An audit was conducted of the management of chemotherapy-induced nausea and vomiting in children and young people in the national Irish paediatric cancer unit. Over three months, the anti-emetic medication and the incidence of nausea and vomiting in 50 consecutive patient episodes were recorded among 25 children receiving chemotherapy for diverse malignancies. Anti-emetic prescription was found to be unrelated to the emetogenic potential of the chemotherapy received, so that effectiveness varied. Dexamethasone was used in only one case. Twenty children did not take any anti-emetics following discharge, although 11 experienced delayed vomiting, evidence-based guidelines were established and now include anti-emetic prescription that is proportional to the emetogenic potential of the chemotherapeutic regimen. It is also recommended that staff, patients, families and carers should receive education about the need for prescription and use of anti-emetics after discharge.
"Medications that cause nausea and vomiting as side effects also need to be excluded (e.g. anti-neoplastic drugs) . Other diseases that could potentially mimic gastroparesis include conditions affecting the gastrointestinal tract (pancreatobiliary disorders, celiac artery compression syndrome) [51,52], endocrine system (hyperaldosteronism), central nervous system (tumors) and the genitourinary tract (pregnancy, chronic pyelonephritis, uremia) . "
[Show abstract][Hide abstract] ABSTRACT: Historically, gastroparesis is characterized by delayed gastric emptying of fluids and/or solids without evidence of a mechanical gastric outlet obstruction. To provide a thorough, evidence-based overview of the diagnosis, treatment, outcome and future advances for gastroparesis in children, a web search (PubMed, Cochrane Database of Systematic Reviews, EMBASE, Clinical Evidence) was performed. Original articles and reviews were identified, examined and included as appropriate. The prevalence of gastroparesis is vague in adults and unknown in children. It is suspected on the presence of symptoms indicating gastric dysmotility (nausea, vomiting, early satiety, postprandial fullness, failure to thrive, weight loss) and is confirmed on the demonstration of delayed gastric emptying. It can be assessed with various methods from which gastric emptying scintigraphy of a radiolabeled solid meal is considered as the golden standard. Therapeutic approaches include: dietary modifications, medical treatment (prokinetics, antiemetics, intrapyloric injection of botulinum toxin, enteral feeds via jejunostomy, total parenteral nutrition) and surgical interventions (laparoscopic placement of gastric pacemaker) aiming at alleviating symptoms and maintaining optimal nutritional status. Gastroparesis in children can be challenging to diagnose and treat. Specific protocols for the evaluation of gastric emptying and for a stepwise management are required to optimise future outcomes.
Annals of Gastroenterology 03/2013; 26(3):204-211.
[Show abstract][Hide abstract] ABSTRACT: Background: Chemotherapy induced nausea and vomiting is an added distress to patients burdened by the illness. In an effort to tackle the emetogenic potential of the agents, guidelines have been proposed to maintain uniformity in prescription and improvement in patient tolerance; but their utility and practice is not consistent. The aim of this clinical audit was to assess the antiemetic practice and investigate the adherence to antiemetic clinical practice guideline.
Methods: We performed an audit of the antiemetic practices in our tertiary referral centre. A questionnaire based interview was completed at the outpatient visit to tabulate the data.
Results: 99 (81.8%) patients received chemotherapy of at least low emetogenic risk. 83 (84%) patients received prophylaxis which was appropriate in 65% based on the our centre’s antiemetic regimen. This was however inappropriate in 76% of patients based on the international practice parameters.
Conclusions: Guidelines are not uniformly representative of all populations and modifications toguidelines based on local data are required to ensure success of such policies. There exist evidence- practice gaps in antiemetic policies.
Journal of Pharmaceutical Care 2014. 2(1):22-26
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