Treatment Plan

Treatment Plan
Conservative measures:

• Relaxation techniques
• Paracetamol
• Hydration
• CBT
• Cool foods and drinks
• Treat identified anxiety

Antiemetics (based on cause):

• Unknown aetiology: levomepromazine, metoclopramide, haloperidol, cyclizine
  • If no improvement: trial dexamethasone
• Opioid-induced: levomepromazine, metoclopramide, haloperidol
• Intracranial cause:
  • Cyclizine
  • Consider radiotherapy & dexamethasone trial (8-16mg daily for 5-7 days; if effective, continue 2mg every 5-7 days) alongside cyclizine.
• Vestibular disruption: cyclizine (second line: prochlorperazine, hyoscine butylbromide, levopromazine)
• Peristaltic disruption: stop all drugs that cause peristalsis g. opiates & TCAs
  • No colic: metoclopramide (Prokinetic)
  • Mechanical bowel obstruction: avoid metoclopramide, use cyclizine ± haloperidol/levopromazine
  • Severe colic and vomiting: consider octreotide and hyoscine butylbromide
• Pelvic and abdominal tumours: cyclizine
• Gastric stasis: metoclopramide (caution: extrapyramidal side effects – If side effects occur switch to domperidone)
• Anxiety: CBT and benzodiazepines (e.g. sublingual lorazepam5mg)

Follow-up:

• Review in 24 hours
• If no improvement, refer