Nausea and Vomiting

Nausea, the unpleasant sensation of being about to vomit, can occur alone or can accompany vomiting. Vomiting is the expulsion of gastric contents through the mouth.

• Most palliative care patients have multiple causes of nausea and vomiting.
• Treat of the underlying cause if possible.
• There are specific guidelines on chemotherapy-induced nausea and vomiting. Check the chemotherapy agent that the patient is having and speak to the oncologist.

• Gastritis
• Compression of the stomach
• Intestinal obstruction
• Severe constipation
• Medications
• Chemotherapy/radiotherapy
• Electrolyte imbalances (e.g. hypercalcaemia, uraemia)
• Increased intracranial pressure (e.g. brain tumours)

General Care

• Small frequent meals
• Avoid strong smell
• Avoid known triggers

Mechanistic Approach to pharmacological treatment
If the underlying cause cannot be reversed or the cause is uncertain, identify the likely mechanism of nausea and vomiting and treat with an agent targeting the mechanism.

For doses of drugs, please refer to Drug Formulary.

• Watson SM, Lucas FC, Hoy MA, Back NI. Symptom management: gastrointestinal symptoms. Oxford Handbook of Palliative Care. New York, NY: Oxford University Press; 2005:246-253.
• Hum A, Koh M. Symptoms: nausea and vomiting: In: Hum A, Koh M, ed. The Bedside Palliative Medicine Handbook. Singapore, SG: Armour Publishing; 2013:42-45.
• Hospital Pharmacists' Special Interest Group in Palliative Care. Nausea and Vomiting. Care Beyond Cure: Management of Pain and Other Symptoms.