Approach to managing nausea and vomiting in palliative care
In patients with palliative care needs, nausea can be intermittent or persistent, and either with or without vomiting. Vomiting that occurs suddenly with little or no nausea is less common, and is typically due to upper gastrointestinal tract obstruction (see Bowel obstruction in palliative care) or intracerebral disease. Uncontrolled nausea and vomiting can cause severe discomfort and interfere with oral drug administration.
Management of nausea and vomiting is generally directed by the cause because this approach may result in faster resolution of symptomsHardy, 2021Hardy, 2018. Causes are often multifactorial and include:
- gastrointestinal causes
- central causes
- vestibular causes
- psychological causes
- intracranial causes
- chemotherapy or radiotherapy.
Determining the cause of nausea and vomiting is often not straightforward. For acute nausea and vomiting, or if the cause remains unclear, treat as undifferentiated nausea and vomiting while the patient is being assessed. Consider and address reversible causes of nausea and vomiting. Review the patient’s medications and consider stopping drugs that can induce nausea and vomiting.
Some antiemetic drugs are inappropriate for patients with Parkinson disease and ‘Parkinson plus’ disorders—see Antiemetic therapy for patients with Parkinson disease who have palliative care needs.
Although nausea and vomiting are commonly intermittent, the best treatment is to provide regular doses of an antiemetic rather than as required. Regularly review the need for ongoing treatment, especially to determine whether treatment is working, or if the cause of the nausea has subsided.
For refractory nausea and vomiting, see Refractory nausea and vomiting in palliative care.