Vomiting is among the most common reasons that dogs and cats are presented for evaluation. Because there are a multitude
of causes of vomiting, ranging from simple to complex, this can be a challenging problem for clinicians to accurately diagnose
and manage. The problem also causes significant concern for pet owners, especially when there is an onset of frequent severe
vomiting or when the occurrence becomes more chronic and intermittent without adequate control. However, by following a systematic
approach beginning with an accurate history, a thorough physical exam, and appropriate baseline testing (Stage 1), then performing
tests more specific for certain conditions or organ systems (e.g., bile acids assay, leptospirosis serology, ACTH stimulation,
ultrasonography) (Stage 2), and finally where indicated performing advanced procedures for more thorough examination and biopsy
or definitive therapy (endoscopy, exploratory laparotomy), most cases can be diagnosed successfully and managed judiciously.
Vomiting does not constitute a diagnosis in itself. It is emphasized that vomiting is simply a clinical sign of any of a number of disorders that can involve any organ system in the body. In fact, one diagnostic registry service listed
over 400 potential causes of vomiting in dogs! These notes summarize diagnostic approach and various treatment options for
managing dogs and cats with vomiting.
Vomiting refers to a forceful ejection of gastric and occasionally proximal small intestinal contents through the mouth. The
vomiting act involves three stages: nausea, retching, and vomiting. Serious consequences of vomiting include volume and electrolyte
depletion, acid-base imbalance, and aspiration pneumonia.
It is essential that the clinician make a clear differentiation between regurgitation and vomiting at the outset. Regurgitation
is defined as passive, retrograde movement of ingested material, usually before it has reached the stomach. Failure to recognize
the difference between regurgitation and vomiting often leads to misdiagnosis. Regurgitation may occur immediately after
uptake of food or fluids or may be delayed for several hours or more.
A detailed, accurate history is essential
One of the most important early considerations is to determine if any toxins may have been ingested, since some compounds can cause life threatening sequelae. The earlier a toxicity is identified, the greater the chance for
successful management. Currently, xylitol toxicity is being recognized more frequently, and sago palm plants, which can cause severe hepatotoxicity in dogs and cats, are found in more homes and yards than in previous years. Cocoa mulch toxicity (theobromine) is also occasionally seen. Many animals that have ingested toxins are presented with vomiting as a prominent
sign. Key summary points about these toxins are listed here.