A Case Report of Continuous Subcutaneous Infusion of Hydromorphone, Metoclopramide and Ondansetron Used To Treat Refractory Pain and Nausea in an Ambulatory Palliative Clinic
Bibliographic record
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.006 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".