Nausea and Vomiting: What to Do and When to Worry

What is making me feel sick to my stomach?

Nausea is the queasy feeling that you might throw up. Vomiting is the act itself. Both are protective reflexes. Your body is trying to clear something it does not like, whether that is a virus, a bad piece of chicken, or a stress hormone surge.

The most common reasons we see in the clinic:

• Viral gastroenteritis (a "stomach bug"): A virus, often norovirus, that inflames the stomach and intestines.
• Food poisoning: Bacteria or toxins from contaminated food, often hitting 2 to 12 hours after a meal.
• Migraine: Many migraines come with nausea before the headache peaks.
• Pregnancy: Morning sickness, particularly in the first trimester.
• Acid reflux (GERD): Stomach acid moving up the food pipe.
• Medication side effects: Antibiotics, opioid pain pills, and weight-loss drugs (GLP-1s) are common offenders.
• Stress and anxiety: A spike in adrenaline can churn the gut.

In most cases the cause is short-lived. Your job is to stay hydrated while your body finishes the cleanup.

How bad is it? A simple at-home triage

Before you reach for any treatment, figure out where you sit on the severity ladder. We use three tiers.

• Mild: You feel queasy but have not vomited. You can sip water without it coming back up.
• Moderate: You have vomited a few times but can still keep small sips of fluid down between episodes.
• Severe: You cannot keep any fluid down for 4 to 6 hours, or you are showing signs of dehydration (dizzy on standing, dark yellow urine, dry mouth, rapid heartbeat).

If you are in the mild or moderate tier, the at-home plan below usually works. If you are in the severe tier, skip ahead to the red-flag list and reach out for help.

How do I stop throwing up at home?

Once your stomach has emptied itself, the goal is to rest the gut and replace what you lost. That means slow fluids first, then bland food, then a careful return to normal eating.

The small-sips rule (the single most important step)

Do not chug a glass of water. A full stomach triggers another round of vomiting. Instead, take 1 to 2 teaspoons of fluid every 5 to 10 minutes for the first hour. If that stays down, increase to a tablespoon every few minutes.

Best fluids:

• Oral rehydration solution (Pedialyte, Liquid IV, DripDrop): The right ratio of sodium, potassium, and glucose to pull water into your cells.
• Diluted apple or grape juice: Half juice, half water. A 2018 trial in JAMA showed this works as well as Pedialyte for kids with mild dehydration.
• Broth: Salty, warm, easy on the gut.
• Flat ginger ale or coconut water: Decent backup options.

Skip plain water for the first few hours; without electrolytes, it can make low sodium worse.

The BRAT diet (when you are ready for food)

Wait at least 6 hours after the last episode of vomiting before trying solid food. Then start with the BRAT plan:

• Bananas
• Rice (plain white)
• Applesauce
• Toast (dry, white bread)

These foods are low in fiber and fat, which lets the gut rest. After 24 hours of feeling better, you can add in plain chicken, eggs, and crackers. Hold off on dairy, spicy food, and alcohol for another day or two.

Ginger and peppermint (real, low-cost help)

Ginger is one of the few "natural" remedies that has held up in clinical trials. A 2020 review in Nutrients found that 1,000 mg of ginger per day reduced nausea in pregnancy, chemotherapy, and post-surgery patients. Peppermint oil aromatherapy has similar (smaller) data.

Practical use: ginger tea, ginger chews, or 250 mg ginger capsules every 4 hours. A whiff of peppermint essential oil on a tissue can calm the queasy feeling within minutes.

Guidance from the clinic

"In my practice, the biggest risk with vomiting is not the symptom itself; it is how fast people get dehydrated, particularly older adults and anyone on a blood pressure or diabetes medication. If you live in Philly and you cannot keep fluids down for half a day, send me a message before you sit in an ER waiting room. Most of the time we can do a video visit, call in an anti-nausea pill (ondansetron) to your pharmacy, and get you back on the couch within an hour."

When should I go to the ER for nausea or vomiting?

You should contact Fishtown Medicine or go to an emergency care facility if any of the following are true. We treat these as red flags because they suggest the cause is more than a stomach bug.

• You cannot keep any fluids down for 8 to 12 hours.
• Signs of severe dehydration: dizziness when you stand, dark or no urine for 8 hours, sunken eyes, racing heart.
• Severe belly pain or a stomach that feels rock hard when you press on it.
• Fever over 101 degrees Fahrenheit along with the vomiting.
• Blood in the vomit or vomit that looks like coffee grounds (old blood).
• A bad headache, stiff neck, or confusion with the vomiting (rare but serious).
• Recent head injury before the vomiting started.
• You are pregnant and cannot keep food or fluid down for 24 hours (this can be hyperemesis gravidarum, a treatable but serious condition).

When in doubt, message us. A 30-second text often saves a 6-hour ER visit.

How Fishtown Medicine handles acute illness

We treat acute care the way we treat longevity care: personally, and with your full chart in front of us. Because we already have your baseline labs, your medication list, and your history, we can sort a routine bug from something that needs imaging or IV fluids in minutes, not hours.

A typical Fishtown acute-care visit for nausea looks like this:

1. Text triage: You message Dr. Ash. He asks 3 to 5 targeted questions.
2. Video visit if needed: Same-day, often within an hour.
3. Prescription: If the at-home plan is not enough, we send ondansetron (Zofran) to your pharmacy.
4. In-person check: If we are worried about appendicitis, a kidney stone, or a bowel issue, we coordinate same-day imaging or a same-day in-person evaluation through our partner network.
5. Follow-up: A check-in text the next morning to make sure you are back on your feet.

This is the systems-thinking diagnosis approach: assume the simple thing first, but keep a hand on the bigger possibilities.

Scientific References

1. Freedman SB, et al. Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial. JAMA. 2016;315(18):1966-1974.
2. Lete I, Allue J. The Effectiveness of Ginger in the Prevention of Nausea and Vomiting during Pregnancy and Chemotherapy. Integr Med Insights. 2016;11:11-17.
3. Hasler WL, Chey WD. Nausea and vomiting. Gastroenterology. 2003;125(6):1860-1867. Foundational review of mechanisms.
4. Camilleri M, et al. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013;108(1):18-37.
5. Sorensen HT, et al. Severity of hyperemesis gravidarum and pregnancy outcomes. Acta Obstet Gynecol Scand. 2009;88(5):539-544.

Dr. Ash is a board-certified internal medicine physician specializing in preventive medicine and healthspan optimization at Fishtown Medicine in Philadelphia. He takes a systems-thinking approach to help patients extend their healthspan, not just treat symptoms.

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