Something so incredibly repugnant it causes you to become very sick instantly. Your brain cannot process things as it should and you begin to projectile vomit while looking up.
Dang, Edna, that old snuff dippin' three chinned goon tried to kiss me. I thought I was gonna puke straight up!
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Something extremely straight, as straight as a stream of vomit.
Avril Lavigne’s hair is puke straight.