Vomiting: what can wait until morning, and what can't

It is eleven at night and the dog has just been sick on the landing. The question is not "why". The question is whether this is a bad night or an emergency, because the answer decides whether you go to bed or get in the car.

Most vomiting in dogs and cats is a bad night. Some of it is not, and the difference is nearly always visible if you know what to look at. This is the short list vets go through on the phone.

First: is it actually vomiting?#

Three things get called vomiting and are not:

• Regurgitation — undigested food comes back up with no effort, often in a tube shape, usually soon after eating. No heaving, no warning. This is the gullet, not the stomach, and if it happens repeatedly it needs looking at, but it is a different problem.
• Coughing up foam — a dog that hacks and produces a little white froth is usually coughing, not vomiting. Kennel cough does this.
• Retching with nothing coming up. This one matters. See below.

Vomiting proper has warning: drooling, lip-licking, swallowing, the heaving of the belly, then the stomach contents. Note what came up — food, bile (yellow or green), foam, blood, or something that is not food — because you will be asked.

Go now: the signs that do not wait#

Any one of these, tonight, regardless of how the animal seems otherwise:

• Retching without producing anything, especially a large or deep-chested dog, especially after a meal, with a swollen or tight belly. That is the picture of bloat (the stomach twisting), and it kills within hours.
• Blood — red, or dark and grainy like coffee grounds — in the vomit.
• Repeated vomiting — more than two or three times in a few hours, or unable to keep even water down.
• Something toxic or something solid. The dog got the chocolate, the grapes, the raisins, the xylitol chewing gum, the ibuprofen; the cat chewed the lily. Or a sock, a corn cob, a toy, a bone has gone missing. Do not wait for symptoms; ring the vet and tell them what and when.
• A swollen, hard or painful abdomen, or a dog standing hunched with its front down and back end up and unable to settle.
• Collapse, pale gums, weakness, or a very fast or very slow heartbeat.
• A puppy or kitten, or a very old or already-ill animal. They have no reserves. What a healthy adult shrugs off can put a puppy in hospital.
• A cat that is also not eating — see the section on cats, because for cats this is its own emergency.

If in doubt at night, ring the emergency line. Describing it costs nothing, and the person answering does this every night.

Can probably wait until morning#

If none of the above applies, and the animal:

• has been sick once or twice,
• is alert, responds to you, wants to move around,
• is drinking and keeping water down,
• has pink gums and a normal belly,

then it is very likely to be a bad night — something it ate, a bit of grass, a change of food, a bin raid. Most of these are better by morning.

What to do meanwhile. Take food away for a few hours, but not water; offer small amounts of water often rather than a full bowl to gulp. When the vomiting has stopped for several hours, offer a small, bland meal — plain boiled chicken or white fish with plain rice — and build back up over a day or two. Keep the animal somewhere easy to clean and check on it during the night.

Book the vet in the morning if it is still vomiting, is off its food, has diarrhoea as well, or simply is not itself. And keep a note of the times and what came up.

Cats are different, and it matters#

A cat that vomits and then stops eating is on a clock in a way a dog is not. A cat that eats nothing for two or three days — especially an overweight cat — can tip into a liver condition (hepatic lipidosis) that is far harder to treat than whatever started it. So the rule for a cat is: vomiting plus not eating for more than a day is a vet visit, not a wait-and-see.

Two other cat things. Hairballs are real, but "it's just hairballs" is the most common excuse for a cat that is actually vomiting from something else. A cat that brings up hair once a fortnight is normal; a cat that vomits weekly is not, and needs a vet. And a cat that is vomiting and drinking more than usual, or losing weight, or has become fussy over months, is describing a chronic illness — kidneys, thyroid, gut — and deserves a proper work-up rather than another change of food.

What the vet will ask#

You can save a consultation's worth of time by knowing these:

• When it started, how many times, and the times.
• What came up — food, bile, foam, blood, foreign material.
• What went in — food, treats, anything new, anything it could have stolen.
• Eating and drinking since; peeing and pooing since, and what the poo was like.
• Any medication, and the last worming.
• Energy: normal, quiet, or flat.

"Sick four times since seven, bile the last two, drank a little at nine and kept it down, no diarrhoea, quiet but walking around" is a diagnosis half made. "He's been sick" is a shrug.

This is exactly what the health history in mypet care is for: three lines typed at eleven at night that the vet reads at nine the next morning. It is a boring feature until the night you need it.