Management of nausea and vomiting

 

 

Metabolic causes:

 

 Haloperidol is a type of antipsychotic (dopamine receptor antagonist) that acts on the CTZ.

Typical doses administered are 1.5mg one to two times daily, however if the cause of vomiting is due to hypercalcaemia (more than 2.8 mmol/L) then this may require admission into hospital and is usually managed by intravenous rehydration and biphosphonates. These are given to slow down the rate of bone loss and to lower the amount of calcium in the blood. Exceptions apply to patients that are in the last stages of life and it may be more suitable to manage symptoms rather than correcting the level of calcium.

Side effect: Drowsiness and extrapyramidal effects may occur but is uncommon at low doses

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Intracranial disease related:

Cyclizine is an antihistamine acting on the vomiting centre which contains a large number of histamine 1 receptors and it is  given at a dose of 50mg up to three times a day orally with a maximum daily dose of 150mg.  If the intracranial pressure is raised then corticosteroids such as dexamethasone may be administered at (8-16mg) for up to seven days. If there is no benefit or improvement after 3-5 days then corticosteroids should be stopped.

Side effects of cyclizine include drowsiness due to it being an older antihistamine , headache, antimuscarinic effects such as urinary retention,dry mouth, blurred vision and GI disturbances.