Vomiting goals

The primary goal of treatment is to relieve the symptoms of nausea and vomiting, which should increase the patient s quality of life. Drug therapy for nausea and vomiting should be safe, effective, and economical. 

The goals of treatment for acute pancreatitis include (1) resolution of nausea, vomiting, abdominal pain, and fever (2) ability to tolerate oral intake (3) normalization of serum amylase, lipase, and white blood cell count and (4) resolution of abscess, pseudocyst, or fluid collection as measured by CT scan. 

The overall goal of treatment should be to prevent or eliminate nausea and vomiting regardless of etiology. 

The primary goal with chemotherapy-induced nausea and vomiting (CINV) is to prevent nausea and/or vomiting. 

Nausea and vomiting that occurs within 24 hours of chemotherapy administration is defined as acute, whereas when it starts more than 24 hours after chemotherapy administration, it is defined as delayed. The primary goal with CINV is to prevent nausea and/or vomiting optimal control of acute nausea and vomiting positively impacts the incidence and control of delayed and anticipatory nausea and vomiting. Clinical practice guidelines for the use of antiemetics in CINV have been published. Despite the availability of nationally recommended guidelines, individual practice varies from one institution to the next. Product availability and recommended doses are institution-specific and may vary considerably from the doses listed in Table 35-5. 

Rehydration and maintenance of water and electrolytes are primary treatment goals until the diarrheal episode ends. If the patient is volume depleted, rehydration should be directed at replacing water and electrolytes to normal body composition. Then water and electrolyte composition are maintained by replacing losses. Many patients will not develop volume depletion and therefore will only require maintenance fluid and electrolyte therapy. Parenteral and enteral routes may be used for supplying water and electrolytes. If vomiting and dehydration are not severe, enteral feeding is the less costly and preferred method. In the United States, many commercial oral rehydration preparations are available (Table 36-3). 

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