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NAUSEA & VOMITING
Treatment Guideline Chart
Nausea is the sensation felt immediately before vomiting.
Vomiting is a partially voluntary act of forceful expelling of stomach contents up to and out of the mouth that may or may not be preceded by nausea.
Retching or repetitive active contraction of the abdominal muscles occurs between nausea and vomiting.
Management includes correction of clinically relevant metabolic complications and treatment of underlying cause.

Nausea & Vomiting References

  1. ASHP therapeutic guidelines on the pharmacologic management of nausea and vomiting in adult and pediatric patients receiving chemotherapy or radiation therapy or undergoing surgery. Am J Health Syst Pharm. 1999 Apr;56(8):729-764. PMID: 10326616
  2. American College of Obstetricians and Gynecologists (ACOG). American College of Obstetrics and Gynecology Practice Bulletin: nausea and vomiting of pregnancy. Obstet Gynecol. 2004 Apr;103(4):803-814. PMID: 15051578
  3. Gan TJ. Post-operative nausea and vomiting-can it be eliminated?. JAMA. 2002 Mar;287(10):1233-1236. PMID: 11886298
  4. American Gastroenterological Association. American Gastroenterological Association medical position statement: nausea and vomiting. Gastroenterology. 2001 Jan;120(1):261-262. PMID: 11208735
  5. Golembiewski J, Chernin E, Chopra T. Prevention and treatment of postoperative nausea and vomiting. Am J Health Syst Pharm. 2005 Jun;62(12):1247-1260. PMID: 15947124
  6. Herrstedt J, Aapro MS, Roila F, Kataja VV; ESMO Guidelines Task Force. ESMO minimum clinical recommendations for the prophylaxis of chemotherapy-induced nausea and vomiting (NV). Ann Oncol. 2005;16(Suppl 1):i77-i79. PMID: 15888767
  7. Markman M. Progress in preventing chemotherapy-induced nausea and vomiting. Cleve Clin J Med. 2002 Aug;69(8):609-617. PMID: 12184469
  8. Quigley EM, Hasler WL, Parkman HP. AGA technical review on nausea and vomiting. Gastroenterology. 2001 Jan;120(1):263-286. PMID: 11208736
  9. MedWormhttp://www.medworm.com/rss/index.php/Gastroenterology/17/http://www.medworm.com/rss/medicalfeeds/specialities/Gastroenterology.xml
  10. MedWormhttp://www.medworm.com/rss/index.php/Pediatrics/33/http://www.medworm.com/rss/medicalfeeds/specialities/Pediatrics.xml
  11. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: antiemesis version 1.2005. NCCN. http://www.nccn.org. 2005. Accessed 22 Aug 2005.
  12. Prodigy Guidance: Nausea and vomiting in pregnancy. http://www.prodigy.nhs.uk. 2005. Accessed 22 Aug 2005.
  13. Society of Obstetricians and Gynaecologists of Canada Clinical Practice Obstetrics Committee. SOGC clinical practice guidelines: the management of nausea and vomiting of pregnancy. http://sogc.org. 2002. Accessed 22 Aug 2005.
  14. Basch E, Prestrud AA, Hesketh PJ, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2011 Nov;29(31):4189-4198. http://jco.ascopubs.org/content/early/2011/09/25/JCO.2010.34.4614.full.pdf. Accessed 11 Feb 2014. PMID: 21947834
  15. Chandrakantan A, Glass PSA. Multimodal therapies for postoperative nausea and vomiting, and pain. Br J Anaesth. 2011 Dec;107(Suppl Suppl 1):i27-40. http://bja.oxfordjournals.org/content/107/suppl_1/i27.full.pdf. Accessed 11 Feb 2014. PMID: 22156268
  16. Ettinger DS, Armstrong DK, Barbour S, et al. Antiemesis. J Natl Compr Canc Netw. 2012;10(4):456-485. http://www.jnccn.org/content/10/4/456.full.pdf. Accessed 11 Feb 2014. PMID: 22491046
  17. Longstreth GF. Approach to the adult with nausea and vomiting. UpToDate. http://www.uptodate.com. 5 Apr 2013. Accessed 11 Feb 2014.
  18. Niebyl JR. Clinical practice. Nausea and vomiting in pregnancy. N Engl J Med. 2010;363(16):1544-1550. http://www.nejm.org/doi/pdf/10.1056/NEJMcp1003896. doi: 10.1056/NEJMcp1003896. Accessed 12 Feb 2014. PMID: 20942670
  19. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: antiemesis version 2.2014. NCCN. http://www.nccn.org.
  20. Poh J. Restrictions on the use of metoclopramide-containing products. Health Sciences Authority (HSA). http://www.hsa.gov.sg. 21 Sep 2016. Accessed 14 Mar 2019.
  21. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: antiemesis version 1.2016. NCCN. http://www.nccn.org. 15 Mar 2016. Accessed 07 Apr 2016.
  22. Herrstedt J, Roila F, Warr D, et al. 2016 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following high emetic risk chemotherapy. Support Care Cancer. 2016 Jul 22. doi: 10.1007/s00520-016-3313-0. PMID: 27443154
  23. Roila F, Warr D, Hesketh PJ, et al. 2016 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following moderately emetogenic chemotherapy. Support Care Cancer. 2016 Aug 11. doi: 10.1007/s00520-016-3365-1. PMID: 27510316
  24. Walsh D, Davis M, Ripamonti C, et al. 2016 updated MASCC/ESMO consensus recommendations: management of nausea and vomiting in advanced cancer. Support Care Cancer. 2016 Aug 17. doi: 10.1007/s00520-016-3371-3. PMID: 27534961
  25. Stanghellini V, Chan FK, Hasler WL, et al. Gastroduodenal disorders. Gastroenterology. 2016 May;150(6):1380-1392. doi: 10.1053/j.gastro.2016.02.011. Accessed 28 Dec 2016. PMID: 27147122
  26. Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV . Gastroenterology. 2016 May;150(6):1262-1279. doi: 10.1053/j.gastro.2016.02.032. Accessed 28 Dec 2016. PMID: 27144617
  27. Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017 Oct 1;35(28):3240-3261. doi: 10.1200/JCO.2017.74.4789. Accessed 07 May 2018. PMID: 28759346
  28. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: antiemesis version 2.2018. NCCN. https://www.nccn.org. 30 Apr 2018. Accessed 07 May 2018.
  29. Roila F, Molassiotis A, Herrstedt J, et al; participants of the MASCC/ESMO Consensus Conference Copenhagen 2015. 2016 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients. Ann Oncol. 2016 Sep;27(Suppl 5):v119-v133. doi: 10.1093/annonc/mdw270. Accessed 07 May 2018. PMID: 27664248
  30. Committee on Obstetric Practice. ACOG practice bulletin no. 189: nausea and vomiting of pregnancy. Obstet Gynecol. 2018 Jan;131(1):e15-e30. doi: 10.1097/AOG.0000000000002456. Accessed 24 Mar 2021. PMID: 29266076
  31. Gan TJ, Belani KG, Bergese S, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2020 Aug;131(2):411-448. doi: 10.1213/ANE.0000000000004833. PMID: 32467512
  32. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: antiemesis version 1.2021. NCCN. https://www.nccn.org. 23 Dec 2020.
  33. Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: ASCO guideline update. J Clin Oncol. 2020 Aug 20;38(24):2782-2797. doi: 10.1200/JCO.20.01296. PMID: 32658626
  34. Majem M, de Las Peñas R, Virizuela JA, et al. SEOM clinical guideline emesis (2021). Clin Transl Oncol. 2022 Apr;24(4):712-723. doi: 10.1007/s12094-022-02802-1. PMID: 35347571
  35. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: antiemesis version 2.2023. NCCN. http://www.nccn.org. 24 May 2023. Accessed 05 Jun 2023.
  36. National Guideline Alliance (UK). Management of nausea and vomiting in pregnancy: antenatal care. NICE. https://www.nice.org.uk. Aug 2021.
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