and Mhamed Harif2
(1)
South African Medical Research Council, Cape Town, South Africa
(2)
Université Mohammed VI des Sciences de la Santé Cheikh Khalifa Hospital, Casablanca, Morocco
Keywords
Acute vomitingDelayed and anticipatory vomitingEmetogenic risk of chemotherapeutic agentsEmetogenic preventionAntiemeticsCase Presentation
A 14-year-old girl presented with a swollen, painful right knee, and a biopsy of the mass confirmed osteogenic sarcoma. Chemotherapy (cisplatinum and adriamycin) was initiated as soon as the staging process had been completed. One hour after the first cisplatinum infusion was commenced, the girl complained of severe nausea and then vomited profusely for the rest of the day. She received appropriate antiemetic treatment and improved, although she was still nauseous and vomited occasionally during the 3 days of chemotherapy.
When the patient had to be admitted for the second cycle of chemotherapy 3 weeks later, she started feeling nauseous on the way to hospital and vomited as soon as she entered the hospital ward.
Discuss the Following Definitions Regarding Chemotherapy-Induced Nausea and Vomiting (CINV) : Acute vs. Delayed Vomiting and Anticipatory Vomiting (Table 29.1)
Table 29.1
Definitions
Acute vomiting | Expulsion of stomach contents within 24 hours after administration of chemotherapy |
Delayed vomiting | Expulsion of stomach contents 2–5 days after administration of chemotherapy. Classically associated with cisplatinum as well as with cyclophosphamide, doxorubicin, and ifosfamide |
Anticipatory vomiting | A learnt response of vomiting, which occurs prior to the administration of chemotherapy. This is more common in children with a history of motion sickness or a previous negative post-chemotherapy nausea and vomiting experience |
What Are the Risk Factors for the Development of CINV in Children?
- 1.
Children older than 6 years, especially adolescents.
- 2.
Female gender.
- 3.
High expectation of nausea and vomiting, even before starting treatment.
- 4.
Moderate to high emetogenic risk of the chemotherapeutic agent.
- 5.
Chemotherapy dose.
- 6.
Concurrent radiotherapy to the abdomen
Discuss the Differential Diagnosis of Nausea and Vomiting in a Cancer Patient
- 1.
Direct intra-abdominal effects of the tumor, e.g. stretching of the intra-abdominal organs or gastrointestinal tract obstruction.
- 2.
Raised intracranial pressure.
- 3.
Complications of recent abdominal surgery.
- 4.
Other drug-induced vomiting, e.g. opioids, antibiotics, sedation agents, antiepileptics, etc.
- 5.
Infection, e.g. gastroenteritis, urinary tract infection, septicemia, etc.
- 6.
Organ dysfunction, e.g. abnormal liver function, renal dysfunction.
- 7.
Acute pancreatitis.
- 8.
Metabolic causes, e.g. hypokalemia (ileus), hyperglycemia, hypercalcemia, etc.
- 9.
Peptic ulcer disease , i.e. esophagitis, gastritis, peptic ulcer.
- 10.
Psychiatric cause, e.g. anxiety.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
