Vomiting in Cats

Overview of Feline Vomiting

Vomiting in cats is the most common symptom for which cats present to veterinarians and veterinary emergency clinics. At one time or another, your cat may have a bout of vomiting. Usually, he’ll have eaten something disagreeable, eaten too much or too fast, played 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 cats followed by in-depth information including the many possible causes of vomiting and detailed information about diagnostic tests and possible medical therapies.

Vomiting (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), the central nervous system, and abdominal muscles that work together to expel the contents from the stomach. There are multiple causes of vomiting. An occasional, infrequent isolated episode of vomiting is usually normal.

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 cat vomits once and 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 cat eats or if your cat acts lethargic, or doesn’t want to eat, then medical attention is warranted.

Learn more about what you can do at home with this article – Home Care for the Vomiting Cat. It is important to know what you can NOT give a cat just as it is what is safe to give.

This is a good article about home care of cats with both vomiting and diarrhea.

What To Watch For with Vomiting in Cats

Besides the vomiting, it is important to look for associated signs that should lead you to seek professional help from your veterinarian. Signs may include:

• Dehydration – persistent vomiting can lead to dehydration. Signs of dehydration may include lethargy, weakness, and hiding.
• Abnormal behavior or physical abnormalities associated with prolonged vomiting – the presence of lethargy (reluctance to move), abdominal pain, lack of appetite, diarrhea, weight loss, blood in the vomit, or other physical abnormalities.

NOTE: Please note that vomiting differs from regurgitation. Regurgitation comes from the esophagus and often looks like undigested food. This is NOT vomiting. Vomiting comes from the stomach and is most often accompanied by nausea and involves forceful abdominal contractions. Regurgitation requires less effort and contains fluid, mucus, or undigested food from the esophagus (often tubular in shape). Unlike vomiting, regurgitation is not accompanied by nausea and does not involve forceful abdominal contractions. It is a symptom of an esophageal disease. Learn more about Regurgitation in Cats.

Diagnosis of Vomiting in Cats

Optimal therapy of any serious or persistent medical condition depends on establishing the correct diagnosis. There are numerous potential causes of vomiting in cats and before any treatment can be recommended, it is important to identify the underlying cause. Initial therapy should be aimed at the underlying cause. Tests may include:

• Complete medical history and physical examination, including abdominal palpation. Medical history will most likely include questions regarding the following: vaccination history; diet; appetite; general health; character of vomitus (frequency, progression, presence of blood duration of vomiting); weight loss; past medical problems; medication history; exposure to toxins; possible exposure or ingestion of trash; ingestion of foreign material such as string, ribbon or toys; and the presence of other gastrointestinal signs (such as lack of appetite and/or 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 diagnosis 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 – This is an exploratory surgery that involves the looking into the abdomen for evaluation of abnormalities.

Treatment of Vomiting in Cats

Treatments for vomiting may include one or more of the following:

• Eliminate predisposing cause such as any change in diet or eating plants.
• An acute episode of vomiting in a playful cat, 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.
• Cats that have abdominal pain, diarrhea and act lethargic or have any other physical abnormalities, may be treated with hospitalization. Hospital therapy may include intravenous (IV) fluid administration, 24-hour monitoring, and drug therapy to stop the vomiting. This treatment is often combined with diagnostic testing to determine the cause of the vomiting.
• Sick cats may require referral to an emergency or 24-hour hospital that offers around-the-clock care.

Home Care and Prevention

Home care recommendations include following up with your veterinarian for re-examinations of your cat as recommended and administer any veterinary prescribed medications. If your cat 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 cat 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 ever 20 minutes or so.

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 feline i/d, Iams Recovery Diet, Purina EN or Waltham Low Fat, are usually recommended. Homemade diets can be made from small pieces of cooked chicken breast, chicken baby food, and/or tuna. If your cat eats with no vomiting, gradually return to regular cat food over one to two days.

If vomiting continues at any time or the onset of other symptoms are noted, call your veterinarian promptly.

If your cat is not eating, acts lethargic, the vomiting continues or any other physical abnormalities mentioned above begins, it is important to see your veterinarian. Your cat needs your help and the professional care your veterinarian can provide. If your cat is having the clinical signs mentioned above expect your veterinarian to perform some diagnostic tests and make treatment recommendations.

Prevention is aimed at minimizing your cat’s exposure to foreign material (strings, ribbons, thread, yarn, plastic, toys, earpieces from stethoscopes, baby bottle nipples, etc.) or toxins. Keep your cat indoors to minimize exposure to foreign material that may be located outside.

In-Depth Information on Vomiting in Cats

Below is information for the possible causes of acute vomiting followed by causes of chronic vomiting.

There are many causes of acute vomiting in cats that may include:

Gastrointestinal (GI) disorders

• Bacterial infection of the GI tract
• Diet-related causes such as diet changes, food intolerance, food allergy, dietary indiscretion
• Foreign bodies ingestion such as from toys, string, plastic, hairballs
• 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 such as roundworms, hookworms, and more

Non-gastrointestinal disorders

• 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)
• Overeating
• Pancreatitis
• Peritonitis (inflammation of the membrane lining the walls of the abdominal and pelvic cavities)
• Post-operative nausea
• Pyometra (an accumulation of pus in the uterus)
• Sepsis/systemic infection
• Toxins or chemicals
• Viral infections

Causes of chronic vomiting may include:

Gastrointestinal disorders

• Chronic colitis
• Chronic gastritis (lymphocytic plasma, eosinophilic, granulomatous)
• A 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)
• Parasites
• Severe constipation

Non-gastrointestinal disorders

• Chronic pancreatitis
• Heartworm infection
• Liver failure
• Neurological disorders (neoplasia, inflammatory diseases, etc.)
• Kidney failure
• Toxicity (such as lead)

As noted above, vomiting in cats may be caused by a number of disorders. A single episode of vomiting is rarely a cause for concern but prolonged or excessive vomiting may be a sign of a serious underlying problem. If your cat is vomiting, have her examined by a veterinarian before she becomes dehydrated or debilitated.

Different diseases will be considered as potential causes of vomiting by your veterinarian depending on your cat’s medical history and physical examination. If the vomiting has been occurring for three months in an 8-year-old cat 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 cat’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 and before any treatment can be recommended, it is important to identify the underlying cause. Therapy should be focused on the underlying cause.

Diagnosis In-depth

Certain diagnostic tests must be performed to confirm the causes of vomiting. Your veterinarian may recommend a number of laboratory tests for your cat.

• CBC – A complete blood count (CBC) may be needed to evaluate your cat for infections, inflammation, parasitic infection or anemia.
• Chemistry – 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 tests that may be recommended include a serum amylase and lipase – to evaluate for evidence of pancreatitis.
• Urine testing – A urinalysis is recommended to evaluate kidney function and look for signs of infection
• Fecal – Fecal examinations will 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, ribbon, toys, etc.); tumors; 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 – Commonly referred to as an “ultrasound”, 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. It can help diagnosis foreign bodies and tumors.
• Endoscopy – An endoscope may be useful to diagnose 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 – 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.

Treatment In-depth

There are numerous potential causes of vomiting in cats; 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 cat’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 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, Purina EN or Waltham Low Fat are usually recommended. You can also try feeding a small amount of canned food, chicken baby food, cooked chicken breast and/or tuna. If your cat eats this without vomiting, you can return to regular cat food gradually over three to four days.
• Fluid therapy is indicated if your cat 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. Occasionally, bicarbonate supplementation 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 cats that are seriously dehydrated or debilitated.
• Antiemetics are drugs that are used to control vomiting. Common drugs used to control vomiting in cats include:
  • Maropitant citrate (Cerenia®)
  • Ondansetron (Zofran®)
  • Metoclopramide (Reglan®)
  • Chlorpromazine (Thorazine®)
  • Prochlorperazine (Compazine®)
• Drugs to decrease gastric acid secretions are also commonly given to cats with vomiting. Common gastrointestinal protectants include:
  • Pantoprazole (Protonix®) (Link pending)
  • Famotidine (Pepcid®)
  • Cimetidine (Tagamet®)
  • Ranitidine HCl (Zantac®)
  • Sucralfate (Carafate®)

Prognosis for Vomiting in Cats

The prognosis for vomiting largely depends on the underlying cause of the vomiting. Cats with vomiting due to viral infections and food changes respond well to therapy. Cats with chronic vomiting with underlying problems such as kidney failure or cancer may carry a poor prognosis.