Nausea and vomiting

R11 + (Z51.5)

GENERAL MEASURES

Treat the underlying cause and rehydrate the patient.

Reversible causes include medication, hypercalcemia, constipation, uraemia, gastritis, gastroenteritis, coughing and infections.

Manage odours e.g. cooking smells and fungating wounds.

MEDICINE TREATMENT

Treat the underlying cause.

  • Metoclopramide, oral/IM/IV, 10 mg 8 hourly, 30 minutes before a meal.

If metoclopramide is ineffective or contra-indicated (i.e. inoperable bowel obstruction):

  • Haloperidol, oral, 0.75–5 mg daily.

LoEIII [5]

OR

  • Haloperidol, SC/IM/IV
    • Initiate 0.5 mg 12 hourly.
    • Titrate to a maximum dose of 5 mg 8 hourly

LoEIII [6]

LoEIII [7]

Drug-induced parkinsonism:

ADD

  • Anticholinergic agent, e.g.:
  • Orphenadrine, oral, 50–150 mg daily according to individual response
    • Usual dose: 50 mg 8 hourly.
    • Maximum dose: 150 mg daily.
    • Use with caution in the elderly as it may cause confusion and urinary retention.

Note: Anticholinergic medicines (e.g. orphenadrine) should not be added prophylactically to antipsychotics to prevent extrapyramidal side effects.

If haloperidol is ineffective/ inoperable bowel obstruction:

  • Promethazine, IM/IV, 12.5–25 mg, 4–6 hourly.

LoEIII [8]

Corticosteroids can decrease cerebral oedema: See Brain oedema due to tumours and inflammation.

REFERRAL

Refer to the appropriate discipline if the underlying cause can be reversed e.g. bowel obstruction - refer to a surgeon.

Consult a palliative care trained doctor if the vomiting persists.