Nausea and Vomiting

Clinical Description

Common causes (see relevant chapter for details). Gastrointestinal - gastric status, intestinal obstruction, Oral/oesophageal candidiasis, indigestion drugs - opioids, antibiotics, iron, NSAIDs metabolic - hypercalcaemia, renal failure, Constipation, Infections - malaria, gastroenteritis, urinary tract infection, severe pain, anxiety, fear etc.

Non-pharmacological

• Encourage clear fluids - small sips better absorbed
• Ginger chewed or boiled as a drink may help or diluted malambe juice

Pharmacological

Table 1.

Pattern of nausea and vomiting

Causes Suggested drugs

Poor stomach emptying:

Main symptom is;

• vomiting
• Vomiting relieves nausea
• Patient feels full quickly
• May have reflux
• Opioids
• Constipation
• Stomach and bowel conditions
• Metoclopramid e 10-20mgs 8 hourly before meals

Blood chemistry disturbances

• Nausea is the main symptom
• Vomiting does not relieve nausea
• Drugs
• Renal failure
• Hypercalcaemia chemotherap y induced nausea and vomiting
• Ondansetron 8mg 30 mins before chemo, then twice daily for 1-2 days after chemo
• Haloperidol 0.5- 1.5mg nocte

Inflammation or swelling in the head

• May be worse on movement
• Vomiti ng does not relieve nausea
• May be worse in
• Ear infections
• Brain tumours
• Meningitis
• Malaria
• dexamethason e 2m-8mg 24 hourly the morning

Vomiting with diarrhoea

Exclude constipation with overflow

• Infectious diarrhoea
• Promethazine 25mg every 8hrs or Partial bowel obstruction

Large volume vomiting

Patient still passing occasional flatus/stools

• Constipation
• Abdominal or pelvic tumour
• Metoclopramid e 10-20mg IM.

STOP if increasing abdominal pain and prescribe as below

Complete bowel obstruction

Large volume vomiting

Patient not passing flatus or faeces

• Abdominal or pelvic tumour
• Promethazine 25mg s/c 8 hourly

Complications and Referral Criteria

• Where nausea and vomiting persists or the patient become dehydrated, referral to next level of care and/or specialist palliative care providers should be considered