Nausea and vomiting in severly ill people

Question

Despite 24-hour oxygen administration, my son suffers from nausea and vomiting in connection with food intake. This often seems to be the case in the late stages of CF. Is there a connection with the lung/heart problem (tachycardia) or a medicinal therapy? It would be important for him to gain weight given the upcoming transplantation. His diabetes is adjusted quite well and the oxygen saturation okay.

Answer

Dear questioner,

Many thanks for your question, which is indeed not easy to answer. It certainly is true that stable weight, or weight with a high BMI (weight divided by height, squared) plays an important role for the success of a lung transplantation. Your son’s nausea, however, is certainly due to a number of reasons. Let me give you only a few – a comprehensive medical opinion is definitely necessary, though only possible in a limited way in writing via this forum:

Basically, virtually all medications can lead to nausea and I assume that your son takes a lot of them. Here, one would need to know in detail which medications these are and which of them could be replaced with others that are easier tolerated if necessary.

Despite the well-adjusted diabetes, particularly long-time diabetes can lead to so-called gastroparasis (“lazy stomach”), which keeps the food in the stomach and can thus lead to nausea. Here, nutritional counseling could help see what could be improved (many small meals instead of a few big ones). Another question in this context is whether your son is already being fed via a stomach tube. If so, again nutritional counseling could help see if a different nutrition plan would bring improvement.

Often, chronic constipation (DIOS – Distal Intestinal Obstructive Syndrome) is partly responsible for nausea; somewhat paradoxically, DIOS can cause so-called paradoxical diarrhea. X-ray would certainly help here.

Generally, the tachycardia surely is directly related to the lung situation, and nausea is a common problem with any severe chronic lung disease. Besides the points mentioned above, this is directly related to the so-called “hyperinflation” of the lungs. This so-called “hyperinflation” causes a downward shift of the diaphragm and thus probably a direct mechanical pressure on the abdominal organs, particularly on the stomach. Therefore, a lot of patients have increased shortness of breath after food intake, since the stomach pushes against the diaphragm. Here again, many small, calorie-rich meals instead of big ones will help.

It is important, however, that your son particularly eats the food he enjoys, especially if it is rich in calories. In this context, it is also important to mention that your son is not on a so-called diabetes diet, after all, but that his diet should consist of food he likes (irrespective of the amount of carbohydrates).

Medicinal help can only be limited: direct drugs that have an effect on the nausea (domperidone or metoclopramide, or also newer drugs such as ondansetron) are certainly sensible. Certain so-called neuroleptics (particularly so-called butyrophenones and also certain anti-depressants) can have a positive influence on the nausea and particularly also on the appetite; however, one has to pay attention to the side effects, and to say that these drugs will help against nausea for sure would be an exaggeration.

I hope I could help you with these thoughts. Again, I generally think that it is important for your son to eat what he enjoys and what causes the least degree of nausea; and whenever possible, he should eat several small meals rather than a few big ones.

Dr.med Markus Hofer
Adult CF clinic and Lung Transplant Program
Pulmonology Clinic
Zurich University Hospital

06.09.2010