1 / 15

Nausea & Vomiting

Nausea & Vomiting. ‘made easy’. First steps. What is the cause? Non-medical treatment Medical treatment 1 st line Other options. Scale of the problem. Occurs in 40-70% patients with advanced cancer 1/3 will have more than 1 contributing factor 1/3 will need more than 1 anti-emetic.

shaine-edwards
Download Presentation

Nausea & Vomiting

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Nausea & Vomiting ‘made easy’

  2. First steps • What is the cause? • Non-medical treatment • Medical treatment • 1st line • Other options

  3. Scale of the problem • Occurs in 40-70% patients with advanced cancer • 1/3 will have more than 1 contributing factor • 1/3 will need more than 1 anti-emetic

  4. Non-medical treatment • Calm environment & good ventilation • Frequent small snacks • Avoid sight & smell of food eg cooking

  5. Gastric stasis - causes • Drugs • Opioids • ‘Squashed stomach syndrome’ • tumour, enlarged liver, ascites • Outflow obstruction • tumour

  6. Gastric stasis - symptoms • Epigastic discomfort • Fullness • Early satiety • Exacerbated by eating / relieved by vomiting • Large volume vomits (undigested food)

  7. Gastric stasis - management • Prokinetic agent metoclopramide 10-20mg tds (oral) 40-80/24hrs sc infusion • Also consider • Domperidone (less side effects but not sc) • PPI to reduce acidity • Steroids 8-12mg dexamethasone for 7 days • 2nd line • Cyclizine 50mg tds po/sc (150mg/24hrs sc infusion) bowel distension

  8. Chemically-induced nausea - causes • Drugs (10-30% on inititation of opioid) • antibiotics, anticonvulsants, antidepressants, cytotoxics, steroids, digoxin, NSAID’s • Metabolic • renal or hepatic failure, hypercalcaemia, hyponatraemia, ketoacidosis • Toxins • ischaemic/obstructed bowel, tumour effect, infection

  9. Chemically-induced nausea - symptoms • Constant nausea • Vomiting is variable in volume & timing • May be other features of drug toxicity

  10. Chemically-induced nausea - management • Haloperidol po/sc 1.5-3mg od/bd 2.5-10 mg/24hrs sc infusion • Also consider • Correct the correctable • Metoclopramide (gastric stasis) 10mg tds

  11. Raised intracranial pressure – causes • Intracranial tumour • Cerebral oedema • Intracranial bleed • Meningeal infiltration by tumour • Skull metastases • Cerebral infection

  12. Raised intracranial pressure – symptoms • Nausea worse in the morning • Headache • Nausea and/or vomiting provoked by head movement

  13. Raised intracranial pressure – management • Cyclizine 50mg tds (oral) 150mg/24hr sc infusion • Also consider • High dose steroid: dexamethasone 16mg od • Hyoscine hydrobromide • Kwells 300mcg qds • 0.8-3.6mg/24hr sc infusion

  14. If at first you don’t succeed… • Consider adding a second agent • Different mechanisms of action eg haloperidol with cyclizine • Avoid antagonistic action cyclizine counteracts the prokinetic affect of metoclopramide • Consider levomepromazine • ‘broad spectrum’ antiemetic • 6.25-12mg (1/4 -1/2 tablet)po or 5-25 mg sc/sc infusion over 24hrs

  15. Summary • Gastric stasis • metoclopramide • Chemically-induced • haloperidol • Raised intracranial pressure • cyclizine • Consider additional or 2nd line treatment • Don’t forget the effect of anxiety & pain

More Related