Stages of vomiting

Vomiting illnesses do not have formal medical stages, but a typical episode - and its main complication, dehydration - moves through recognizable phases. Knowing them tells you when home care is enough and when it is not.

Phase 1 - nausea and warning. Queasiness, loss of appetite, extra saliva, sweating and unease precede vomiting. This is the window to act: stop eating, sit still, sip small amounts of fluid or ORS, and get fresh air. Some episodes abort here.

Phase 2 - active vomiting. One or several bouts over a few hours. The priorities now are small, frequent sips of ORS (a teaspoon to a tablespoon every few minutes - large gulps provoke vomiting), rest, and nothing solid until vomiting settles for a few hours. In stomach infections this phase usually burns out within 6-24 hours as the irritant clears.

Phase 3 - settling and re-feeding. Vomiting stops, nausea fades, appetite creeps back. Reintroduce fluids freely, then light food (rice, dal water, khichdi, toast, banana) in small amounts, returning to normal diet over a day or two. Dairy, oil and spice come last.

The dangerous track - progressive dehydration. If fluid loss outpaces replacement: first thirst and reduced urine; then very dark scanty urine, dry mouth, dizziness on standing; then lethargy, sunken eyes, rapid heartbeat and confusion - at which point this is an emergency needing IV fluids (112/108). Children slide down this track in hours, not days, which is why ORS after every vomit and close watching of urine and energy matter so much in them.

Chronic patterns (pregnancy hyperemesis, cyclic vomiting, obstruction) do not follow this arc - they persist or recur and need medical management from the start.