Potential Complications of Continued Vomiting
If a patient continues vomiting, they will develop dehydration, electrolyte abnormalities (particularly hypokalemia and metabolic alkalosis), and risk aspiration, malnutrition, and potentially life-threatening complications including cardiac arrhythmias from electrolyte disturbances. 1, 2, 3
Immediate Life-Threatening Complications
Fluid and Electrolyte Disturbances
- Dehydration occurs rapidly with persistent vomiting, manifesting as tachycardia, hypotension, decreased urine output, and altered mental status 1, 4, 2
- Electrolyte imbalances develop quickly, including hypokalemia, hyponatremia, hypochloremia, and metabolic alkalosis, which can cause cardiac arrhythmias and neurological alterations 5, 2, 3
- Hypoglycemia may occur with prolonged fasting, particularly dangerous in vulnerable populations 6
Aspiration Risk
- The oral route becomes non-feasible during active vomiting, creating risk of aspiration pneumonia and respiratory compromise 7, 6
- Aspiration is a recognized serious complication that can lead to respiratory distress 5
Progressive Complications with Prolonged Vomiting
Nutritional Consequences
- Malnutrition develops when vomiting persists beyond several days, particularly in patients unable to maintain adequate oral intake 8
- Thiamin deficiency becomes a critical concern when vomiting continues for more than 2-3 weeks, leading to potentially irreversible neurological complications including Wernicke's encephalopathy 1, 4
Gastrointestinal Complications
- Mallory-Weiss tears can occur from forceful vomiting, causing hematemesis and gastrointestinal bleeding 1
- Esophageal injury and gastritis worsen with continued acid exposure 1
- Wound dehiscence may occur in post-surgical patients 7
Systemic Effects
Cardiovascular Complications
- Severe dehydration leads to hypovolemic shock with hypotension and decreased tissue perfusion 1, 2
- Electrolyte abnormalities, particularly hypokalemia and hypomagnesemia, cause cardiac arrhythmias that can be fatal 2
Renal Complications
- Prerenal acute kidney injury develops from volume depletion and decreased renal perfusion 2
- Electrolyte disturbances affect renal function and acid-base balance 2, 3
Neurological Complications
- Altered mental status occurs from severe dehydration, electrolyte imbalances, or hypoglycemia 1, 2
- Seizures may result from severe hyponatremia or hypoglycemia 2
- Thiamin deficiency causes irreversible neurological damage if vomiting persists beyond 2-3 weeks 1, 4
Healthcare Utilization Impact
- Uncontrolled vomiting leads to emergency department visits, unplanned hospital admissions, and increased healthcare costs 7, 5
- One-third of postoperative bariatric patients present to emergency departments within 3 months specifically for dehydration-related complications 4
Critical Pitfall to Avoid
The most dangerous mistake is delaying IV fluid resuscitation and electrolyte correction while attempting oral rehydration in a patient with ongoing vomiting. The oral route is not feasible during active vomiting, and attempting it wastes critical time while dehydration and electrolyte abnormalities worsen 7, 6. Immediate IV access with crystalloid bolus (500-1000 mL) followed by electrolyte assessment and correction is mandatory 6.