Nausea and Vomiting
Gastrointestinal Conditions
R11 + (Z51.5)
See: Nausea and vomiting, non-specific
DESCRIPTION
- Nausea and vomiting may have many causes in palliative care patients e.g. medication, constipation, anxiety, infection and raised intracranial pressure.
GENERAL MEASURES
Refer to a dietician if available.
Identify and manage reversible causes, which 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 and rehydrate the patient if necessary.
Deliver medicines via an appropriate route and regularly.
Adults:
- Metoclopramide, oral, 10 mg, 8 hourly as needed.
- In renal impairment start with a dose of 5 mg, 8 hourly.
- Increase according to clinical response using alternate 5 mg and 10 mg doses if required.
LoE:IVb5, LoE:IVb6
Children:
- Metoclopramide, oral, 0.1 mg/kg/dose, 8–12 hourly.
|
Weight
kg |
Dose
mg |
Syrup
5 mg/5 mL |
Age
months/years |
|
>9–11 kg
|
1 mg
|
1 mL
|
>12–18 months
|
|
>11–14 kg
|
1.2 mg
|
1.2 mL
|
>2–3 years
|
|
>14–17.5 kg
|
1.6 mg
|
1.6 mL
|
>3–5 years
|
|
>17.5–25 kg
|
2 mg
|
2 mL
|
>5–7 years
|
|
>25–35 kg
|
3 mg
|
3 mL
|
>7–11 years
|
|
>35–55 kg
|
4.5 mg
|
4.5 mL
|
>11–15 years
|
|
Use with caution as extrapyramidal side effects may occur |
LoE:IVb7
REFERRAL
- All patients with a diagnosed or suspected underlying cause that requires treatment at a higher level of care.
- Consult a palliative care trained doctor if nausea and vomiting persist despite treatment.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_07 November 2024
Chapter 22: Medicines Used in Palliative Care_22.1 Gastrointestinal Conditions_22.1.3 Nausea and Vomiting