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NAUSEA AND VOMITING IN THE MANAGEMENT OF CANCER PATIENTS

NAUSEA AND VOMITING IN THE MANAGEMENT OF CANCER PATIENTS. Case Presentation. Case I. Mr. LC, 56 yr old, retired army officer Referred on acct of non resectable lung cancer, exact histology unknown b/c failed bronchoscopic biopsy. Hx of smoking

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NAUSEA AND VOMITING IN THE MANAGEMENT OF CANCER PATIENTS

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  1. NAUSEA AND VOMITING IN THE MANAGEMENT OF CANCER PATIENTS Case Presentation

  2. Case I • Mr. LC, 56 yr old, retired army officer • Referred on acct of non resectable lung cancer, exact histology unknown b/c failed bronchoscopic biopsy. • Hx of smoking • He was counseled on the options and was started on combination chemotherapy

  3. Cisplatin, adriamycin. Vincristin and cyclophosphomide. • Antiemetic therapy included pre chemotherapy IV ondansetron, high dose methoclopromide and dexamethazone • H/O administered drug and ignored the time course of antiemetics

  4. Very severe acute emesis ensued that Doc stopped the ongoing Cisplatin, abandoned patient and chemo until the next day. Chemo was completed the next day but patient refused that H/O will attend to him again

  5. Following his refusal to go for RTH, he was scheduled for 2nd course chemo in 3weeks but presented two day before then with persistent severe head ache, recurrent vomiting and unstable gait. • Treatment given was DMZ at 12mg start and 4mg tds. • Questionable improvement before he lapsed into unconsciousness and died two days later

  6. CASE II • Mrs. UG, Hosp no 456832, 45yr old pre-menopausal lady • Had mastectomy for stage III ca of the rt breast. • Commenced adjuvant Chemotherapy with Adriamycin, Cyclophosphomide and Fluoro-uracil. • Antiemetic therapy included • Iv metochlopromide 20mg and DMZ 4mg pre chemo • Tabs metochlopromide, chlorpheniramine and DMZ for 5 days

  7. Had moderately severe emesis in the 1st two courses and by the 3rd and 4th courses, vomited each time an IV line was being set for the chemo. • Refused further chemo after the 4th course.

  8. Following a lengthy discussion, the antiemetics were revised to include • Iv ondansetron 8mg stat, methoclopromide 30mg stat, DMZ 12mg stat before chemo • Tablet lorazepam 2mg daily x 5days • Tablet metochlopromide 20mgtds, chlopheniramine 1 tds and DMZ 8mg tds for 5days • Completed 8 courses of chemo + RTH without N/V and is still alive 4yrs after diagnosis.

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