What should you know about excessive vomiting after drinking alcohol?

Alcohol can irritate the stomach and can trigger repeated vomiting. Vomiting also removes fluid and salts, while intoxication can make it harder to protect the airway. A person who is very drowsy, confused or difficult to wake may have alcohol poisoning rather than a simple upset stomach.

Other explanations are possible when vomiting continues, especially if there is fever, diarrhoea, a severe headache or strong upper-abdominal pain. Gastroenteritis and food poisoning can cause vomiting; pancreatitis and gallstones may cause significant abdominal pain. A migraine can cause nausea and vomiting, while meningitis is a rare but serious possibility when headache, fever, neck stiffness or light sensitivity occur.

Stay with the person and keep them sitting forward or on their side, never flat on their back. Once fully awake and able to swallow, offer small frequent sips of water or an oral rehydration drink. Pause if sipping triggers more vomiting. Avoid more alcohol, sleeping tablets and driving, and do not make the person vomit.

When vomiting settles, bland foods can be introduced gradually. Keep track of urination, alertness and whether fluids stay down. Do not give drinks to someone who is unconscious, having a seizure or unable to swallow safely.

Call emergency services if the person cannot be woken, is confused, has slow or irregular breathing, turns blue or grey, has a seizure, collapses or may have hit their head. Urgent assessment is also needed for blood or coffee-ground material in vomit, severe or worsening abdominal pain, a rigid abdomen, fainting or signs of severe dehydration.

Seek medical advice promptly when repeated vomiting prevents fluids staying down, urination becomes very limited, dizziness is marked, or symptoms continue after the effects of alcohol should have eased. A clinician can check hydration, blood sugar and other causes safely.

Ask what may be driving the vomiting, whether medicines or other substances changed the risk, and how to rehydrate safely. Mention the amount and timing of alcohol, the number of vomiting episodes, abdominal pain, injuries, existing conditions and any medicines taken.