Treatment of Nausea and Vomiting in Terminally Ill Cancer Patients

Glare, Paul; Dunwoodie, David; Clark, Katherine; Ward, Alicia; Yates, Patsy; Ryan, Sharon; Hardy, Janet

doi:10.2165/0003495-200868180-00004

Cited by 55 publications

(48 citation statements)

References 107 publications

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“…14 If the patient continues to experience symptoms of nausea, prokinetic agents, dopamine antagonists, and corticosteroids can he helpful. 9 Gastric cancer is rare in the United States and often presents at a late stage. Gastric cancer should be suspected in patients older than 55 years with new-onset dyspepsia, decreased appetite, or weight loss.…”

Section: Discussionmentioning

confidence: 99%

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84-Year-Old Man With Respiratory Distress and Abdominal Distention

Pachman

Morrison

Szostek

2011

Mayo Clinic Proceedings

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A n 84-year-old man presented to his local hospital after falling from his wheelchair. He had tachypnea and abdominal distention. Chest radiography revealed a rightsided pleural effusion, and abdominal radiography showed dilated loops of bowel, suggestive of bowel obstruction. The patient was then transferred to our hospital for further work-up.The patient reported worsening of shortness of breath and abdominal distention for the past few weeks. He had a 1-year history of early satiety, nausea, and dyspepsia but had noted no weight loss. The patient was taking omeprazole for peptic ulcer disease. Recently, after positive findings on a urea breath test, metronidazole and clarithromycin were initiated for treatment of Helicobacter pylori. The patient's medical history also included type 2 diabetes, benign prostatic hyperplasia, and hypertension for which he was taking aspirin, glipizide, lisinopril, and finasteride. He was a former smoker who had quit 50 years ago.Physical examination revealed the following: temperature, 36.4° C; blood pressure, 108/58 mm Hg; regular pulse rate, 103 beats/min; respiratory rate, 26 breaths/min; and oxygen saturation of 93% while breathing 3 L of oxygen. The patient was visibly tachypneic, with diffuse expiratory wheezing and decreased breath sounds in the right base. His abdomen was distended with bulging flanks and a positive fluid wave.Important laboratory values on admission included the following (reference ranges provided parenthetically): hemoglobin, 10.4 g/dL (13.5-17.5 g/dL); white blood cells, 12.2 x 10 9 /L (3.5-10.5 x 10 9 /L); platelets, 348 x 10 9 /L (150-450 x 10 9 /L); sodium, 134 mEq/L (135-145 mEq/L); bicarbonate, 21 mEq/L (22-29 mEq/L); blood urea nitrogen, 35 mg/dL (8-24 mg/dL); creatinine, 1.5 mg/dL (0.8-1.3 mg/ dL); chloride, 103 mmol/L (100-108 mmol/L); glucose, 160 mg/dL (70-100 mg/dL); aspartate aminotransferase, 15 U/L (17-59 U/L); total bilirubin, 0.3 mg/dL (0.1-1.0 mg/dL); albumin, 2.9 g/dL (3.5-5.0 g/dL); and lactate, 0.78 mmol/L (0.6-2.3 mmol/L).Abdominal computed tomography without contrast medium showed a moderate amount of ascites, moderate right-sided pleural effusion, and a mildly nodular configuration of the liver. Thoracentesis resulted in removal of 1 L of serosanguineous fluid. Pleural fluid lactate dehydrogenase (LDH) was 724 U/L, total protein was 4.1 g/dL, glucose was 121 mg/dL, and pH was 7.7. The total nucleated cell count was 1196 U/L, with differential of neutrophils at 46%, lymphocytes at 5%, monocytes at 2%, and eosinophils at 2%. The serum LDH level was 200 U/L, and the serum protein level, 5.7 g/dL. The first step in the evaluation of the pleural fluid is to determine whether it is a transudate or exudate. On the basis of criteria from Lights et al, 1 an exudate has a pleural fluid protein to serum protein ratio greater than 0.5, pleural fluid LDH to serum LDH greater than 0.6, or pleural fluid LDH greater than two-thirds the upper limit of the laboratory's normal serum LDH level. Fulfilling any of these 3 criteria indicates an exuda...

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Section: Discussionmentioning

confidence: 99%

“…However, they should be considered if stenting is not an option. 9 The patient responded to metoclopramide and prochlorperazine after stenting was unsuccessful. He remained in the hospital but continued to deteriorate.…”

Section: Which One the Following Is The Most Effective Initial Managementioning

confidence: 95%

84-Year-Old Man With Respiratory Distress and Abdominal Distention

Pachman

Morrison

Szostek

2011

Mayo Clinic Proceedings

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“…The mechanism for the antiemetic effect of dexamethasone remains unknown [15]. The proposed mechanisms include the ability of dexamethasone to deplete γ-amino butyric acid stores, reduce the blood-brain barrier's permeability to emetic toxins, inhibit brainstem enkephalin release and inhibit central prostaglandin and serotonin synthesis [15,16].…”

Section: Effect Of Intravenous Dexamethasone On Postoperative Nausea-mentioning

confidence: 99%

“…Dexamethasone is an effective antiemetic agent with minimal side effects after single dose administration [9][10][11][12][13][14].The mechanism for the antiemetic effect of dexamethasone remains unknown [15]. The proposed mechanisms include the ability of dexamethasone to deplete γ-amino butyric acid stores, reduce the blood-brain barrier's permeability to emetic toxins, inhibit brainstem enkephalin release and inhibit central prostaglandin and serotonin synthesis [15,16]. We hereby present a study performed to evaluate the efficacy of IV dexamethasone to reduce PONV in mothers receiving intrathecal morphine for post caesarean analgesia.…”

Section: Introductionmentioning

confidence: 99%

Effect of Intravenous Dexamethasone on Postoperative Nausea-Vomiting (PONV) after Intrathecal Morphine during Caesarean Section

Jadon¹

2016

SOJAPM

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Background: Post-operative pain relief after Caesarean section is important; it improves mobility and reduces the risk of thromboembolic complications. Neuraxial opioids are effective in postoperative pain relief but untoward effects like postoperative nausea and vomiting (PONV) prevent their regular use. Recent studies have shown that IV Dexamethasone reduces the incidence of PONV associated with intrathecal opioids when used for post Caesarean analgesia. We evaluated the efficacy of 8mg IV dexamethasone in reducing PONV in mothers receiving intrathecal morphine for post Caesarean analgesia.

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“…Nausea and vomiting is a distressing symptom affecting up to 60% of those with advanced cancer, at some stage 1. Contemporary palliation of nausea and vomiting involves identification of the underlying cause and selecting the most appropriate anti-emetics according to the pathophysiology 1.…”

Section: Introductionmentioning

confidence: 99%

Oesophageal spasm, vomiting and hyoscine hydrobromide patch

Murray-Brown¹,

Davies

2015

BMJ Support Palliat Care

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We report the case of a 60-year-old woman with metastatic breast cancer whose intractable nausea and vomiting were effectively managed with a hyoscine hydrobromide (scopolamine) patch. Contrast swallow revealed oesophageal spasm to be the underlying cause. Symptom relief may be attributed to the antimuscarinic properties of the patch, allowing lower oesophageal sphincter relaxation. Following patch use she was able to enjoy small meals and fluids without symptoms. This is the first time this mechanism of action of scopolamine for alleviating nausea and vomiting has been described in the literature.

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Treatment of Nausea and Vomiting in Terminally Ill Cancer Patients

Cited by 55 publications

References 107 publications

84-Year-Old Man With Respiratory Distress and Abdominal Distention

84-Year-Old Man With Respiratory Distress and Abdominal Distention

Effect of Intravenous Dexamethasone on Postoperative Nausea-Vomiting (PONV) after Intrathecal Morphine during Caesarean Section

Oesophageal spasm, vomiting and hyoscine hydrobromide patch

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