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Hello, I am Dr Ola and I would be happy to address your concerns about your puppy... The top concern for curious puppies that have sudden/acute gastrointestinal symptoms is ingestion of a poison/household toxin and/or ingestion of a foreign object that may be causing a GI obstruction. Not all foreign objects that are ingested can be visualized on x-ray however. At this point in time, since his lethargy has not improved and he is still vomiting and eating grass (a symptoms of stomach upset), you will need to take him in to your veterinarian again for additional diagnostics so the proper treatment can be started.
I would recommend comprehensive blood work be completed (including a complete blood count, blood chemistry and urinalysis) which will to evaluate infectious/inflammatory process and most importantly organ function in the event of a toxin exposure/ingestion). I also would recommend repeating the stomach x-ray to determine if gas pattern has changed from the previous x-ray yesterday. Your puppy should be kept for the day on intravenous fluids and vomiting medications during this time. If blood work and x-rays are inconclusive, an "exploratory" stomach may be warranted to evaluate the stomach and entire GI tract for foreign objects, functional obstruction (such as intussaception) or perforation of the gut.
I hope this advice was helpful to you. Please let me know if you need clarification on anything or have other questions about this. Also, please do not forget to rate my answer which I hope you found to be "excellent." You may do this by clicking "rate our conversation" below (Your rating is the only means of compensation I receive for answering your question). Again, let me know if I can help you further:)
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