Your dog just threw up. It might be 9pm, and you're standing there with paper towels asking the question every owner asks: is this a "watch him" night, or a "get in the car" night?

Here is the short answer. One or two bouts of vomiting in a dog who is still bright, alert and drinking is usually something to watch at home. Vomiting that repeats, vomiting with blood, a dog who seems weak or in pain, or anything your dog may have swallowed that shouldn't have been swallowed is when to worry. The list below sorts it into three: watch at home, book a video visit, or go to the ER now.

Go to the ER now

Start here, because this is the part that can't wait. Go to an emergency vet now, or call your nearest one on the way, if you see any of these:

• Vomiting that keeps repeating over a few hours. The AKC puts repetitive vomiting over several hours on its emergency list.
• Blood in the vomit. Red, or dark like coffee grounds.
• Retching with little or nothing coming up, especially with a swollen or hard belly, drooling and restlessness. These can be signs of bloat (GDV), a twisted stomach that needs surgery. Large, deep-chested breeds carry the most risk (Merck Veterinary Manual).
• A dog who is weak, collapsed, struggling to stand, or very quiet and not himself.
• Signs of pain: hunched over, whining, shaking, or crying out.
• Dehydration: tacky gums, a dog who can't keep water down, or skin that stays up when you gently lift it (AKC).
• A puppy who vomits and then goes weak or limp. The AKC warns that puppies can go downhill fast, and parvovirus is a real possibility.
• Your dog may have swallowed something: a sock, a corn cob, a toy, or part of one. Vomiting can be the first sign of a blockage (VCA).

If you think your dog ate something toxic (chocolate, xylitol gum, grapes or raisins, human medication, rat bait), call ASPCA Poison Control at 888-426-4435 or your nearest ER vet right away. Don't try to make your dog vomit unless a vet or Poison Control tells you to. They know what fits that exact substance.

A video visit is not an emergency service. If any line above sounds like your dog, skip this post and go.

Book a video visit

This is the middle ground, and where most vomiting nights land: someone with vet training should look in the next day or two. Book a visit if:

• Your dog has vomited more than twice in a day, even if he perks up in between.
• Vomiting has gone on for more than a day or two, even though he seems fairly well (VCA).
• He's eating less, quieter than usual, or has loose stools as well. Vomiting with lethargy, poor appetite or diarrhea is the kind of mix the AKC says to take seriously.
• It keeps coming back. Yellow bile first thing every morning, or an upset stomach every few weeks, is a pattern worth a plan (the AKC's own example of a planned visit).
• He vomits right after drinking. The AKC says that needs an exam, since a blockage is possible.
• A senior dog, a tiny dog, or a dog with kidney or heart problems. Call sooner than you would for a healthy adult.
• You're not sure. That alone is a fine reason.

If it can't wait a day or two, that's your answer: your regular vet or the ER.

Watch at home

Some vomiting is a quick bump. Watching at home is reasonable when all of these are true:

• It happened once or twice, and it has stopped.
• Your dog is alert, drinking, keeping water down and acting like himself.
• No blood, belly swelling or obvious pain, and nothing he could have swallowed that he shouldn't have.
• He's an adult dog, not a young puppy.

While you watch:

• Take a photo of the vomit in good light. Food, foam, yellow bile or something that isn't food all tell a vet a lot.
• Note the time and how many times. The AKC says frequency matters: a couple of bouts in ten minutes followed by a normal dog is less worrying than three over eight hours.
• Check his gums and energy every few hours. Wet, slippery gums are a good sign.
• Ask a vet before you hold back food or water. Don't give human medication either. A vet picks what's right for your dog.

If anything on the first two lists shows up, move up a list. If the vomiting is still going after a day, book the visit. Vomiting in dogs goes through the common reasons why, if you want to read more.

Why it's hard the old way

Vomiting has bad timing. It tends to start in the evening or on a weekend, when the clinic is closed or booked for days. So you either rush to an ER for a bill you didn't need, or you wait and wonder.

And the old way sees one moment: today's dog, not the three bouts last month or the new food. If there's diarrhea too, why does my dog have diarrhea and yellow dog poop help you describe what you're seeing.

What a video visit does

A video visit with Dr. Ellen's team is built for the middle list. Here's how it goes.

1. The records get read first. Upload past visits and lab results once, and the history is there before the call starts.
2. They see your dog on camera. Energy, posture, gums, how he reacts when you touch his belly, and your photo of the vomit.
3. They go through the pattern with you. When it started, how often, what he ate.
4. You get clear next steps. If it means an in-person exam, X-rays or bloodwork, you hear that, and why. Video can't feel a belly or run a test.
5. Your regular vet gets a summary. It goes to the vet who knows your dog.

Visits are scheduled, and most are scheduled within 48 hours. In California you see a vet, and prescriptions are possible when they're right. In every other state it's a wellness visit with Dr. Ellen or a vet tech on her team: advice, a plan, and what to ask your regular vet. A video visit can't promise an answer or a prescription, because some stomachs need hands-on care.

Book a vet visit

Not sure which list your dog is on?

If you can't tell, a video visit with Dr. Ellen's team is a fair next step.

Book a vet visit

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FAQ

When should I worry about my dog vomiting?

Worry when it repeats over a few hours, when there's blood, when he retches with nothing coming up or has a swollen belly, when he seems weak, in pain or dehydrated, or when he may have swallowed something toxic or something that can block. Those mean the ER now. One bout in a dog who acts normal can usually be watched.

How many times can a dog throw up before going to the vet?

There is no magic number; how he acts matters as much as how often. More than two bouts in a day is worth a vet's look, and so is vomiting that carries on for more than a day or two, even in a dog who seems well (VCA). Repeated vomiting over several hours, or any vomiting with blood or weakness, is an ER visit (AKC).

Why is my dog throwing up yellow foam?

Yellow is usually bile, and it often shows up when the stomach is empty. One bout in a bright, otherwise normal dog is usually a watch-and-note case. Yellow bile every morning is a reason to book a planned visit (AKC). Retching with only foam and a swollen belly, or foam with weakness, is an emergency.

Can I see a vet online for my dog vomiting?

Yes, for the middle list. Dr. Ellen's team reads your records, sees your dog on camera and says plainly when he needs an in-person exam. In California that's a vet visit, with prescriptions possible; in other states it's a wellness visit. For emergencies, go to an ER vet or call ASPCA Poison Control at 888-426-4435.

Sources

• Merck Veterinary Manual, pet owner version: Vomiting in dogs
• Merck Veterinary Manual, professional version: Gastric dilation and volvulus in small animals
• American Kennel Club: Tummy troubles: when dog vomiting requires veterinary care
• American Kennel Club: Should I call my dog's vet?
• VCA Animal Hospitals: Vomiting in dogs
• ASPCA Animal Poison Control: 888-426-4435