Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++ Nausea is usually defined as the inclination to vomit or as a feeling in the throat or epigastric region alerting an individual that vomiting is imminent. Vomiting is defined as the ejection or expulsion of gastric contents through the mouth, often requiring a forceful event. +++ ETIOLOGY AND PATHOPHYSIOLOGY ++ Specific etiologies associated with nausea and vomiting are presented in Table 27-1. Table 27-2 presents cytotoxic agents categorized by their emetogenic potential. Although some agents may have greater emetogenic potential than others, combinations of agents, high doses, clinical settings, psychological conditions, prior treatment experiences, and unusual stimuli to sight, smell, or taste may alter a patient’s response to a drug treatment. The three consecutive phases of emesis are nausea, retching, and vomiting. Nausea, the imminent need to vomit, is associated with gastric stasis. Retching is the labored movement of abdominal and thoracic muscles before vomiting. The final phase of emesis is vomiting, the forceful expulsion of gastric contents due to GI retroperistalsis. Vomiting is triggered by afferent impulses to the vomiting center, a nucleus of cells in the medulla. Impulses are received from sensory centers, such as the chemoreceptor trigger zone, cerebral cortex, and visceral afferents from the pharynx and GI tract. The vomiting center integrates the afferent impulses, resulting in efferent impulses to the salivation center, respiratory center, and the pharyngeal, GI, and abdominal muscles, leading to vomiting. ++Table Graphic Jump LocationTABLE 27-1Etiologies of Nausea and VomitingView Table||Download (.pdf) TABLE 27-1 Etiologies of Nausea and Vomiting Intraperitoneal Mechanical obstruction Gastric outlet obstruction Small-bowel obstruction Altered sensorimotor function Gastroparesis Gastroesophageal reflux Intestinal pseudo-obstruction Irritable bowel syndrome Chronic idiopathic nausea Functional vomiting Cyclic vomiting syndrome Cannabinoid hyperemesis syndrome Rumination syndrome Inflammatory diseases Pancreatitis Pyelonephritis Cholecystitis Appendicitis Hepatitis Acute gastroenteritis Viral Bacterial Biliary colic Liver failure Cardiovascular diseases Myocardial infarction Cardiomyopathy Neurologic processes Increased intracranial pressure Migraine headache Vestibular disorders Intracerebral hemorrhage Intracerebral malignancy Metabolic disorders Diabetes mellitus (diabetic ketoacidosis) Addison’s disease Renal disease (uremia) Psychiatric causes Depression Anxiety disorders Anorexia and bulimia nervosa Therapy-induced causes Antineoplastic agents Radiation therapy Anticonvulsant preparations Digoxin, cardiac antiarrhythmics Opioids Oral hypoglycemics Oral contraceptives Antibiotics Volatile general anesthetics Drug withdrawal Opioids Benzodiazepines Miscellaneous causes Pregnancy Noxious odors Postoperative vomiting ++Table Graphic Jump LocationTABLE 27-2Emetic Risk of Agents Used in Oncology and Treatment OptionsView Table||Download (.pdf) TABLE 27-2 Emetic Risk of Agents Used in Oncology and Treatment Options Antiemetic Agent Antiemetic Dose on Day 1 of Chemotherapy Antiemetic Dose on Subsequent Days High Risk (>90%): Anthracycline/Cyclophosphamide combination, carboplatin AUC >4, carmustine, cisplatin, cyclophosphamide >1500 mg/m2, dacarbazine, mechlorethamine, streptozocin NK-1 Antagonist Aprepitant 125 mg oral 80 mg oral on days 2–3 Fosaprepitant 150 mg IV Netupitant/Palonosetron 300 mg/0.5 mg oral Rolapitant 180 mg oral 5-HT3 Antagonista Dolasetron 100 mg oral Granisetron 2 mg oral or 1 mg IV or 10 mcg/kg IV or ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth