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Pediatric Chemotherapy-Induced Nausea and Vomiting Workup

  • Author: Reuven J Schore, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
Updated: Sep 16, 2015

Laboratory Studies

In cases of severe or persistent emesis, monitoring serum electrolyte levels may be warranted.


Imaging Studies

Imaging studies are useful if chemotherapy is not thought to be solely responsible for the nausea and vomiting. Abdominal imaging (radiography or CT scanning) or CNS imaging (head CT scanning) may be indicated depending on the potential cause under investigation.

Contributor Information and Disclosures

Reuven J Schore, MD Assistant Professor of Pediatrics, George Washington University School of Medicine and Health Sciences; Attending Physician, Center for Cancer and Blood Disorders, Leukemia and Lymphoma Program, Division of Oncology, Children's National Medical Center

Reuven J Schore, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Hematology, American Society of Pediatric Hematology/Oncology

Disclosure: Received research grant from: Millennium Pharmaceuticals, Inc; Onyx Pharmaceuticals, Inc; Merck Inc<br/>Received income in an amount equal to or greater than $250 from: Baxalta Pharmaceuticals, Inc.


Devona Williams, PharmD Pharmacy Clinical Specialist, Children's National Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Max J Coppes, MD, PhD, MBA Executive Vice President, Chief Medical and Academic Officer, Renown Heath

Max J Coppes, MD, PhD, MBA is a member of the following medical societies: American College of Healthcare Executives, American Society of Pediatric Hematology/Oncology, Society for Pediatric Research

Disclosure: Nothing to disclose.

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Vomiting reflex.
Table. Emetogenic Risk of Intravenously Administered Antineoplastic Agents[2, 6]
Emetogenic Risk levelAntineoplastic AgentsAntiemetic 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, streptozotocinSerotonin-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, oxaliplatinSerotonin-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, trastuzumabSerotonin-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, vinorelbineNo antiemetic routinely administered*
*If antiemetic required for individual patients, may use a single dose of serotonin-receptor antagonist
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