Causes of vomiting bile in the morning

Reviewed and updated for accuracy on August, 11, 2020 by Susanne Felser, DVM

You’ve probably seen your dog scarf down something that is indigestible and chuck it right back up later. Intermittent instances of dog vomiting are generally fine and mostly not concerning from a health perspective.

The presence of bile, however, is a different story. This yellow-green substance is similarly unpleasant to clean up, but if it’s in your dog’s vomit, and especially if your dog is throwing up bile with any frequency, you should have them checked out right away.

Here are five of the most common reasons why dogs throw up bile:

Bilious Vomiting Syndrome

“Bile is a fluid produced in the liver and stored in the gallbladder,” says Dr. Rachel Barrack, DVM. “Once food is ingested, bile gets released into the small intestine and helps to break down food so the body can digest and utilize it appropriately.”

Bilious vomiting syndrome occurs when bile leaks into the stomach from the small intestine. This usually happens because a dog hasn’t eaten in a while or because they’ve consumed an abnormally large amount of fatty foods. It can also happen if the dog has eaten a lot of grass or drank a lot of water.

“Typically, patients affected by bilious vomiting benefit from readily digestible, low-fat, high-fiber diets,” Dr. Barrack says. You may also want to consider smaller, more frequent meals for your dog, especially if the bilious vomiting occurs first thing in the morning, after a long period without eating.

Gastrointestinal Diseases

When a dog is throwing up bile, it’s a sign of a number of conditions that affect the digestive system, including inflammatory disease, ulcers, parasite infections, and certain cancers. In each of these cases, the underlying condition needs to be diagnosed and treated by a veterinarian to relieve the vomiting.

Because bile’s acidity can wear down the esophagus, it can lead to ulcerations if left unchecked. Breeds with sensitive stomachs that are predisposed to problems like this include Bulldog breeds, toy breeds, retrievers, and Poodles, says Dr. Taylor Truitt, DVM.

Pancreatitis

Endocrine disorders like pancreatitis can occur after a dog ingests highly fatty or oily foods, Dr. Truitt says. This causes inflammation of the pancreas, and in turn, bilious vomiting, along with intense abdominal pain and diarrhea.

Pancreatitis usually occurs three to five days after a dog eats fatty foods, but it can occur as early as 24 hours after. So you could see your dog throwing up bile between 24 and 48 hours after they ate the fatty food.

To help treat this, veterinarians will provide care to prevent against dehydration and electrolyte imbalances, Dr. Truitt says. During this time, treatment includes withholding food to allow the pancreas to rest.

Intestinal Blockages

Dr. Truitt states that toys, bones, and even large hairballs can create a blockage in the intestine. “These are emergencies and require immediate medical intervention,” she adds.

Regular vomiting turns into a dog throwing up yellow bile after their stomach has been emptied, but it’s ideal to address this problem before reaching this point. An extreme lack of energy and severe abdominal pain may indicate a blockage.

Surgery is the most common method for removal, Dr. Truitt says, but an endoscopic procedure can resolve some cases.

Allergies

If your dog consumes something they’re allergic to, vomiting may occur, and bile may be present.

Often, this happens shortly after switching to a new food, and Dr. Truitt says that if you notice this, you should switch back to a food that you know works for your dog right away. “Common food offenders include beef, dairy, wheat, egg, chicken, corn, lamb, soy, pork, rabbit, and fish,” she says.

In other cases, a dog may become allergic to something they’ve eaten regularly for years. “Most pets develop food allergies within 1 to 5 years of age,” Dr. Truitt says, “but some pets move, and the change in the environment can trigger new allergies.”

In this case, a strict 12-week diet trial may be conducted to identify the offending protein. You could then work with a veterinary nutritionist to create a diet that removes the allergen without depriving your dog of the vitamins and nutrients needed to function at full strength.

Concerned about your dog vomiting? Learn more about when dog vomiting is an emergency.

Featured Image: iStock.com/Amax Photo

4 most common causes

If you’re throwing up, it usually means your body is trying to get rid of a toxin. But the color of your vomit tells you a lot about what’s going on.

Vomiting clear liquid and stomach bile means there is nothing in your stomach to regurgitate. This can happen because you’ve already thrown up all the food and fluid in your stomach, you’ve been drinking a lot of water, or you haven’t eaten in a long time.

Often, it is a sign of a stomach infection, caused by a bacteria, virus, or parasite. Or it could be from food poisoning. Morning sickness during pregnancy is another reason someone may vomit clear liquid.

Clear vomit can be from cancer chemotherapy and other drugs that can stimulate the vomiting center of the brain. It’s also why migraine headaches, injury, and vertigo may cause vomiting.

Drinking too much alcohol, which your body views as a toxin, can trigger vomiting. Less commonly, clear vomit is due to an obstruction in the GI tract.

1. Indigestion (dyspepsia)

Symptoms

• Nausea
• Stomach bloating
• Dyspeptic symptoms
• Bloating after meals
• Vomiting

Indigestion—also called upset stomach, dyspepsia, or functional dyspepsia—is a general term for discomfort in your upper abdomen. It’s caused by:

• Eating too much or too quickly
• Eating greasy or spicy foods
• Consuming too much caffeine, alcohol, or carbonated beverages
• Smoking
• Anxiety
• Some medications like antibiotics and pain relievers

Indigestion is usually treated by eating smaller meals throughout the day, eating light, bland food, managing stress, and possibly changing medications. If it lasts longer than 2 weeks or doesn’t respond to treatment, contact your doctor. It could be a sign of a more serious condition.

Read more about indigestion.

2. Stomach viruses

Symptoms

• Nausea and vomiting
• Often watery, non-bloody diarrhea
• Often crampy abdominal pain
• Moderate dehydration (dry mouth or skin; urinating less often)

There are many viruses that may cause vomiting. The exact cause is often not as important as managing symptoms and preventing dehydration.

The norovirus is a very contagious viral infection. If you've spent time around large groups of people who haven’t washed their hands enough—like in a daycare center or on a cruise ship—you're more likely to catch it. Symptoms usually come on quickly and last for a few days. It can become serious if you get severely dehydrated. 

The rotavirus is also highly contagious and spread through contaminated water or food, as well as contact with infected surfaces. The young (less than 5 years old) and elderly are at the greatest risk of dehydration as symptoms often last for several days. A rotavirus vaccine is given within the 1st year of life and decreases the severity of disease, but does not completely prevent it.

Treatment focuses on staying hydrated. As long as you can do that at home, you don't need to see a doctor. But if your symptoms last for more than 1 week, or if you become moderately to severely dehydrated, call your doctor or go to urgent care.

Read more about norovirus and rotavirus.

Pro Tip

A common misconception with vomiting is that we must stop it. Yes, vomiting is miserable and, yes, it can lead to dehydration. But depending on the cause, it may be your body’s way of getting rid of a toxin—whether from an infection or something you ingested, such as too much alcohol. —Dr. Chandra Manuelpillai

3. Viral infections

Symptoms

• Nausea and vomiting
• Often watery, non-bloody diarrhea
• Often crampy abdominal pain
• Moderate dehydration (dry mouth or skin; urinating less often)

A range of viral infections, including the cold and flu and COVID-19, can also cause nausea and vomiting. The adenovirus can cause many different symptoms from those of the common cold to gastroenteritis (diarrhea, vomiting, nausea, and stomach pain). It is spread through the stool of an infected person such as with diaper changes.

The flu can also have many different symptoms ranging from fever and body aches to cough, sore throat, and stuffy nose, as well as vomiting and diarrhea, particularly in children. The flu vaccine can be given to anyone over the age of 6 months to prevent it.

COVID-19 can cause many symptoms including fever, chills, headache, body aches, fatigue, sore throat, cough, loss of taste or smell, and vomiting and diarrhea. Symptoms usually start approx 2 to 14 days after exposure. Currently the COVID vaccine, which is being rolled out, has been approved for those over the age of 16.

Treatment focuses on staying hydrated. If you can do that at home, you don't need to see a doctor. But if your symptoms last for more than 1 to 2 weeks, or if you become moderately to severely dehydrated, call your doctor or go to urgent care.

Read more about the cold, flu, and COVID-19.

4. Food poisoning

Symptoms

• Nausea, stomach ache, or cramps
• Headache
• Dizziness
• Diarrhea

Food poisoning, also called foodborne illness or "stomach flu," is an infection of the digestive tract. It can be from food contaminated with bacteria (e.g., E. coli, salmonella, shigella), viruses, parasites, or other toxins. It can also happen when you eat food that’s prepared in an unclean kitchen, isn’t cooked thoroughly, or isn’t stored properly. The symptoms can start anywhere from 20 minutes to several days after eating the contaminated food and end quickly.

Most people recover on their own with rest, fluids, and over-the-counter pain relievers and fever reducers. If you become moderately to severely dehydrated, call your doctor or go to urgent care.

Read more about food poisoning.

5. Acute gastritis

Symptoms

• Nausea or vomiting
• Loss of appetite
• Belly pain, usually in the upper abdomen
• Feeling bloated, usually after eating

Gastritis is an umbrella term for when your stomach lining becomes inflamed. This can happen due to a bacterial infection, overuse of non-steroidal anti-inflammatory drugs (NSAIDs like ibuprofen and naproxen), too much alcohol, or an autoimmune condition. Chronic gastritis can be a lifelong issue, but acute gastritis usually clears up within a few days to weeks.

Treatment requires a visit to your doctor. If it's due to a medication, they may switch your prescription. If it's an infection, your doctor will prescribe antibiotics. And if it's an autoimmune reaction, you might need to see a specialist.

Read more about acute gastritis.

6. Cyclic vomiting syndrome

Symptoms

• Fatigue
• Nausea
• Headache
• Abdominal pain (stomach ache)
• Trouble sleeping

Cyclic vomiting syndrome is marked by severe vomiting that has no apparent cause. Episodes can last for hours or days. Often, you’ll have relatively symptom-free periods in between.

Treatment involves lifestyle changes to try to stop triggering the vomiting episodes. Medications like anti-nausea and migraine therapies can also help.

7. Morning sickness

Symptoms

• Nausea
• Vomiting
• Pregnancy

Morning sickness is nausea and vomiting that happens during pregnancy, usually in the first trimester. It can happen at any time of day. But when it happens in the morning with an empty stomach, the vomit will be clear.

Treatment may include over-the-counter options such as ginger, vitamin B-6 supplements, and doxylamine (Unisom), as well as prescription anti-nausea medications such as ondansetron (Zofran), metoclopramide (Reglan) and/or phenergan.

Other options include not having an empty stomach and avoiding triggers. Some women find acupuncture, acupressure, or aromatherapy helpful. But it is important to always discuss any treatment options with your doctor first to make sure they are safe for you and your baby.

Pro Tip

Depending on the cause, bland foods—like dry bread—may help with the symptoms. Particularly if it is caused by morning sickness. —Dr. Manuelpillai

Other possible causes

A number of conditions and substances may also cause clear vomit, though these are either rare or clear vomit is not usually the most important symptom. They include migraines, chemotherapy, hepatitis A, drugs or alcohol, anesthesia (for surgery), acute pancreatitis, gallbladder disease, and reflux.

When to call the doctor

Call your primary care physician if you are:

• Fever
• Bloody stools
• Unintentional weight loss
• Signs of mild-to-moderate dehydration (excessive thirst, dry mouth or tongue, muscle cramps, and/or dark urine)
• Bloating
• Symptoms lasting for more than 2 days
• Flu-like symptoms that are getting worse

Should I go to the ER for clear vomit?

You should go to the ER for clear vomit with any of these:

• Chest pain
• Persistent bloody stools
• Severe headache or stiff neck
• Lethargy
• A recent head injury
• Unintentional weight loss
• Signs of moderate-to-severe dehydration (dizziness, confusion, and/or no urine output)
• Being unable to hold down any liquid or solid food for 24 hours

Clear vomit treatments

Dr. Rx

Since vomiting is common in children, it is important to discuss proper home management. The younger the child, the higher risk of dehydration. And the more difficult it is to assess for concerning signs and symptoms. This is also true for the elderly. —Dr. Manuelpillai

At-home care

Most symptoms of clear vomiting go away on their own after 2 to 3 days. During this time:

• Stay well-hydrated. Drink water and replace lost electrolytes by drinking sports drinks (e.g., Gatorade) and/or electrolyte supplements (e.g., Pedialyte).
• Slowly reintroduce bland food once you can hold down clear fluids.
• If soft, bland foods stay down, try small amounts of carbohydrates, such as crackers or bread.
• Avoid fatty foods. They can make vomiting worse.

Over-the-counter medications and supplements

• Pepto-Bismol
• Kaopectate
• Antihistamines, such as Dramamine
• Ginger supplements like teas and chews. This is especially helpful if you have morning sickness.

Other treatment options

Prescription medications

• Your doctor may prescribe anti-nausea and vomiting medications, such as ondansetron, metoclopramide, diclegis (approved for use in pregnancy), compazine, or phenergan.

Dr. Manuelpillai is a board-certified Emergency Medicine physician. She received her undergraduate degree in Health Science Studies from Quinnipiac University (2002). She then went on to graduated from Rosalind Franklin University of Medicine and Sciences/The Chicago Medical School (2007) where she served on the Executive Student Council, as well as was the alternate delegate to the AMA/ISMS-MSS G...

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