Medically, there wouldn't really be a cause for black liquid, necessarily Unless she ingested something black recently, it wouldn't happen. Instead, it would be more of a green color. This is part of what makes the color choice so interesting. Black typically symbolizes, obviously, something that is unclean or maybe even bad. What the color could suggest is that Emma is unclean, or she at least feels that way, emotionally and now physically.
The black liquid that pours from Emma's mouth after her death is interesting. Emma, in my opinion, didn't think very highly of herself and certainly didn't think that she had amounted much to anything. She was depressed, it seemed. So, the black liquid could be metaphorical to her being as dark, or as gross, as she felt for a long time, manifested literally.
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