Table 1 Clinical practice guidelines for the management of nausea
Dominant cause | Treatment Step 1 | Treatment Step 2 | Treatment Step 3 |
|---|---|---|---|
A: Central/chemoreceptor trigger zone (CTZ) stimulation | Prochlorperazine 5 mg tds po or 25 mg PR then 5 mg tds po or 12.5 mg bd IM/iv | Haloperidol 1.5 mg/24 h po or sc | Haloperidol 3 mg/24 h po or sc |
B: Central nervous system (CNS) disease | Dexamethasone 8 mg/24 h po/sc/iv | Dexamethasone 12 mg/24 h po/sc/iv | Dexamethasone 16 mg/24 h po/sc/iv |
C: Vestibular involvement | Prochlorperazine 5 mg tds po or 25 mg PR then 5 mg tds po or 12.5 mg bd IM/iv | Prochlorperazine 10 mg tds po or 25 mg PR then 10 mg tds po or 12.5 mg tds IM/iv | Promethazine 25 mg tds po or 12.5 mg sc then 10 mg tds po |
D: Gastric stasis | Metoclopramide 10 mg qid po/sc/iv | Metoclopramide 10 mg Q4h po/sc/iv | Metoclopramide 10 mg Q4h po/sc/iv Dexamethasone 8 mg/24 h po/sc/iv |
E: Ileus | Metoclopramide 10 mg qid po/sc/iv | Metoclopramide 10 mg Q4h po/sc/iv | Metoclopramide 10 mg Q4h po/sc/iv Dexamethasone 8 mg/24 h po/sc/iv |
F: Mechanical obstruction | Haloperidol 1.5 mg/24 h po/sc Dexamethasone 8 mg/24 h po/sc/v | Haloperidol 3 mg/24 h po/sc Dexamethasone 8 mg/24 h po/sc/iv | Haloperidol 3 mg/24 h po/sc Dexamethasone 8 mg/24 h po/sc/iv Hyoscine butylbromide 80 mg/24 h sc or Ranitidine 200 mg/24 h sc |
G: Gastritis | Metoclopramide 10 mg qid po/sc/iv PPI min dose | Metoclopramide 10 mg qid po/sc/iv PPI max dose | Metoclopramide 10 mg Q4h po/sc/iv PPI max dose |
H: Cause undetermined (or multifactorial) | Metoclopramide 10 mg qid po/sc/iv | Metoclopramide 10 mg qid po/sc/iv Haloperidol 1.5 mg/24 h po/sc | Metoclopramide 10 mg Q4h po/sc/iv Haloperidol 3 mg/24 h po/sc |