Effects of fluid manipulation on the incidence of vomiting during outpatient cisplatin infusion.
The influence of fluid intake and hydration rate on the frequency of vomiting was evaluated during 254 outpatient cisplatin infusions administered to 60 patients. The basic antiemetic regimen was consistent and used metoclopramide hydrochloride (Reglan) 2 mg/kg/dose (means = 150 mg) starting 30 minutes before cisplatin for a total of three doses; dexamethasone (Decadron) mean - 15 mg - and lorazepam (Ativan) 1 mg intravenous bolus before cisplatin, along with thiethlperazine maleate (Torecan) given routinely throughout the treatment beginning the evening before. Only 20% (38/192) of patients experienced symptoms of vomiting when hydrated at a rate of greater than 333 cc/hour as opposed to 44% (27/62) patients hydrated at a rate of 300 cc/hour or less (p = 0.01). Patients whose oral intake ranged from 400 cc to 1000 cc experienced noticeably less vomiting (14%) than patients who either refused fluids (39%, p = 0.001) or exceeded 1000 cc oral intake (36%, p less than 0.05) during treatment. Manipulation of total fluid intake (IV plus oral), although not statistically significant, seemed to affect the incidence of vomiting. By maintaining a positive intake/output ratio greater than 1, patients were able to decrease their vomiting episodes. Patients who gained weight during the treatment experienced significantly fewer episodes of vomiting (29%) than those who either lost or maintained their weight (71%). Findings suggest that manipulating both oral and IV fluid intake as well as the IV fluid rate may reduce symptoms of vomiting in the outpatient cisplatin setting.
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D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use; D002945:Cisplatin / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014839:Vomiting / Q000139:chemically induced / Q000503:physiopathology* / Q000517:prevention & control; D014882:Water-Electrolyte Balance
D000932:Antiemetics; D002945:Cisplatin