Pediatric Chemotherapy-Induced Nausea and Vomiting Follow-up
- Author: Reuven J Schore, MD; Chief Editor: Max J Coppes, MD, PhD, MBA more...
Further Outpatient Care
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- Ensure episodes of emesis are well controlled prior to discharge.
- Monitor serum laboratory levels in the ambulatory setting and correct for abnormalities of fluid and electrolyte status due to vomiting.
- Educate patients and caregivers on mechanisms of rehydration and the importance of oral hydration during chemotherapy and following periods of vomiting.
- Verify patients and caregivers are able to maintain proper nutritional status for patients at home. Provide nutrition supplements as needed.
Further Inpatient Care
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- Monitor serum laboratory values and correct for abnormalities of fluid and electrolyte status due to episodes of chemotherapy-induced vomiting.
- Monitor and supplement nutritional needs as appropriate for the child’s age.
- Monitor the patient’s weight loss, if the patient is not able to maintain oral intake.
Inpatient & Outpatient Medications
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- Antiemetic prophylaxis should always be initiated prior to administration of emetogenic chemotherapy.
- If infusions are administered in an ambulatory setting, provide patients and caregivers with appropriate prescriptions and instructions prior to initiation of emetogenic chemotherapy.
Complications of chemotherapy-induced nausea and vomiting may include the following:
- Patient discomfort
- Electrolyte imbalance
- Poor nutrition
- Prolonged hospitalizations
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- Selection and modification of appropriate antiemetic therapy based on emetogenic potential of chemotherapy scheduled, prior patient experience, and patient risk factors increase the opportunity for administration of chemotherapy without emetic complications.
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- Importance of adequate hydration
- Adherence to schedules antiemetic regimen
- Maintaining chemotherapy treatments as scheduled
- Diet modifications to decrease emesis risk
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|Emetogenic Risk level||Antineoplastic Agents||Antiemetic Regimen|
|level 4 (High): More than 90% of patients who receive these agents experience nausea and vomiting.||Carmustine, cisplatin, cyclophosphamide (>1500 mg/m2), dacarbazine, dactinomycin, mechlorethamine, streptozotocin||Serotonin-receptor antagonist,|
dexamethasone, and aprepitant
|level 3 (Moderate): Nausea and vomiting occurs in 30-90% of patients who receive these agents.||Carboplatin, cyclophosphamide (< 1500 mg/m2), cytarabine (>1 g/m2), daunorubicin, doxorubicin, epirubicin, idarubicin, ifosfamide, irinotecan, oxaliplatin||Serotonin-receptor antagonist and dexamethasone|
|level 2 (Low): Nausea and vomiting occurs in 10-30% of patients who receive these agents.||Bortezomib, cetuximab, cytarabine (< 1 g/m2), docetaxel, etoposide, fluorouracil, gemcitabine, methotrexate, mitomycin, mitoxantrone, paclitaxel, pemetrexed, topotecan, trastuzumab||Serotonin-receptor antagonist|
|level 1 (Minimal): Less than 10% of patients who receive these agents experience nausea and vomiting.||Bevacizumab, bleomycin, busulfan, 2-chlorodeoxyadenosine, fludarabine, rituximab, vinblastine, vincristine, vinorelbine||No antiemetic routinely administered*|
|*If antiemetic required for individual patients, may use a single dose of serotonin-receptor antagonist|