A Case Report of Continuous Subcutaneous Infusion of Hydromorphone, Metoclopramide and Ondansetron Used To Treat Refractory Pain and Nausea in an Ambulatory Palliative Clinic
Journal Title: Palliative Medicine & Hospice Care – Open Journal - Year 2017, Vol 3, Issue 1
Abstract
Background: This case report describes a patient with advanced breast cancer with both refractory pain related to metastatic skeletal lesions and nausea who was successfully managed during the last nine months of her life with a continuous subcutaneous infusion of hydromorphone, metoclopramide and ondansetron in one chemically compatible mixture. Case presentation: A 56-year-old woman with widespread metastatic breast cancer to bone who was followed in an ambulatory palliative care clinic for pain management and nausea. As her disease progressed and she was in the last year of her life, her pain and nausea had become very difficult to manage despite multiple modalities of treatment. Case management: A continuous subcutaneous infusion of hydromorphone, metoclopramide and ondansetron was started and titrated to achieve relief of her intolerable and refractory pain and nausea. All three medications were chemically compatible, and provision for bolus was ensured. Case outcome: The patients ultimate goals of care were achieved, including nine months of excellent relief of both nausea and pain, while enhancing quality of life due to ease of administration of one mixture. Conclusion: The combination of hydromorphone, metoclopramide and ondansetron is a potentially useful regimen for the targeted treatment of concomitant refractory pain and nausea in the palliative care setting. This represents the first time the triad mixture has been reported successfully in case studies.
Authors and Affiliations
Lawrence Aoun
Keywords
Related Articles
- EP ID EP549321
- DOI 10.17140/PMHCOJ-3-118
- Views 125
- Downloads 0
Emerging Quality Improvement Concepts to Enhance the Patient and Family Experience in Hospice and Palliative Care
Most quality improvement in end-of-life care has been related to symptom management, goals of care, cost-effectiveness, and adhering to patient preferences. The patient and family’s experience of care, the environment of...
Transforming End-of-Life Care
Currently, hospice care which focuses on caring for a terminally ill person delivers holistic, supportive, interdisciplinary, and patient-centered management. There have been numerous efforts to establish hospice care fo...
The Fight against the “Human Disaster” of Cancer in the Middle Eastern Countries
Cancer is considered to be one of the leading causes of death globally. With the increasing prevalence of cancer, the World Health Organization (WHO) expects cancer cases to surge in the next two decades from 14 million...
Effects of Perception of Prognosis on Existential Well-Being and Ego-Integrity Among Advanced Cancer Patients
Background: Based on literature review, advanced stage cancer patients hold over-optimistic perception of their prognosis. This phenomenon is presumed to be an implication of defense and coping mechanisms, aiming to alie...
Religious Cultural Sensitivity in Israel: A Case Study of an Orthodox Jewish Family
The challenges of hospice care can scarcely be overstated, considering that the complexity of managing the physical, psychosocial and spiritual issues of the patient and of the family may seem daunting. The task becomes...