Side effects of systemic cancer therapy - vomiting
Red flags
- Faeculent vomiting, colicky pain, distension, absent bowel sounds -> bowel obstruction
- Projectile or early-morning vomiting with headache, papilloedema -> raised ICP
- Haematemesis or coffee-ground vomit -> upper GI bleed (mucositis, ulcer, varices, thrombocytopenia)
- Fever with neutropenia -> neutropenic sepsis - treat this first
- Severe dehydration, oliguria, postural drop, rising creatinine -> admit for IV fluids
- Hypokalaemia + metabolic alkalosis + tetany -> severe protracted vomiting
- Hypotension, hyponatraemia, hyperkalaemia -> adrenal insufficiency
- Inability to keep down oral chemotherapy, anticonvulsants, opioids, immunosuppressants or antimicrobials -> the vomiting is now a treatment failure risk, not just a symptom
- Confusion + polyuria -> hypercalcaemia
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