The conditions that can be associated with severe and prolonged vomiting relate to the chronic acid attack and pressure changes in the lower esophagus. The earliest changes of a severe nature can lead to the Mallory-Weiss Syndrome which manifests itself as flecks of blood or larger quantities of blood in the vomitus. This bleeding results from the acidic attack and a breakdown of the mucosa and erosion into the small blood vessels in the mucosa. There is a syndrome called the cyclic vomiting syndrome that can be confused with Mallory-Weiss. The most severe and life threatening event possible is Boorhave's Syndrome. This is a rupture of the esophagus with esophageal contents spilling into the central mediastinal cavity of the chest or into a pulmonary cavity. This event is accompanied by severe chest pain followed shortly by collapse. The fatality of this event approaches 90%.

If one is ill enough to be only partially alert and perhaps on the edge of consciousness another event can occur with vomiting which can bring severe illness and possible death. This happens if one vomits and then inhales deeply when the vomitus is still in the mouth and thus the deep breath intake drags it down into the lungs. This causes a severe chemical inflammation of the insides of the lungs and is frequently fatal. If the amount inhaled is large it can be similar to drowning and the person simply drowns in their own vomit. This is most usually seen in alcoholic or drug stupor.

Recommendations:
If vomiting persists and a feeling of severe irritation occurs in the diaphragm area, or the back of the mouth then one needs to seek help in stopping the process.

You can begin to treat yourself with some antacids. If the vomiting is not too severe any of the commercial antacids will do. If you do not have antacids at home and cannot get someone to go to the store for you then you could try a teaspoon of baking soda in a glass of water. This won't taste very good but it will help neutralize the acid. If you plan ahead you could keep a small supply of antacids in your medicine cabinet at home. There is one called Gaviscon® that actually develops protective foam to help protect the gastric and esophageal mucosa. If the vomiting is thought to be associated with tainted food then taking two CharcoCaps® will help. These capsules of activated charcoal are good to keep in the home medicine cabinet. These activated charcoal capsules will also help treat an infectious diarrhea.

If the vomiting persists and treatment with antacids does not seem to help at all then do not hesitate to go to your physician or an urgent care facility. These medical care facilities can give medications that will help stop the nausea by acting on the nerve centers that are initiating the vomiting. Many of these medications have a side effect of making one quite sleepy so someone besides yourself should get you to the medical facility. If you go to a medical facility be sure and tell them if there has been any blood in your vomitus and if any of the severe vomiting was accompanied by severe pain just under your diaphragm.

Vomiting can also accompany radiation or chemotherapy for malignancies.


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