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Managing Nausea and Vomiting in Palliative Care

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Managing Nausea and Vomiting in Palliative Care

Nausea and vomiting are unfortunately a common occurrence in palliative care patients. They are debilitating and lower the quality of life in patients and their relatives. Nausea and vomiting are majorly present in malignant conditions but can be present in non-malignant disorders as well. In such cases, palliative care improves end-of-life care. Let’s understand more about palliative care in such patients.

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Causes of Nausea and Vomiting

Finding and treating the underlying cause is the first step while managing nausea and vomiting. Some of the common causes are:

  • Liver metastasis
  • Anxiety
  • Gastritis
  • Organ failure
  • Meningeal tumor
  • Medications
  • Constipation

Palliative Care 

The most important aim of palliative care is to improve the quality of life. Medications are not always needed to manage nausea or vomiting. Simple palliative measures to manage them are:

  • Regular mouth care 
  • Limit odors of food that can trigger nausea or vomiting
  • Dressing the patient in loose clothing
  • Providing small and simple meals
  • Including carbohydrate-rich food in the diet
  • Preferring cool and fizzy drinks over hot drinks
  • Providing parenteral hydration
  • Using complementary therapies, such as relaxation and acupressure

Medications

If non-pharmacological measures fail to manage nausea and vomiting, medications are used to manage them. While giving medications, the underlying condition is managed and not just the symptoms. 

In the majority of cases, antiemetics are used. Care should be taken to give antiemetic through the best route and the patient should be observed frequently. Antiemetics can be given regularly until the symptoms are resolved.

Various analgesics used to manage pain, such as opioids, can cause nausea and vomiting. Using antiemetic in such cases is often necessary. 

Depending on the cause, other medications that can be used to manage nausea and vomiting are:

  • Diphenhydramine: It can help to dull the middle ear’s sense of motion, which blocks the transmission of signals to the brain that is responsible for nausea and vomiting.
  • Haldol: It blocks the dopamine receptors and aids in managing nausea and vomiting. 
  • Metoclopramide: It is useful in cases of nausea and vomiting due to gastroesophageal reflux disease. This medicine is also helpful in cases of subjects with altered emptying of the stomach. It works by improving the contractions of the muscles of the digestive tract, which improves the movement of the stomach and intestines.
  • Lorazepam: It binds to a chemical gamma-aminobutyric acid (GABA) in the brain. This lowers anxiety and produces a calming effect, reducing nausea and vomiting.
  • Prochlorperazine: Similar to Haldol, it blocks the secretion of dopamine. This medicine is commonly used to manage nausea and vomiting triggered by chemotherapy.
  • Promethazine: It blocks histamine released by chemotherapy and other treatments. Promethazine binds to the histamine receptors, reducing the need to vomit. It can also manage nausea caused postoperative pain.

Depending on the patient’s condition, these medications are administered as liquid doses, topical gel, pills, or suppositories.

Palliative care depends on the efficacy of the previous treatment. If nausea is managed by the current regimen, the same drugs should be given subcutaneously. In cases of new symptoms, the same treatment can be carried out with the removal of cause if any. For uncontrolled nausea and vomiting, levomepromazine is generally preferred as it acts in various ways. The risk of drowsiness is also less.

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