Nausea and vomiting at the end of life: Difference between revisions

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** Increased ICP
 
** Increased ICP
 
** Meningeal irritation
 
** Meningeal irritation
** Anxiety
+
** [[Anxiety]]
 
** Vestibular disorders
 
** Vestibular disorders
 
* Gastrointestinal
 
* Gastrointestinal
** Esophageal: GERD, thrush
+
** Esophageal: [[GERD]], [[thrush]]
 
** Gastric
 
** Gastric
 
*** Gastric irritation
 
*** Gastric irritation
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* Other causes
 
* Other causes
 
** Medications
 
** Medications
** Hypercalcemia
+
** [[Hypercalcemia]]
 
** Tumour-induced
 
** Tumour-induced
** Sepsis
+
** [[Sepsis]]
   
 
== Pathophysiology ==
 
== Pathophysiology ==
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*** Causes: sensory input, anxiety, meningeal irritation, increased ICP
 
*** Causes: sensory input, anxiety, meningeal irritation, increased ICP
 
** Peripheral pathways
 
** Peripheral pathways
*** Causes: mechanical stretch, chemotherapy, radiotherapy, GERD, candida, metastases, local drugs or toxins
+
*** Causes: mechanical stretch, chemotherapy, radiotherapy, [[GERD]], [[Candida]], metastases, local drugs or toxins
 
*** Receptors: 5HT3 serotonin receptors (GI tract), mechanoreceptors and chemoreceptors in GI tract
 
*** Receptors: 5HT3 serotonin receptors (GI tract), mechanoreceptors and chemoreceptors in GI tract
   
 
== Management ==
 
== Management ==
   
* Metabolic: D2 antagonist (e.g. haldol, metoclopramide)
+
* Metabolic: D2 antagonist (e.g. [[haloperidol]], [[metoclopramide]])
* Chemotherapy: D2 antagonist (e.g. haldol, metoclopramide)
+
* Chemotherapy: D2 antagonist (e.g. [[haloperidol]], [[metoclopramide]])
* Increased ICP: dexamethasone
+
* Increased ICP: [[dexamethasone]]
 
* Obstruction: general surgery consult or medical management (AAAH)
 
* Obstruction: general surgery consult or medical management (AAAH)
 
** Anti-emetic
 
** Anti-emetic
*** Neuroleptics: haloperidol 0.5-2mg po/sc up to q1h prn
+
*** Neuroleptics: [[haloperidol]] 0.5-2mg po/sc up to q1h prn
*** If partial: metoclopramide 5-10mg po/sc QID
+
*** If partial: [[metoclopramide]] 5-10mg po/sc QID
 
** Analgesic
 
** Analgesic
 
*** Opioids
 
*** Opioids
*** Anti-spasmodics: buscopan 10mg po/sc q6h (antikinetic)
+
*** Anti-spasmodics: [[buscopan]] 10mg po/sc q6h (antikinetic)
 
** Anti-secretory
 
** Anti-secretory
*** Somatostatin analogues: octreotide 100-500 mcg sc TID
+
*** Somatostatin analogues: [[octreotide]] 100-500 mcg sc TID
*** Anticholinergics: scopolamine, buscopan
+
*** Anticholinergics: [[scopolamine]], [[buscopan]]
 
** Anti-inflammatory
 
** Anti-inflammatory
*** Dexamethasone 4mg po/sc daily to QID
+
*** [[Dexamethasone]] 4mg po/sc daily to QID
 
*** Decreases edema around obstruction to allow passage of some stool
 
*** Decreases edema around obstruction to allow passage of some stool
 
** Hydration
 
** Hydration

Latest revision as of 07:28, 30 November 2022

Differential Diagnosis

  • Head
    • Increased ICP
    • Meningeal irritation
    • Anxiety
    • Vestibular disorders
  • Gastrointestinal
    • Esophageal: GERD, thrush
    • Gastric
      • Gastric irritation
      • Gastric stasis
    • Obstruction
    • Infection
  • Organ failure
    • Renal failure
    • Liver failure
  • Other causes

Pathophysiology

  • Four pathways
    • Vestibular system
      • Causes: motion, labyrinth disorders
      • Receptors: muscarinic acetylcholinergic and H1 histamine receptors
    • Chemoreceptor trigger zone (area outside blood-brain barrier)
      • Causes: drugs, metabolic products, bacterial toxins
      • Receptors: central D2 dopamine receptors (most important), 5HT3 serotonin receptors, and NK1 receptors
    • Cortex
      • Causes: sensory input, anxiety, meningeal irritation, increased ICP
    • Peripheral pathways
      • Causes: mechanical stretch, chemotherapy, radiotherapy, GERD, Candida, metastases, local drugs or toxins
      • Receptors: 5HT3 serotonin receptors (GI tract), mechanoreceptors and chemoreceptors in GI tract

Management