Nonpharmacologic Therapy

A variety of effective pharmacologic treatments exist for nausea and vomiting, but they all have unwanted adverse treatment effects. For this reason, nonpharmacologic treatment options may be considered in selected patients.

Nonpharmacologic options are desirable for treating NVP due to concern for te-ratogenic effects with drug therapies. When treating PONV, the nonpharmacologic approach is appealing to minimize additive CNS depression with antiemetics and an-

esthetic agents. Nonpharmacologic approaches to treating nausea and vomiting include dietary, physical, and psychological changes.

Dietary approaches are the cornerstone of treatment for NVP.16 They are included in treatment guidelines even though there is little evidence to support their effect-iveness.12 Recommendations include eating frequent, small meals; avoiding spicy or fatty foods; eating high-protein snacks; and eating bland or dry foods the first thing in the morning.12,16,1 In addition to dietary changes, there is some evidence that wo men taking a multivitamin at the time of conception are less likely to seek medical attention for NVP.12

FIGURE 20-1. Physiologic pathways that result in nausea and vomiting. (5-HT3, serotonin type 3 receptor; D2, dopamine type 2 receptor; H1 histamine type 1 receptor, NK1, neurokinin-1.) (From Ref. 13.)

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