Chronic Vomiting in Cats

What Is Chronic Vomiting in Cats?

As a cat parent, it doesn’t take long to realize that cleaning up vomit is a common occurrence.  Occasional vomiting is normal in cats, but if it happens regularly, then it often has an underlying cause and should be investigated. 

Vomiting in cats usually follows drooling, excessive swallowing, retching, nausea, and a lack of appetite. Occasional vomiting or acute vomiting (lasting more than 7 days) can often be a normal reflex to hair buildup in the cat’s stomach or as a protective mechanism.

Chronic vomiting (persisting more than 3 weeks) is caused by many conditions and diseases. It can often be a true medical or even surgical emergency. If you think your cat suffers from chronic vomiting, seek the advice of your veterinarian immediately.

Symptoms of Chronic Vomiting in Cats

Besides vomiting, which may contain blood, cats with chronic vomiting often have other symptoms including:

• Dehydration

• Lethargy

• Foul breath

• Fever

• Weight loss

• Decreased appetite

• Behavioral changes

• Increased thirst

• Increased urination

• Unkempt hair coat

• Painful abdomen

• Palpable thickened intestines

• Palpable masses in abdomen

• Diarrhea (bright-red bloody or black tarry stools)

Causes of Chronic Vomiting in Cats

Vomiting has many causes that may or may not be related to the gastrointestinal tract, which makes determining the specific cause frustrating for veterinarians.

Your veterinarian considers your cat’s age, lifestyle, and environment to help narrow down the cause of their chronic vomiting. For example, given their inquisitive and playful nature, kittens may ingest foreign objects causing gastrointestinal obstruction and vomiting, and cats allowed outdoors may have chronic vomiting due to bacterial or parasitic infections. 

Medium- and long-haired cats vomit more often because they ingest hair while grooming themselves. Excessive grooming causes a buildup of hair (hairballs) in the stomach. These hairballs are often passed undigested in the cat’s feces, or they are occasionally vomited.

You can minimize your cat’s excessive grooming behavior by routinely grooming and brushing them, feeding them a special diet, giving them hairball medication, and keeping them on a strict flea control medication schedule.

Other more serious causes of chronic vomiting in cats include:

• Infections (bacterial, viral, parasitic)

• Endocrine disorders (diabetes, hyperthyroidism, liver or kidney disease)

• Pancreatitis

• Electrolyte disturbances

• Obstruction (due to ingestion of a foreign object, cancer, or intestinal obstruction

• Certain medications or toxins

• Food allergies or intolerance

• Gastrointestinal disorders

• Inflammatory bowel disease (IBD)

• Psychogenic disorders (due to chronic fear or stress)

How Veterinarians Diagnose Chronic Vomiting in Cats

Your veterinarian usually performs a physical exam to determine the type of care your cat needs,

Additional testing may include:

• Stool testing and urinalysis

• Bloodwork

• X-ray and ultrasound imaging

• Biopsy of the gastrointestinal tract or mass (through endoscopy, laparoscopy, or exploratory surgery)

Test results in cats with a chronic vomiting diagnosis may show signs of:

• Anemia (low red blood cell count due to chronic blood loss or inflammation)

• Erythrocytosis (high red blood cell count due to dehydration)

• Low proteins (albumin, cholesterol)

• Electrolyte disturbances

• Increased liver enzymes (ALT, ALKP)

• Increased kidney enzymes (CREA, BUN, phosphorous)

• Organ size (presence of tumors or foreign bodies)

• Increased thickness of the intestinal walls; changes in intestinal function

Further tests may include PLI/TLI/folate/cobalamin to determine absorption ability and markers of pancreatic inflammation, as well as stool cultures or PCR panels to determine the presence of infectious agents.

Also, if food intolerance or allergy is a known cause, your veterinarian may recommend a food trial for diagnostic and treatment purposes. This may entail a novel protein diet (consisting of less common sources of protein, such as fish, duck, rabbit, venison, or kangaroo) or a hydrolyzed diet, where the protein is chemically broken into pieces so the immune system is less likely to react. In some cases, this may be effective as the sole therapy. 

Treatment of Chronic Vomiting in Cats

The primary goal of treatment is to identify the real cause of chronic vomiting so that targeted treatment can be prescribed. For example, hyperthyroidism in cats can be treated with medications, diet, radiation, and even surgery. Surgery is often done when there is a known ingestion of a foreign object, evidence of an obstruction, or evidence of certain cancers.

Supportive care measures, such as IV fluid therapy or pain and antiemetic medications, are often prescribed. Medications such as maropitant citrate, metoclopramide, and ondansetron are used to treat the vomiting, help with nausea, and increase gastrointestinal motility. 

Appetite stimulants such as mirtazapine or capromorelin, vitamin B12 injections, or deworming agents may also be recommended.

It is important to follow your veterinarian’s instructions throughout the treatment, as a combination of medications is typically required to treat your cat’s chronic vomiting.

Recovery and Management of Chronic Vomiting in Cats

The prognosis of cats with more significant or severe disease is often guarded until the underlying cause is determined. Specific treatment to alleviate symptoms and increase comfort can improve your cat’s quality of life. 

Conditions caused by infections or foreign body obstructions offer a much better prognosis and often need only short-term medications and care. Endocrinopathies, such as hyperthyroidism and diabetes, can be managed, but treatments often require lifelong supplementation and monitoring. 

Cancer often carries a much more serious prognosis, and while some cancers can be cured, other types can only be managed until euthanasia is suggested. Certain reasons for vomiting, such as foreign body obstructions, are preventable. So veterinarians advise pet parents to be vigilant and block their cat’s access to trash, hair ties, string, and other small objects.