Naltrexone for cholestatic itch: a systematic review.

Background: Cholestatic itch is caused by intrahepatic liver diseases, such as primary biliary cirrhosis and extrahepatic obstruction of the biliary tree, often caused by tumours. The pathophysiology of cholestatic itch is complex and no single treatment has proved definitive. Naltrexone is an opioid receptor antagonist, which reduces central opioidergic tone, believed to be raised in patients with cholestatic pruritus.

Oesophageal spasm, vomiting and hyoscine hydrobromide patch.

We report the case of a 60-year-old woman with metastatic breast cancer whose intractable nausea and vomiting were effectively managed with a hyoscine hydrobromide (scopolamine) patch. Contrast swallow revealed oesophageal spasm to be the underlying cause. Symptom relief may be attributed to the antimuscarinic properties of the patch, allowing lower oesophageal sphincter relaxation.

Haloperidol for the treatment of nausea and vomiting in palliative care patients.

Background: Nausea and vomiting are common symptoms in patients with terminal, incurable illnesses. Both nausea and vomiting can be distressing. Haloperidol is commonly prescribed to relieve these symptoms.

A morbid reason for consent.

We report the case of a recently bereaved elderly lady admitted on the acute surgical take who gave consent for emergency surgery in the hope of dying intraoperatively. To her dismay she survived and, thereafter, refused all food and medical intervention leading to her death 15 days later. This case highlights concerns regarding both the process of consent following emergency admission and failure to identify a vulnerable patient's wishes.