Vomiting in Dogs
Overview of Vomiting in Dogs
At one time or another your dog may have a bout of vomiting. In fact, vomiting in dogs is one of the most common problems that require a dog to see a veterinarian or go to a veterinary emergency room. Vomiting can be caused by eating something disagreeable, eating too much or too fast, exercising too soon after eating or any number of non-serious conditions. Vomiting may be a sign of a very minor problem or it may be a sign of something very serious.
This article will provide an overview of vomiting in dogs followed by in-depth information including the many possible causes of vomiting and detailed information about diagnostic tests and possible medical therapies.
First, what is vomiting? Vomiting, also known by the medical term “emesis”, is the act of expelling contents from the stomach through the mouth. It’s a reflex act, involving a triggering stimulus (such as inflammation of the stomach) that causes the central nervous system and abdominal muscles to work together to expel the contents from the stomach. An occasional, infrequent isolated episode of vomiting is usually normal.
There are multiple causes of vomiting. Vomiting is a symptom that can be caused by disorders of the gastrointestinal system (stomach and/or intestines) or it can be secondary to a disease from a different system (such as from cancer, kidney failure, diabetes, or infectious diseases). This can make the diagnosis of the cause of the vomiting a challenge.
Vomiting can be defined as acute (sudden onset) or chronic (longer duration of one to two weeks). The severity or concurrence of other signs will determine the recommendation of specific diagnostic tests. Important considerations include monitoring the duration and frequency of the vomiting.
If your dog vomits once then eats normally with no further vomiting, has a normal bowel movement and is acting playful, then the problem may resolve on its own. If the vomiting continues after your dog eats or if your dog acts lethargic, or doesn’t want to eat, then medical attention is warranted.
Here is a very useful article about what you can do at home if your dog is vomiting. Go to: Home Care of the Vomiting Dog.
Vomiting can occur alone or with other symptoms of diarrhea or lack of appetite or not eating. Learn more about home care for a dog that is having both vomiting and diarrhea.
What to Watch For
Additional problems to watch for include:
- Weight Loss
- Blood in the vomit
- Ineffective vomiting
IMPORTANT NOTE: If your dog is trying to vomit but is ineffective, acts restless, please call your veterinarian IMMEDIATELY. This could be a life-threatening emergency medical problem called “Bloat”. Learn more about “Bloat in Dogs.”
Diagnosis of Vomiting in Dogs
Optimal therapy of vomiting in dogs or any other serious or persistent medical condition depends on establishing the correct diagnosis. There are numerous potential causes of vomiting and before any specific treatment can be recommended, it is important to identify the underlying cause. Initial therapy should be aimed at the underlying cause.
Tests to determine the cause of vomiting in dogs may include:
- Complete medical history and physical examination, including abdominal palpation. Medical history will most likely include questions regarding the following: exposure to trash; vaccination history; diet; appetite; general health; character of vomitus (frequency, progression, presence of blood duration of vomiting); weight loss; past medical problems; medication history and presence of other gastrointestinal signs (such as diarrhea).
- Your veterinarian may recommend a number of laboratory tests. These can include a complete blood count (CBC), a serum biochemical panel, and a urinalysis.
- A fecal examination may be recommended to determine the presence of parasites or blood.
- Plain radiography (X-rays) or contrast X-rays (X-rays performed with a contrast material such as barium or aqueous iodine), can help to determine the cause of the vomiting.
- Ultrasonography is an imaging technique that allows visualization of abdominal structures by recording reflection (or echoes).
- Endoscopy may be useful to diagnose or remove certain foreign bodies that are in the stomach.
- Endoscopy can also be used for examination of the stomach and a portion of the intestine (and potentially obtain biopsies of abnormal areas).
- Laparotomy is an exploratory surgery that involves looking into the abdomen for evaluation and correction of abnormalities.
Treatment of Vomiting in Dogs
Treatments for vomiting may include one or more of the following:
- Eliminate any predisposing causes for vomiting such as exposure to trash, change in diet, eating plants, or eating toys.
- An acute episode of vomiting in a playful dog, in the absence of other physical abnormalities, may be treated symptomatically without hospitalization (outpatient treatment). Outpatient treatment may consist of subcutaneous fluids, injectable antiemetics (drugs used to control nausea and vomiting) and a follow-up appointment if the symptoms are not resolved immediately.
- Dogs that have abdominal pain, diarrhea and act lethargic or have any other physical abnormality may be treated with hospitalization. Hospital therapy may include intravenous fluid administration, 24-hour monitoring, and drug therapy. This is often combined with diagnostic testing to determine the cause of the vomiting.
- Sick dogs may require referral to an emergency or 24-hour hospital that offers around-the-clock care.
Home Care and Prevention
Home care includes following-up with your veterinarian for re-examinations of your dog as recommended and administering any veterinary prescribed medications.
If your dog experiences an inadequate response to prior measures, a further workup may be indicated to determine the underlying cause of the vomiting.
Treatments for vomiting are dependent on the cause. Symptomatic therapy of an episode of vomiting includes withholding food and water for three to four hours. If your dog has not vomited by the end of this time, offer small amounts of water (a few tablespoons at a time). Continue to offer small amounts of water every 20 minutes or so until your dog is hydrated.
After the small increments of water are offered, gradually offer a bland diet. Small frequent feedings of a bland digestible diet such as Hill’s prescription diet i/d, Iams Recovery Diet, Provision EN or Waltham Low Fat, are usually recommended. Homemade diets can be made of boiled rice or potatoes (as the carbohydrate source) and lean hamburger, skinless chicken or low-fat cottage cheese (as the protein source). Return to regular dog food should be gradual over one to two days.
If your dog is not eating, acts lethargic, the vomiting continues or any other physical abnormalities mentioned above begins, it is important to see your veterinarian. Your dog needs your help and the professional care your veterinarian can provide. If your dog is having the clinical signs mentioned above expect your veterinarian to perform some diagnostic tests and make treatment recommendations. Recommendations will be dependent upon the severity and nature of the clinical signs.
Prevention of vomiting is aimed at minimizing your dog’s exposure to trash (bones, food products), foreign material (socks, strings, underwear, strings, rope and etc.) or toxins. Leash-walk your dog to minimize exposure to foreign material that may be located outside.
Below is information about both acute and chronic causes of vomiting. These can be divided into conditions that involve the gastrointestinal tract and diseases that do not involve the gastrointestinal tract.
Causes of Acute Vomiting include:
Gastrointestinal (GI) disorders
- Bacterial infection of the GI tract
- Diet-related causes (diet change, food intolerance, food allergy, dietary indiscretion)
- Foreign bodies (bones, toys, clothes, string, plastic, hairballs, rocks)
- Gastric dilatation-volvulus
- Intestinal intussusception (prolapse of one part of the intestine into another)
- Intestinal volvulus (torsion of a loop of intestine, causing obstruction with or without compromising the blood supply to the part by strangulation)
- Intestinal parasites
- Acute kidney failure
- Acute liver failure or gallbladder inflammation
- Diabetes mellitus
- Drugs (certain drugs can cause vomiting including digoxin, cyclophosphamide, cisplatin, adriamycin, erythromycin, and tetracycline)
- Hypercalcemia (excess calcium in the blood)
- Motion sickness
- Neurological disorders (such as vestibular disease, meningitis, increased intracranial pressure or other central nervous system disorders)
- Peritonitis (inflammation of the membrane lining the walls of the abdominal and pelvic cavities)
- Post-operative nausea
- Prostatitis (inflammation of the prostate [the gland in the male which surrounds the neck of the bladder and the urethra])
- Pyometra (an accumulation of pus in the uterus)
- Sepsis/systemic infection
- Toxins or chemicals
- Viral infections (such as parvovirus, coronavirus, distemper)
Causes of chronic vomiting may include conditions that involve the gastrointestinal tract and diseases that do not involve the gastrointestinal tract. Below are possible causes for chronic vomiting in dogs divided into these two groups:
- Chronic colitis
- Chronic gastritis (lymphocytic plasma, eosinophilic, granulomatous)
- Diaphragmatic hernia
- Diet-related (food allergy or intolerance)
- Foreign bodies
- Gastric motility disorders
- Gastric outflow obstruction (due to a variety of causes)
- Gastrointestinal ulceration
- Hiatal hernia (protrusion of a structure, often a portion of the stomach, through the esophageal hiatus of the diaphragm)
- Hypertrophic gastropathy
- Intestinal obstruction
- Neoplasia (the formation of a tumor)
- Severe constipation
- Chronic pancreatitis
- Heartworm infection
- Hypoadrenocorticism (diminished hormone production from the cortex of the adrenal gland)
- Liver failure
- Neurological disorders (neoplasia, inflammatory diseases, etc.)
- Renal failure (kidney failure)
- Toxicity (such as lead)
Vomiting may be caused by a number of disorders. A single episode of vomiting is seldom the reason for concern but prolonged or excessive vomiting may be a sign of a serious underlying problem. If your dog is vomiting, your dog should be examined by a veterinarian before he becomes seriously dehydrated or debilitated.
Different diseases will be considered as potential causes of vomiting by your veterinarian depending on your dog’s medical history and physical examination. For example, when vomiting is acutely noted in an unvaccinated 4-month-old puppy with bloody diarrhea, the first differential diagnosis would be parvoviral enteritis and tests for this virus may be performed. If the vomiting has been occurring for three months in an 8-year-old dog with a history of weight loss, then laboratory work and radiographs (X-rays) may be the diagnostic tests of choice.
Since vomiting can be a symptom of many different diseases, numerous diagnostic tests may be needed to determine the cause of your dog’s problem. The extent of the workup should be discussed with your veterinarian.
Optimal therapy of any serious or persistent medical condition depends on establishing the correct diagnosis. There are numerous potential causes of vomiting in dogs and before any treatment can be recommended, it is important to identify the underlying cause. Initial therapy is most effective when aimed at the underlying cause.
Certain diagnostic tests must be performed to confirm the causes of vomiting. Your veterinarian may recommend a number of for your dog that may include:
- A complete blood count (CBC) may be needed to evaluate your dog for infections, inflammation, parasitic infection or anemia.
- A serum biochemical panel may reveal the cause of vomiting (such as diabetes, liver disease or kidney failure) or demonstrate complications of vomiting (such as abnormal blood potassium).
- Other laboratory tests that may be recommended include 1) a serum amylase and lipase – to evaluate for evidence of pancreatitis; 2) urinalysis – to evaluate kidney function and look for signs of infection; and/or 3) fecal examination to determine the presence of parasites or blood.
- Radiography – Plain radiography (X-rays) can help to determine if the following are present: some foreign bodies (string, rocks, bones, metal, etc.); tumors; gastric dilatation; intussusception (where one piece of intestine prolapses into and becomes trapped in another); gastric or intestinal obstruction; and abnormalities of the kidney and liver. Contrast X-rays (X-rays performed after a contrast material such as barium or aqueous iodine has been ingested by the animal or fed via a stomach tube or given intravenously) can help in the diagnosis of some foreign bodies, show whether food empties from the stomach normally, and determine whether the urinary tract (kidneys, ureter, bladder, and urethra) are normal. Aqueous iodine is preferred over barium if perforation of the stomach or intestines is suspected due to the potentially irritating effects of barium when it leaks into the abdomen.
- Ultrasonography is an imaging technique that allows visualization of abdominal structures by recording reflection (or echoes). This is a non-invasive tool that can be used for evaluation of abdominal contents.
- Endoscopy may be used to diagnosis or remove certain foreign bodies that are in the stomach or to perform an examination of the stomach and a portion of the intestine. It can also be used to obtain biopsies of abnormal areas. A specialist may perform this procedure for which general anesthesia is usually required. The benefit of this procedure is that it is less invasive than surgery. Basically, a fiber-optic tube is inserted into the mouth and advanced through the esophagus and into the stomach and upper small intestine. A disadvantage of endoscopy over surgery is that endoscopy only allows visualization of a small portion of the gastrointestinal tract and only partial thickness biopsies of the bowel can be taken.
- Laparotomy is an exploratory surgery that involves opening the abdomen to look for abnormalities such as foreign bodies, tumors, intestinal obstruction or to obtain biopsies of abnormal tissues. The disadvantage of this procedure is that it requires that an abdominal incision is made. The advantage of this procedure is that all of the abdominal organ contents can be visualized and it allows some abnormalities to be repaired (for example, removal of intestinal foreign bodies). It also allows full thickness biopsies of tissues to be taken for microscopic evaluation.
There are numerous potential causes of vomiting in dogs; therefore, before any treatment can be recommended it is important to identify the underlying cause. The intensity of the treatment will be determined by your dog’s condition.
Treatment often includes withholding food and water while giving fluids and electrolytes intravenously and administering drugs for control of vomiting and/or gastrointestinal protectants.
Potential symptomatic treatments for vomiting in dogs may include:
- Giving no food or water until vomiting has stopped for 12 to 24 hours. This is usually done in conjunction with fluid and electrolyte therapy. Water is then initiated after 12 to 24 hour period. Small increments of water are offered and gradually a bland diet is started. Small frequent feedings of a bland digestible diet such as Hill’s prescription diet i/d, Iams Recovery Diet, Provision EN or Waltham Low Fat are usually recommended. Homemade diets can be made of boiled rice or potatoes (as the carbohydrate source) and lean hamburger, skinless chicken or low-fat cottage cheese (as the protein source). The return to regular dog food should be gradual over three to four days.
- Fluid therapy is indicated if your dog is dehydrated or actively vomiting and/or having diarrhea. For severe cases, IV (intravenous) fluid therapy is important. Balanced electrolyte solution with potassium supplemented may be recommended. Examples of fluids commonly given include Plasmaylte®, Normal Saline, Normosol, and/or Lactated Ringers Solutions (LRS). Occasionally, bicarbonate supplementation or potassium may be required (which will be determined by serum biochemistry lab testing). Dextrose may also be added to the IV fluids. Mild cases can be treated with subcutaneous fluid therapy where the fluid is given under the skin. Subcutaneous fluids are slowly absorbed. Intravenous fluids are important for the survival of animals that are seriously dehydrated or debilitated.
Antiemetics are drugs that are used to control vomiting. Common drugs used in dogs include:
- Metoclopramide (Reglan®)
- Maropitant citrate (Cerenia®)
- Ondansetron (Zofran®)
- Chlorpromazine (Thorazine®)
- Prochlorperazine (Compazine®)
Gastrointestinal protectants may be used to reduce acid secretion in the stomach. Common gastrointestinal protectants used in dogs include:
- Famotidine (Pepcid®)
- Cimetidine (Tagamet®)
- Ranitidine HCl (Zantac®)
- Sucralfate (Carafate®)
- Pantoprazole (Protonix®) (LINK PENDING)
The prognosis for vomiting in dogs largely depends on the underlying cause of the vomiting. Minor problems have a very good prognosis. Serious problems that cause vomiting such as cancer or kidney failure can be more difficult to treat or cure and therefore have a worse prognosis.