Management of intractable nausea and vomiting in patients at the end of life: "I was feeling nauseous all of the time... nothing was working"

Gordon John Wood*, Joseph W. Shega, Beth Lynch, Jamie H. Von Roenn

*Corresponding author for this work

Research output: Contribution to journalReview article

66 Citations (Scopus)

Abstract

Nausea and vomiting, symptoms that occur commonly near the end of life, represent a substantial source of physical and psychological distress for patients and families. In the context of the case of Mr Q, a 50-year-oldman with metastatic esophageal cancer admitted to the hospital with intractable nausea and vomiting, we review the evaluation and treatment of this symptom complex. A thorough history and physical examination are essential first steps in the management of these patients because they define the severity of the symptoms and clues to their underlying etiology. Once the most likely cause is determined, the clinician discerns the mechanism, specific transmitters,and receptors by which this etiology is triggering nausea and vomiting. Subsequent pharmacological management focuses on prescribing the appropriate antagonist to the implicated receptors. If symptoms are refractory despite adequate dosage and around-the-clock prophylactic administration, an empirical trial combining several therapies to block multiple emetic pathways should be attempted. Less traditional agents are also discussed, although evidence for their use is limited. Often, oral administration of medication is not feasible and alternate routes such as rectal suppositories, subcutaneous infusions, and orally dissolvable tablets should be considered. Using this step-wise approach, nausea and vomiting can be successfully managed in most patients at the end of life.

Original languageEnglish (US)
Pages (from-to)1196-1207
Number of pages12
JournalJournal of the American Medical Association
Volume298
Issue number10
DOIs
StatePublished - Sep 12 2007

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Nausea
Vomiting
Emotions
Emetics
Subcutaneous Infusions
Suppositories
Symptom Assessment
Esophageal Neoplasms
Tablets
Physical Examination
Oral Administration
History
Pharmacology
Psychology
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Management of intractable nausea and vomiting in patients at the end of life: {"}I was feeling nauseous all of the time... nothing was working{"}",
abstract = "Nausea and vomiting, symptoms that occur commonly near the end of life, represent a substantial source of physical and psychological distress for patients and families. In the context of the case of Mr Q, a 50-year-oldman with metastatic esophageal cancer admitted to the hospital with intractable nausea and vomiting, we review the evaluation and treatment of this symptom complex. A thorough history and physical examination are essential first steps in the management of these patients because they define the severity of the symptoms and clues to their underlying etiology. Once the most likely cause is determined, the clinician discerns the mechanism, specific transmitters,and receptors by which this etiology is triggering nausea and vomiting. Subsequent pharmacological management focuses on prescribing the appropriate antagonist to the implicated receptors. If symptoms are refractory despite adequate dosage and around-the-clock prophylactic administration, an empirical trial combining several therapies to block multiple emetic pathways should be attempted. Less traditional agents are also discussed, although evidence for their use is limited. Often, oral administration of medication is not feasible and alternate routes such as rectal suppositories, subcutaneous infusions, and orally dissolvable tablets should be considered. Using this step-wise approach, nausea and vomiting can be successfully managed in most patients at the end of life.",
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Management of intractable nausea and vomiting in patients at the end of life : "I was feeling nauseous all of the time... nothing was working". / Wood, Gordon John; Shega, Joseph W.; Lynch, Beth; Von Roenn, Jamie H.

In: Journal of the American Medical Association, Vol. 298, No. 10, 12.09.2007, p. 1196-1207.

Research output: Contribution to journalReview article

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