ABSTRACT
Nausea and vomiting are common, troublesome, multifactorial symptoms in terminally ill patients. Reuben and Mor1 estimated that 62% of terminally ill patients developed nausea and vomiting, with 40% having symptoms in the last 6 weeks of life. However, little evidence is available that has evaluated the most effective way to manage these symptoms. Much of the literature on managing severe nausea and vomiting is based on patients who have received chemotherapy. Because chemotherapy-induced nausea and vomiting differs both in mechanism and pathophysiology from nausea and vomiting due directly to advanced disease, those findings may not be applicable in terminal care. Of the evidence available on terminally ill patients, most are descriptive case reports or case series. (Table 1)
Several authors have reviewed this topic. 2-S Lichter3,4 described a protocol used in 100 terminally ill patients. Control of symptoms was achieved in 70% of patients within 24 hours, and 93% within 48 hours. Lichter's approach is to assess the causes of nausea and vomiting and to select receptor-specific antiemetic agents. The drug therapy choices in this protocol were based on neurotransmitter receptor binding studies conducted by I son 9 and Peroutka.lO Basing drug therapy on probable receptors provides a systematic process for evaluating and managing patients' symptoms. The following steps. are useful in evaluating patients and determining the treatment options.
