pituitrin and Hematemesis

Topics: Aged; Angiography; Antacids; Blood Cell Count; Blood Chemical Analysis; Blood Transfusion; Emergency Medical Services; Female; Fluid Therapy; Gastric Juice; Gastric Lavage; Gastrointestinal Hemorrhage; Gastroscopy; Gravity Suits; Hematemesis; Hemostatic Techniques; Histamine H2 Antagonists; Humans; Intubation, Gastrointestinal; Male; Medical History Taking; Middle Aged; Oxygen Inhalation Therapy; Patient Admission; Physical Examination; Prognosis; Propranolol; Resuscitation; Transportation of Patients; Vasopressins

Bleeding occurs with some regularity at the end of life. Patients often endure fatigue, weakness, pain, dyspnea and anxiety. These symptoms are magnified in visually apparent bleeds. Management can be particularly challenging as we attempt to balance therapies with goals of care. Children are at risk for such complications and symptoms; providers must ensure comfort for both the patient and family.. A 7-year-old male with recurrent, refractory Burkitt lymphoma was frequently hospitalized for palliative chemotherapy and disease complications. On his final admission, he experienced gross hemoptysis and hematemesis: he was short of breath, fatigued and anxious due to his blood loss. His and his family's angst were heightened by "seeing" his bleed. Potential, especially invasive, treatments were limited by our goals to promote comfort, limit interventions, maintain alertness, poor intravenous access and a small bowel obstruction. Nebulized vasopressin, 10 units in 4ml of normal saline given over 10 minutes provided JC with needed relief. His bleeding remitted and he tolerated its administration.. There are many treatments for hemorrhage; however, given the challenges of goals of care, administration, side-effects and tolerability, further investigation into nebulized vasopressin as a potential therapy for hemoptysis and hematemesis at the end-of-life is warranted.

Topics: Administration, Inhalation; Burkitt Lymphoma; Child; Fatal Outcome; Hematemesis; Hemoptysis; Humans; Male; Palliative Care; Vasoconstrictor Agents; Vasopressins

Topics: Arteriovenous Fistula; Blood Component Transfusion; Blood Transfusion; Carcinoma, Hepatocellular; Child; Endoscopy, Gastrointestinal; Epistaxis; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hematemesis; Hepatic Artery; Humans; Hypertension, Portal; Liver Neoplasms; Portal Vein; Sclerotherapy; Tomography, X-Ray Computed; Ultrasonography; Vasopressins

Topics: Blood Transfusion; Cryosurgery; Esophageal and Gastric Varices; Gastric Hypothermia; Hematemesis; Hypertension; Hypertension, Portal; Hypothermia, Induced; Liver Cirrhosis; Liver Diseases; Neomycin; Prognosis; Surgical Procedures, Operative; Vasopressins