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management of nausea/vomiting by etiology
Management:
1) cerebral cortex
- increased intracranial pressure -> dexamethasone
- anxiety -> lorazepam (Ativan)
2) vestibular apparatus
- initial opioid effect -> scopolamine patch
- vestibular disease -> meclizine (Antivert)
3) vomiting center
- pain -> diphenhydramine (Benadryl)
- visceral stimuli
- scopolamine patch
- ondansetron (Zofran)
4) chemoreceptor trigger zone (CTZ)
a) etiology
- medications
- digoxin, theophylline, opioids, chemotherapy, antibiotics, others
- hypercalcemia
- uremia
b) management
- discontinue or adjust medications
- pharmaceutical agents
- promethazine (Phenergan)
- haloperidol (Haldol)
- droperidol (Inapsine)
- ondansetron (Zofran) ?
5) gastric distension due to medications (GI irritants) i.e. NSAIDs, iron supplements, alcohol, antibiotics
- adjust or discontinue medications
- substitute trilisate
6) gastric damage due to tumor infiltration or radiation injury
- dexamethasone
7) infection
- Candida esophagitis -> fluconazole (Diflucan)
- Clostridium colitis -> metronidazole (Flagyl)
8) poor motility
- constipation
- stimulant/bulk combination (Senokot, Pericolace)
- obstruction
- metoclopramide (Reglan)
- octreotide (Sandostatin)
9) intrinsic pressure
- ascites
- diuretic (spironolactone)
- paracentesis
Related
nausea
vomiting
General
management
References
- Frederich M., Multicampus Program in Geriatrics & Gerontology,
Syllabus: The Cutting Edge in Palliative Medicine, 2001