Nausea and vomiting medical therapy: Difference between revisions
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== Medical Therapy == | == Medical Therapy == | ||
* Mainstay of treatment of nausea and vomiting is correcting any electrolyte imbalance, dehydration, malnutrition, and suppression of symptoms while evaluating and treating the underlying cause. | * Mainstay of treatment of nausea and vomiting is correcting any electrolyte imbalance, dehydration, malnutrition, and suppression of symptoms while evaluating and treating the underlying cause. | ||
* Dietary recommendations include a low-fat, low-fiber diet with frequent small meals if able to tolerate oral intake. Liquid diet is recommended in case solid diet is not well tolerated. <ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url=}}</ref> | * Dietary recommendations include a low-fat, low-fiber diet with frequent small meals if able to tolerate oral intake. Liquid diet is recommended in case solid diet is not well tolerated. <ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url=}}</ref> | ||
* Various antiemetics are used with some more effective in specific etiologies. | |||
* Benzodiazepines are used for anticipatory nausea. Eg., Lorazepam 0.5-2mg oral, sublingual or intramuscular, Alprazolam 0.25-1mg oral or IV. | |||
*Serotonin antagonists are used in post-operative, post-radiation and chemotherapy induced nausea and vomiting. Eg., Ondansetron 4-8mg oral or IV, Granisetron 1-2 mg every 4-8 hours or 0.075mg-0.25mg every 24 hours oral or IV. | |||
*Antihistamines are used in motion sickness and labrythitis. Eg., Meclizine 25-50mg every 24 hours oral, Diphenhydramine, Cyclizine, Hydroxazine 25-50mg every 6-8 hours, 25–75 mg every 8 hours, 25–50 mg every 4–6 hours, 25–100 mg every 6–8 hours oral, IM or IV. <ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url=}}</ref> <ref name="pmid15023018">{{cite journal |vauthors=Flake ZA, Scalley RD, Bailey AG |title=Practical selection of antiemetics |journal=Am Fam Physician |volume=69 |issue=5 |pages=1169–74 |date=March 2004 |pmid=15023018 |doi= |url=}}</ref> | |||
*Anticolenergic agents are used in motion sickness. Eg., Scopolamine 0.3–0.6 mg every 24 hours SL, IV, IM or transdermal. | |||
*Antidopaminergics | |||
* Ginger has some efficacy to reduce post-operative nausea and vomiting, morning sickness and motion sickness. <ref name="pmid10793599">{{cite journal |vauthors=Ernst E, Pittler MH |title=Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials |journal=Br J Anaesth |volume=84 |issue=3 |pages=367–71 |date=March 2000 |pmid=10793599 |doi=10.1093/oxfordjournals.bja.a013442 |url=}}</ref> <ref name="pmid12233808">{{cite journal |vauthors=Keating A, Chez RA |title=Ginger syrup as an antiemetic in early pregnancy |journal=Altern Ther Health Med |volume=8 |issue=5 |pages=89–91 |date=2002 |pmid=12233808 |doi= |url=}}</ref> | * Ginger has some efficacy to reduce post-operative nausea and vomiting, morning sickness and motion sickness. <ref name="pmid10793599">{{cite journal |vauthors=Ernst E, Pittler MH |title=Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials |journal=Br J Anaesth |volume=84 |issue=3 |pages=367–71 |date=March 2000 |pmid=10793599 |doi=10.1093/oxfordjournals.bja.a013442 |url=}}</ref> <ref name="pmid12233808">{{cite journal |vauthors=Keating A, Chez RA |title=Ginger syrup as an antiemetic in early pregnancy |journal=Altern Ther Health Med |volume=8 |issue=5 |pages=89–91 |date=2002 |pmid=12233808 |doi= |url=}}</ref> | ||
* Alternative approaches include hypnosis, acupressure and acupuncture. <ref name="pmid10971166">{{cite journal |vauthors=Marchioro G, Azzarello G, Viviani F, Barbato F, Pavanetto M, Rosetti F, Pappagallo GL, Vinante O |title=Hypnosis in the treatment of anticipatory nausea and vomiting in patients receiving cancer chemotherapy |journal=Oncology |volume=59 |issue=2 |pages=100–4 |date=August 2000 |pmid=10971166 |doi=10.1159/000012144 |url=}}</ref> <ref name="pmid19370583">{{cite journal |vauthors=Lee A, Fan LT |title=Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD003281 |date=April 2009 |pmid=19370583 |pmc=3113464 |doi=10.1002/14651858.CD003281.pub3 |url=}}</ref> | * Alternative approaches include hypnosis, acupressure and acupuncture. <ref name="pmid10971166">{{cite journal |vauthors=Marchioro G, Azzarello G, Viviani F, Barbato F, Pavanetto M, Rosetti F, Pappagallo GL, Vinante O |title=Hypnosis in the treatment of anticipatory nausea and vomiting in patients receiving cancer chemotherapy |journal=Oncology |volume=59 |issue=2 |pages=100–4 |date=August 2000 |pmid=10971166 |doi=10.1159/000012144 |url=}}</ref> <ref name="pmid19370583">{{cite journal |vauthors=Lee A, Fan LT |title=Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD003281 |date=April 2009 |pmid=19370583 |pmc=3113464 |doi=10.1002/14651858.CD003281.pub3 |url=}}</ref> | ||
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While short-term nausea and vomiting are generally harmless, they may sometimes indicate a more serious condition, such as [[Coeliac disease]]. When associated with prolonged vomiting, it may lead to [[dehydration]] and/or dangerous electrolyte imbalances. | While short-term nausea and vomiting are generally harmless, they may sometimes indicate a more serious condition, such as [[Coeliac disease]]. When associated with prolonged vomiting, it may lead to [[dehydration]] and/or dangerous electrolyte imbalances. | ||
There are several types of [[antiemetic]]s, and researchers continue to look for more effective treatments. The main types used post operatively for surgical patients are [[ondansetron]], [[dexamethasone]], [[promethazine]], [[diphenhydramine]], and in small doses [[droperidol]]. [[Doxylamine]] is the drug of choice in pregnancy-related nausea. Anecdotally, another remedy used by recovery room nurses is to place an [[isopropyl alcohol]] swab under the patient's nose while he or she breathes through the nose. This may abate the nausea until the antiemetic medication takes effect. When ingested or inhaled, the chemical compound [[tetrahydrocannabinol]] has been shown to reduce nausea in some users.<ref>{{cite web | url = http://www.drugpolicy.org/marijuana/medical/challenges/litigators/medical/conditions/nausea.cfm | title = Medicinal Uses of Marijuana: Nausea, Emesis and Appetite Stimulation | accessdate = 2007-08-02 | date = 2001 | author = Drug Policy Alliance}}</ref> Also available are a variety of non-invasive (often untested) mechanical devices used to suppress nausea due to motion sickness. | There are several types of [[antiemetic]]s, and researchers continue to look for more effective treatments. The main types used post operatively for surgical patients are [[ondansetron]], [[dexamethasone]], [[promethazine]], [[diphenhydramine]], and in small doses [[droperidol]]. [[Doxylamine]] is the drug of choice in pregnancy-related nausea. Anecdotally, another remedy used by recovery room nurses is to place an [[isopropyl alcohol]] swab under the patient's nose while he or she breathes through the nose. This may abate the nausea until the antiemetic medication takes effect. When ingested or inhaled, the chemical compound [[tetrahydrocannabinol]] has been shown to reduce nausea in some users.<ref>{{cite web | url = http://www.drugpolicy.org/marijuana/medical/challenges/litigators/medical/conditions/nausea.cfm | title = Medicinal Uses of Marijuana: Nausea, Emesis and Appetite Stimulation | accessdate = 2007-08-02 | date = 2001 | author = Drug Policy Alliance}}</ref> Also available are a variety of non-invasive (often untested) mechanical devices used to suppress nausea due to motion sickness. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: {{VVS}
Overview
Medical Therapy
- Mainstay of treatment of nausea and vomiting is correcting any electrolyte imbalance, dehydration, malnutrition, and suppression of symptoms while evaluating and treating the underlying cause.
- Dietary recommendations include a low-fat, low-fiber diet with frequent small meals if able to tolerate oral intake. Liquid diet is recommended in case solid diet is not well tolerated. [1]
- Various antiemetics are used with some more effective in specific etiologies.
- Benzodiazepines are used for anticipatory nausea. Eg., Lorazepam 0.5-2mg oral, sublingual or intramuscular, Alprazolam 0.25-1mg oral or IV.
- Serotonin antagonists are used in post-operative, post-radiation and chemotherapy induced nausea and vomiting. Eg., Ondansetron 4-8mg oral or IV, Granisetron 1-2 mg every 4-8 hours or 0.075mg-0.25mg every 24 hours oral or IV.
- Antihistamines are used in motion sickness and labrythitis. Eg., Meclizine 25-50mg every 24 hours oral, Diphenhydramine, Cyclizine, Hydroxazine 25-50mg every 6-8 hours, 25–75 mg every 8 hours, 25–50 mg every 4–6 hours, 25–100 mg every 6–8 hours oral, IM or IV. [1] [2]
- Anticolenergic agents are used in motion sickness. Eg., Scopolamine 0.3–0.6 mg every 24 hours SL, IV, IM or transdermal.
- Antidopaminergics
- Ginger has some efficacy to reduce post-operative nausea and vomiting, morning sickness and motion sickness. [3] [4]
- Alternative approaches include hypnosis, acupressure and acupuncture. [5] [6]
Treatment of Nausea
While short-term nausea and vomiting are generally harmless, they may sometimes indicate a more serious condition, such as Coeliac disease. When associated with prolonged vomiting, it may lead to dehydration and/or dangerous electrolyte imbalances.
There are several types of antiemetics, and researchers continue to look for more effective treatments. The main types used post operatively for surgical patients are ondansetron, dexamethasone, promethazine, diphenhydramine, and in small doses droperidol. Doxylamine is the drug of choice in pregnancy-related nausea. Anecdotally, another remedy used by recovery room nurses is to place an isopropyl alcohol swab under the patient's nose while he or she breathes through the nose. This may abate the nausea until the antiemetic medication takes effect. When ingested or inhaled, the chemical compound tetrahydrocannabinol has been shown to reduce nausea in some users.[7] Also available are a variety of non-invasive (often untested) mechanical devices used to suppress nausea due to motion sickness.
The spice ginger is also used for centuries as a folk remedy to treat nausea, and recent research has supported this use.[8]
Treatment of Vomiting
Acute Pharmacotherapies
- Antiemetics: An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of some opioid analgesics and chemotherapy directed against cancer. Antiemetics act by inhibiting the receptor sites associated with emesis. Hence, anticholinergics, antihistamines, dopamine antagonists, serotonin antagonists and cannabinoids are used as anti-emetics.
- Anticholinergics
References
- ↑ 1.0 1.1 Singh P, Yoon SS, Kuo B (January 2016). "Nausea: a review of pathophysiology and therapeutics". Therap Adv Gastroenterol. 9 (1): 98–112. doi:10.1177/1756283X15618131. PMC 4699282. PMID 26770271.
- ↑ Flake ZA, Scalley RD, Bailey AG (March 2004). "Practical selection of antiemetics". Am Fam Physician. 69 (5): 1169–74. PMID 15023018.
- ↑ Ernst E, Pittler MH (March 2000). "Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials". Br J Anaesth. 84 (3): 367–71. doi:10.1093/oxfordjournals.bja.a013442. PMID 10793599.
- ↑ Keating A, Chez RA (2002). "Ginger syrup as an antiemetic in early pregnancy". Altern Ther Health Med. 8 (5): 89–91. PMID 12233808.
- ↑ Marchioro G, Azzarello G, Viviani F, Barbato F, Pavanetto M, Rosetti F, Pappagallo GL, Vinante O (August 2000). "Hypnosis in the treatment of anticipatory nausea and vomiting in patients receiving cancer chemotherapy". Oncology. 59 (2): 100–4. doi:10.1159/000012144. PMID 10971166.
- ↑ Lee A, Fan LT (April 2009). "Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting". Cochrane Database Syst Rev (2): CD003281. doi:10.1002/14651858.CD003281.pub3. PMC 3113464. PMID 19370583.
- ↑ Drug Policy Alliance (2001). "Medicinal Uses of Marijuana: Nausea, Emesis and Appetite Stimulation". Retrieved 2007-08-02.
- ↑ University of Maryland Medical Centre (2006). "Ginger". Retrieved 2007-08-02.