ABC of palliative care: Nausea, vomiting, and intestinal obstruction

• Published in: BMJ Vol. 315; no. 7116; pp. 1148 - 1150
• Main Author: Baines, Mary J
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 01.11.1997; British Medical Association; BMJ Publishing Group LTD; BMJ Publishing Group
• Edition: International edition
• Subjects: Abdomen; Antiemetics; Anxiety; Cancer; Cancer therapies; Chemotherapy; Clinical Review; Community health care; Constipation; Digestive system; Dopamine; Dosage; Drug dosages; Gastrointestinal agents; Humans; Hypodermoclysis; Intestinal Neoplasms - therapy; Intestinal obstruction; Intestinal Obstruction - therapy; Medical disorders; Motility; Narcotics; Nausea; Nausea - drug therapy; Nausea - etiology; Ostomy; Pain; Palliative care; Palliative Care - methods; Radiation therapy; Receptors; Surgery; Symptoms; Vomiting; Vomiting - drug therapy; Vomiting - etiology
• ISSN: 0959-8138; 0959-8146; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.315.7116.1148

Management Common causes of vomiting in patients with advanced cancer Drugs Especially opioids and chemotherapy Gastric causes Gastritis or ulceration Functional gastric stasis due to external pressure Carcinoma of stomach Gastroduodenal obstruction Constipation Intestinal obstruction Biochemical causes Renal failure Hypercalcaemia Infection Tumour toxins Raised intracranial pressure Vestibular disturbance Abdominal or pelvic radiotherapy Anxiety Cough induced Nausea can be treated with oral drugs, but alternative routes are needed for patients with severe vomiting. Antiemetic Dose (per 24 hours) * Main site of action Prokinetics Metoclopramide [dagger] 30-80 mg Increase peristalsis in upper gut, also dopamine antagonists Domperidone 30-80 mg Cisapride Increase peristalsis in upper gut, also dopamine antagonists Cisapride 20-30 mg Increases peristalsis in gut Antihistamines Cyclizine [dagger] 150 mg Vestibular and vomiting centres Butyrophenones Haloperidol [dagger] 1.5-10 mg Blocks dopamine receptors at chemoreceptor trigger zone Phenothiazines Methotrimeprazine [dagger] 12.5-75 mg Blocks dopamine and serotonin receptors at chemoreceptor trigger zone, also acts at vestibular and vomiting centres 5-HT3 receptor antagonists Ondansetron [dagger] 8-16 mg Blocks 5-HT3 receptors at area postrema and in gut Corticosteroids Dexamethasone [dagger] 8-20 mg Reduces inflammatory oedema, also central and peripheral antiemetic effects Anticholinergics Hyoscine butylbromide [dagger] 60-300 mg Reduces gastrointestinal secretions and motility Somatostatin analogues Octreotide [dagger] 300-600 μg Reduces gastrointestinal secretions and motility * A single dose will be about a third of this dose [dagger] Can be given as subcutaneous infusion Functional gastric stasis-A prokinetic drug such as metoclopramide, domperidone, or cisapride should be used.