Nausea & vomiting due to altered intestinal function
Step one
Diagnose the cause and treat if possible
Treat constipation aggressively
Step two
High GI tract - metoclopramide
Lower GI tract – cyclizine
Step three
Consider a surgical referral
Ask for help
This can be due to tumour compressing the lumen, altered intestinal flow or tumour bleeding and causing irritation (especially in the upper gastrointestinal tract). If the patient is thought to have complete bowel obstruction then surgical intervention should be considered although it may not be appropriate, (see additional sheet).
If the problem is thought to be high in the gastrointestinal tract consider metoclopramide 20mg every 8 hours, although may make pre-existing colic worse.
Consider cyclizine 25-50mg every 8hours, although this will slow bowel transit time.
If colic is a significant feature hyoscine butylbromide 60-100mg in a syringe driver over 24hours may help.
