Why Does My Cat Keep Puking? Understanding Vomiting in Cats

If your feline friend is frequently throwing up, it’s natural to be concerned. Occasional vomiting might seem like a normal cat behavior, perhaps after eating too quickly or having a hairball. However, persistent or frequent vomiting, often referred to as “puking,” is not normal and can be a sign of an underlying health issue. Understanding why your cat keeps puking is the first step in ensuring their well-being. This guide will explore the potential causes of vomiting in cats, what you should discuss with your veterinarian, and the diagnostic and treatment options available.

Understanding Cat Vomiting: When is it a Concern?

Cats vomit for a variety of reasons, and it’s important to differentiate between occasional, benign vomiting and chronic or severe vomiting that requires veterinary attention. While a hairball every now and then might be normal, regular vomiting, even if it seems mild, warrants investigation.

To help your veterinarian diagnose the issue, be prepared to answer questions about your cat’s vomiting habits and overall health, such as:

Potential Toxins: Could your cat have been exposed to poisonous plants or household toxins?
Onset of Vomiting: When did the vomiting episodes begin?
Diet: What is your cat’s regular food, including brand and type?
Outdoor Access and Hunting: Does your cat go outside? If so, does it hunt and potentially ingest prey?
Vomit Composition: What does the vomit look like? (e.g., food, liquid, color)
Medications: Is your cat currently taking any medications or supplements?
Other Symptoms: Is your cat also experiencing diarrhea alongside vomiting?
Appetite: Is your cat still eating normally, or has their appetite decreased?
Vomiting Timing: When does the vomiting occur in relation to meals or other activities?
Weight Changes: Has your cat lost weight recently?
Drinking and Urination: Is your cat drinking or urinating more or less than usual?
String or Toy Ingestion: Does your cat play with and potentially ingest string, yarn, or small toys?

Providing detailed answers to these questions will give your veterinarian valuable clues and help them determine the next steps for diagnosis and treatment.

Decoding Cat Vomit: What Can the Appearance Tell Us?

While the appearance of cat vomit isn’t a definitive diagnosis, it can provide helpful hints for your veterinarian. Here’s a breakdown of what different types of vomit might indicate:

Yellow Vomit: Yellow vomit typically contains bile, a digestive fluid produced by the liver. While it can sometimes suggest liver issues, it’s often seen when a cat vomits on an empty stomach. It could also simply mean your cat ate something yellow.
Clear Vomit: Clear vomit can be due to regurgitation from the esophagus or result from vomiting an empty stomach’s contents.
White, Foamy Vomit: Similar to clear vomit, white, foamy vomit is often associated with regurgitation or vomiting from an empty stomach.
Blood in Vomit: The presence of blood in the vomit indicates bleeding somewhere in the upper digestive tract, which could be the mouth, esophagus, or stomach. This is a serious sign and requires immediate veterinary attention.
Coffee-Ground Vomit: Vomit that looks like coffee grounds suggests digested blood, usually originating from stomach bleeding, commonly seen with stomach ulcers. This is also a serious sign.
Brown, Smelly Vomit: Brown, smelly vomit can also indicate bleeding in the upper gastrointestinal tract or could simply be due to your cat eating something brown and unpleasant.
Undigested Food in Vomit: Vomiting undigested food means the food hasn’t moved out of the stomach properly. This can be caused by food intolerances, allergies, gastrointestinal obstructions, or general irritation. It’s important to note when your cat last ate to help differentiate between these causes. For example, vomiting undigested food after not eating for a day suggests a potential obstruction or motility issue.

Veterinary Examination and Diagnostic Tests for Cat Vomiting

Following a detailed history, the next crucial step is a thorough physical examination by your veterinarian. During the exam, the vet will check for various signs, including:

Abdominal Pain: Palpating the abdomen to check for tenderness or pain.
Abdominal Masses: Feeling for any abnormal lumps or masses in the abdomen.
Foreign Bodies: Checking for obvious foreign objects, such as string under the tongue.
Weight Loss: Assessing for signs of recent weight loss.
Heart Murmurs: Listening to the heart for any abnormal sounds.
Enlarged Thyroid Gland: Palpating the neck area to check for thyroid enlargement.
Fever: Taking the cat’s temperature to check for fever.

The physical exam findings, combined with the information you provide, will guide your veterinarian in determining which diagnostic tests, if any, are necessary.

Initial Diagnostic Tests: X-rays and Blood Work

If further investigation is warranted, initial diagnostic tests often include abdominal radiographs (X-rays) and blood work with a urinalysis.

Abdominal X-rays: X-rays can reveal abnormalities in organ size and shape, identify foreign bodies, detect tumors or masses, assess for constipation, and highlight other structural issues that cannot be felt during a physical exam.
Blood Work: Blood tests can detect organ dysfunction (e.g., liver or kidney disease) and diagnose endocrine disorders like diabetes and hyperthyroidism, which can sometimes cause vomiting.
Urinalysis: A urinalysis, performed alongside blood work, is important for diagnosing conditions such as diabetes, kidney disease, and urinary tract infections, which can also present with vomiting.

Blood work can also sometimes provide clues about toxin exposure, such as antifreeze poisoning. However, definitive tests for many toxins are limited. Often, diagnosis of toxin exposure relies on the owner’s knowledge of potential exposure and the presence of classic clinical signs.

Advanced Diagnostics: Barium Study, Ultrasound, and Endoscopy

Often, initial X-rays may not pinpoint the exact cause of vomiting, but they can help guide further diagnostics. If needed, your veterinarian might recommend more advanced imaging and procedures:

Barium Study: A barium study involves giving the cat barium (a contrast agent) orally and then taking a series of X-rays. This can help visualize the gastrointestinal tract and identify foreign objects within the intestines or assess for motility problems (issues with the movement of food through the digestive system).
Ultrasound: Abdominal ultrasound uses sound waves to create detailed images of internal organs. It’s excellent for evaluating the architecture of organs like the liver, kidneys, pancreas, and intestines, and can help detect tumors, inflammation, or other abnormalities. Ultrasound can also be used to guide biopsies of organs for a definitive diagnosis.
Endoscopy: Endoscopy involves inserting a thin, flexible tube with a camera and light source (endoscope) into the cat’s body. For vomiting cats, endoscopy is typically used to examine the stomach, upper intestines, or colon. It can help locate and sometimes remove foreign objects that don’t show up on X-rays. Endoscopy also allows for direct visualization of the lining of the stomach and intestines to look for inflammation, ulcers, or tumors, and enables the collection of tissue biopsies for microscopic examination.

Exploratory Surgery: When is it Necessary?

In some cases of persistent vomiting that doesn’t respond to initial treatments, or when there’s a strong suspicion of a foreign body or serious underlying condition, exploratory surgery might be recommended. This could be necessary in both acute (sudden onset) and chronic (long-term) vomiting situations.

Foreign Body Removal: If a foreign object is suspected but not confirmed by other imaging, surgery can be used to both diagnose and remove the object.
Biopsy Collection: If no foreign body is found, surgery allows for comprehensive biopsies of the intestines, stomach, liver, pancreas, lymph nodes, and any other abnormal-looking tissues. This is especially helpful in diagnosing chronic vomiting causes like inflammatory bowel disease (IBD) or intestinal cancer.

Surgery vs. Endoscopy:

Both surgery and endoscopy have their pros and cons as diagnostic tools.

Surgery Advantages: Surgery allows for a complete evaluation of the entire intestinal tract and other abdominal organs. It also enables the collection of full-thickness biopsies of the intestinal wall and larger biopsies of other organs like the liver and pancreas.
Surgery Disadvantages: Surgery is more invasive, has a longer recovery time (several weeks), and is generally more expensive.
Endoscopy Advantages: Endoscopy is less invasive, has a faster recovery (usually within a day), and is typically less expensive than surgery. It can often provide representative intestinal biopsies for diagnosis.
Endoscopy Disadvantages: Endoscopy only allows visualization of the inner lining of the gastrointestinal tract and may not always provide full-thickness biopsies. It’s also limited in its ability to evaluate organs outside the gastrointestinal tract.

The choice between endoscopy and surgery depends on the individual cat’s situation, the suspected causes of vomiting, and the veterinarian’s expertise and recommendations.

Cost Considerations:

Diagnostic procedures like endoscopy and exploratory surgery can be expensive. Endoscopy can cost up to $1,500, and exploratory surgery can exceed $2,000. Due to these costs, some pet owners may opt for less invasive treatments without a definitive diagnosis. It’s crucial to have an open and honest discussion with your veterinarian about the risks and benefits of different diagnostic and treatment approaches based on your cat’s specific case and your financial considerations.

Treatment Options for Vomiting Cats

Treatment for cat vomiting is highly dependent on the underlying cause. While a detailed discussion of every possible cause and treatment is beyond the scope of this article, here are some common general treatment approaches:

Fluid Therapy

Fluid therapy is a cornerstone of treatment for most vomiting cats.

Subcutaneous Fluids: For mild cases or as supportive care, veterinarians may administer fluids subcutaneously (under the skin). This helps rehydrate the cat and flush out toxins. Even if a cat isn’t clinically dehydrated, fluids can be beneficial due to fluid loss from vomiting and reduced water intake.
Intravenous (IV) Fluids: In cases of severe dehydration or weakness, IV fluids are often necessary. This involves placing a catheter into a vein to deliver fluids directly into the bloodstream. IV fluids are more effective for severely dehydrated cats and allow for faster and greater fluid administration. However, IV fluid therapy is more expensive and requires hospitalization.

Dehydration itself can worsen vomiting as it makes cats feel unwell, reducing their appetite and increasing the likelihood of further vomiting. Fluid therapy breaks this cycle by rehydrating the cat and improving their overall condition.

Anti-Vomiting Medications (Antiemetics)

Antiemetics are commonly prescribed to help control vomiting. These medications can reduce fluid loss, alleviate abdominal discomfort, and encourage the cat to eat. In some cases, stomach protectants like Pepcid (famotidine) or sucralfate might be considered, although their effectiveness is debated. They are generally safe to use. If antiemetics don’t provide sufficient pain relief, pain medication may be added to the treatment plan.

Dietary Management

Dietary changes are crucial for both acute and chronic vomiting in cats.

Easily Digestible Diet (Acute Vomiting): For acute vomiting episodes, a temporary switch to a highly digestible diet is often recommended. Examples include prescription diets like Royal Canin Gastrointestinal High Energy, Hill’s Prescription Diet i/d, or bland homemade options like plain meat-flavored baby food (ensure it’s onion and garlic-free) or boiled chicken. Note that chicken and baby food are not nutritionally complete and should only be used short-term (a few days).
Dietary Trials (Chronic Vomiting): For chronic vomiting, a diet change can be both therapeutic and diagnostic. If a new diet resolves the vomiting, it suggests a food intolerance, allergy, or potentially low-grade inflammatory bowel disease. Diet trials for chronic vomiting require consistency; keep the cat on the new diet for several weeks to assess its effectiveness. Prescription limited-ingredient or hydrolyzed protein diets are often recommended for diet trials to ensure they are complete and balanced.

Prednisone and Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease (IBD) is a potential cause of chronic vomiting in cats. Prednisone, a corticosteroid medication, is often used to treat IBD. However, prednisone has significant side effects, including increased thirst and urination, weakened immune system, and muscle weakness. It can also worsen certain conditions that cause vomiting, such as pancreatitis, diabetes, and kidney disease.

Prednisone should never be used without veterinary guidance and prior diagnostic testing (at least blood work and X-rays). If initial diagnostics are normal, and further testing is declined, a trial of prednisone might be considered after a thorough discussion with your veterinarian about the potential risks and benefits.

In conclusion, if your cat keeps puking, it’s essential to seek veterinary attention. Vomiting can be a symptom of various underlying conditions, ranging from mild to severe. Working closely with your veterinarian to investigate the cause, consider appropriate diagnostics, and implement a tailored treatment plan is the best way to ensure your feline companion’s health and well-being.