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Gastrointestinal Complications (PDQ®): Supportive care - Health Professional Information [NCI] - Diarrhea

Table 3. National Cancer Institute's Common Terminology Criteria for Adverse Events: Nausea and Vomitinga

Adverse EventGradeDescription
TPN = total parenteral nutrition.
a Adapted from National Cancer Institute.[8]
b Definition: A disorder characterized by a queasy sensation and/or the urge to vomit.
c Definition: A disorder characterized by the reflexive act of ejecting the contents of the stomach through the mouth.
Nauseab1Loss of appetite without alteration in eating habits
2Oral intake decreased without significant weight loss, dehydration, or malnutrition
3Inadequate oral caloric or fluid intake; tube feeding, TPN, or hospitalization indicated
4Grade not available
5Grade not available
Vomitingc11–2 episodes (separated by 5 min) in 24 h
23–5 episodes (separated by 5 min) in 24 h
3≥6 episodes (separated by 5 min) in 24 h; tube feeding, TPN, or hospitalization indicated
4Life-threatening consequences; urgent intervention indicated
5Death

The goal of physical examination is to identify potential causes of diarrhea and its complications as quickly as possible to reduce morbidity. The physical examination includes vital signs and evaluation of skin turgor and oral mucosa to assess hemodynamic status and dehydration. Abdominal examination includes evaluation for rebound tenderness, guarding, hypoactive or hyperactive bowel sounds, and stool collection. A rectal exam can rule out fecal impaction but is performed judiciously in neutropenic or thrombocytopenic patients.[5]

Laboratory tests may include stool cultures for bacterial, fungal, and viral pathogens. A complete chemistry panel and hematologic profile can provide information regarding the effect of diarrhea on kidney function and electrolytes as well as identify changes in white blood cell count in response to infection. Urinalysis with specific gravity can provide information regarding hydration status. Stool osmolality may also be measured.[5]

In some cases, radiographic procedures are conducted to identify ileus, obstruction, or other abnormalities. In rare cases, endoscopy may be indicated.

Management

A review of early toxic deaths in two NCI-sponsored cooperative trials of irinotecan plus high-dose fluorouracil and leucovorin for advanced colorectal cancer has led to the revision of previously published clinical practice guidelines for the treatment of cancer treatment–induced diarrhea, with a heightened emphasis on assessment and early aggressive interventions. The guidelines distinguish between uncomplicated and complicated diarrhea.[28]

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