Nausea

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Info bulb.pngWhile this may appear to be an indulgence in semantics, confusing the terms nauseated and naseous is bound to upset someone with a pedantic streak. Most patients are nauseated, i.e. they feel sick. To describe them as nauseous means that they make you, or somebody else, feel sick. While this might be true in some cases, it is better, by far, to mean what you say.[1]
NauseaVomiting.png

Unpleasant sensation associated with the urge to vomit.

Contents

Causes

Treatment

This is often less than optimal as much prescribing is by analogy and outside the strict license of the respective products. Prescribers are often ignorant of relevant issues resulting in adverse effects. Any guideline older than 2014 is likely to be out of date as many products have been subject to regulatory action in the last few years !

Antiemetics

  • Prescribe only when the cause of vomiting is known as a rule as they may delay diagnosis.
  • Unnecessary and sometimes harmful when the cause can be treated, such as in diabetic ketoacidosis, or in digoxin or other drug overdose where their drug-drug interactions could cause malignant arrhythmias or other side effects.
  • It is very important to anticipate nausea and vomiting with certain therapies. Where this is likely it should be recognised that there are three different situations:
    1. Acute: This usually happens during or within several hours of systemic medication administration
    2. Delayed: Can happen and continue for several days after the treatment has been administered
    3. Anticipatory: If nausea and vomiting is not well controlled in the previous two phases, patients may experience a conditioned response of nausea and vomiting prior to receiving treatment
  • Chose drug according to the aetiology of vomiting.
  • Consider:
    • Other medications patient is on
    • Age
    • Pregnancy
    • Renal impairment
    • Hepatic failure


Antihistamines

  • Effective against nausea and vomiting resulting from many underlying conditions.
  • Typically:

Dopamine agonists

5HT3-receptor antagonists

Corticosteroids

  • Typically dexamethasone
  • Used to prevent cancer chemotherapy induced vomiting and PONV
  • Unpleasant perineal sensations when given iv to awake patients

Benzodiazepines

  • Typically lorazepam to prevent cancer chemotherapy induced vomiting

Neurokinin 1-receptor antagonists

Cannabinoids

References

  1. When I use a word: Nauseated/nauseous. Direct link: http://bmj.bmjjournals.com/cgi/content/full/332/7552/1271