Abstract Intro Nausea and vomiting are common symptoms at the end of life, occurring in up to 62% of terminally ill cancer patients. Poorly controlled symptoms of nausea and vomiting can lead to dehydration, starvation, and acceleration of disease if the patient is unable to take oral medications and chronic medications. Case An 81-year-old female with ovarian cancer, peritoneal metastasis, malignant ascites and pleural effusion with indwelling pleural catheter, presented to the hospital with intractable nausea and vomiting. This was her second hospital admission after presenting for the same complaint 7 days prior, where she was treated and discharged home on oral mirtazapine. Her symptoms persisted after returning home, prompting her to return to hospital. On her return admission, she continued to experience nausea and vomiting and was also found to have new-onset pulmonary embolism with a PESI score of 131 (high-risk for deterioration). She was treated with IV ondansetron, IV metoclopramide, and IV fluids in addition to heparin drip prior to discharge on hospice. She died the day after returning home after complaining of “shortness of breath” to friends and family. Although the patient was discharged on home hospice appropriately after her second admission, it is possible that her pulmonary embolism occurred in the setting of not taking oral medication and no anticoagulation for weeks in the setting of intractable nausea/ vomiting, and cancer, a pro-coagulant condition. Discussion Intractable nausea and vomiting is common in cancer patients and not always treated aggressively, or with different forms/routes of medication until patients experience relief. Providers should be creative and attentive to their patients by offering different anti-emetic medications and different routes of administration until patients experience improvement or resolution in their symptoms. Examples of this include rectal suppositories, subcutaneous infusions, and orally dissolvable tablets. Medications include and are not limited to metoclopramide, haloperidol, prochlorperazine, scopolamine, diphenhydramine, promethazine, amongst others. Providers should be systematic and proactive in trialing different medications for patients. Without symptom relief, patients may be at risk of faster progression of their underlying disease, and continue to experience distress and discomfort. This abstract is funded by: None
Tao et al. (Fri,) studied this question.