As a prelude to this paragraph it needs to be mentioned that only a modest number of valid studies on remedies for seasickness has been conducted thus far. Unfavorably the intensity of current research activities lags behind the 1960ties and -70ties, when space motion sickness research was heavily funded by the US and Russian governments. Noteworthy, a significant percentage of remedies used today are either not backed by controlled trials, or they are supported by trials with a design not fully representative of real life sea-sickness conditions. This is the case for many clinical studies investigating anti-emetics in anaesthesia and oncology. Ondansetron for instance is effective in a chemotherapy and PONV (postoperative nausea and vomiting) setting, but it failed in a real life navigation trial [42]. Still data of a few nicely designed though small controlled studies are available (please refer to paragraphs on specific medications), some even including active comparator arms, and thus they may be helpful in choosing the appropriate prophylactic or therapeutic medication. In general investigators also need to acknowledge that the design of sea-sickness studies is strongly affected by intra-(day-to-day) and inter-individual variability in response to motion sickness stimuli, as well as a high level of placebo-responsiveness. And last but not least, certain side affects of remedies investigated may even mimic some of the seasick symptoms such as drowsiness, headache, and vertigo.

There are also rather different policies and practices in the use of motion sickness remedies found in different countries and regions, hence the drug-of-choice in one country may even be banned or not registered at all in another country (e.g. the anti-histamine cinnarizine is popular in the UK, but banned in the US!).

 

Therapy should start as soon as possible after onset of first symptoms. Individuals with a known predisposition for motion sickness should be asked which remedies have worked in the past for them and how well they were tolerated. If not done yet motion-sick individuals should apply prophylactic measures described above. If feasible, one ought to look at the horizon which may help to stabilize head posture and vestibular system in relation to vessel movements. Resting in supine position and closing the eyes usually improves, or at least contains motion sickness symptoms [43].

Mildly motion-sick individuals on leisure sailing yachts or motor yachts should be offered to take the helm, however without fixing the compass for longer periods (surveillance of a qualified person/navigator is recommended anyway). This often provides the affected person with a feeling of control over the vessel and the situation [ [iii] ], furthermore reducing the sensory information conflict by anticipation of ship movements (waves are seen before they move the vessel). Complex tasks involving forced head movements should be avoided. The head should be turned towards the direction of the most prominent vessel movement, for instance facing sidewards in case of heavy rolling, or towards the bow in case of intense pitching. A rather favorable resting place is within a hammock, which largely reduces the impact of rolling or pitching movements (depending on the axis of hammock installation).

 

A relieving non-pharmacological remedy is manual acupressure of the so called Nei-Guan-Point (P6) (Figure 3) at the volar side of the forearm approximately 3 fingertips proximal of the wrist fold the between the two most prominent flexor tendons [35]. Alternatively wrist-bands with pressure pads (motion sickness bands) may also be used at the same site, however pressure needs to be applied with caution to avoid tissue damage (interchanging wrist-bands between left and right arm is recommended). Anti-emetic efficacy of wristbands has also been shown in palliative care patients [ 45], and a recent Cochrane Review concluded that there is evidence that P6-stimulation reduces risk of nausea and vomiting vs sham treatment in postoperative care [46]. An FDA-approved electro-stimulation device (ReliefBand®) was found to be efficacious both before and after start of anaesthetic treatment in patients with high risk of experiencing post-surgery nausea and vomiting [47]. An alternative acupressure point is K-K9 on the volar side of the middle phalanx of the 4th finger [48].

 

Fig._3a_           Fig._3b_       Fig._3c_

 

                    Figure 3 a,b,c: Manual Acupressure of the Nei Kuan-Point (PC-6); a: The Nei Kuan Pont is located two thumbwidths cranial of the volar wrist skinfold between the two prominent flexor tendons. b: Gently press the Nei-Kuan-Point with the opposite hand´s thumb tip with slightly circulating and undulating motions for at least a minute, thereafter switch to the opposite arm. Repeat procedure regularly several times, as long as needed. c: Acupressure wristbands should be positioned similarly. (© Dr. Thomas Wolffgram, 2011)  

 Pharmacotherapy of motion sickness comprises a variety of drug-classes with differing principles (Table 3). In general caution is warranted when prescribing or administering motion sickness remedies, in particular with regards to children, to pregnant women, to the elderly or to persons with relevant co-morbidities ( also see table 3 and paragraph on “Pharmacotherapy (prophylaxis and treatment) of seasickness in specific populations” below).

 The anticholinergic scopolamine (transdermal patches, tablets, nasal spray) is among the most potent and reliable drugs for prophylaxis and treatment of motion sickness available [49]. However quite a few caveats and contraindications, in particular in the elderly have to be regarded (Table 3), something that renders this drug less popular among doctors on cruise ships, usually with a high percentage of elderly passengers on board. Special caution should be warranted in passengers with a medical history of glaucoma, restricted urinary flow (e.g. due to prostate adenoma), pylorus stenosis, cardiac arrhythmia, clincally relevant cerebral sclerosis or atopic dermatitis (Table 3). Despite its proven efficacy, about 26-38% of individuals fail to respond, probably due to low scopolamine plasma levels [51]. As a workaround for lack of efficacy and delay in onset of action (0.5- 4hrs, full plasma levels at 6 hrs) some studies have used transdermal scopolamine in combination with a single dose of oral scopolamine (0.3 mg or 0.6 mg [49]. Another trial investigated the utility and safety of double scopolamine patches in the sailors (age 18-21 years) who did not respond adequately to a standard single patch in the first instance. The authors conclude that a double dose may be safely administered (notably in the in young sailors investigated only) and increases the likelihood of efficacy by raising scopolamine plasma levels [50]. A recent study by Simmons et al. [52] shows the utility of intranasal scopolamine (INSCOP) in subjects prone to seasickness. The combination with amphetamines (e.g. d-amphetamine (=dexedrine) 5- 10 mg.) is considered superior to scopolamine monotherapy by some investigators [53], however legal restrictions for storage and use of amphetamines on ships have to be regarded. Scopolamine works via inhibition of both gastral tachyarrhythmia and vasopressin release, furthermore by reduction of the CNS neural mismatch signal (modifying neural store). Scopolamine also seems to facilitate the process of habituation regarding motion stimuli [54].

Seasickness per se may impair vigilance, performance of complex tasks and decision making. Most studies support the notion that scopolamine does not impair mental performance and conclude that individuals treated may safely handle a ship. However, an increase in reaction time compared to placebo has been observed in Swedish naval cadets in a simulation model [55]. Combination with amphetamines may potentially compensate these effects.

 

 

Table. 3: Stage-related treatment of motion sickness. Please always refer to the current prescription information or package leaflet first for all treatment aspects including dosing. Side effects, drug interactions and contraindications listed in this table are exemplary and may not be complete. In established motion sickness oral medication should be avoided (except liquid) and either suppositories or parenteral administration (i.v., i.m.) should be used if feasible.

 

 

Therapy

Dose

Contraindications, Caveats, Side effects, Drug interactions

Children, pregnancy, comments

Prophylaxis

 

 

 

 

 

Behavioural measures

E.g. looking at horizon, acupressure, etc.

n.a.

Details see chapters prophylaxis and treatment

 

Wrist bands

Apply either simultaneously to both wrists or alternating between sides

Caveats:

Wrist bands not to be fixed too tight; release when painful, uncomfortable or numb

Adjust wrist band dome right above the Nei-Kuan-Point (Figure 3)

 

Fresh ginger root or ginger-tablets (e.g. ZintonaÒ)

Fresh ginger: Procedure see right column;

alternative: ginger tablets. Give 1 hour before journey, then 2 tbl. every 4 hours

Side effects:

Hot peppery taste, may cause burning sensation in the mouth, esophageal reflux, heartburn

Dose for fresh ginger root: 1- 2 g finely chopped ginger root, chew briefly with some bread and ingest with a sip of water or tea (1-2 hours before departure)

 

Scopolamine transdermal patch (e.g. TranscopÒ 1.5 mg)

Details: Refer to section Severe motion sickness below.

Details:

Refer to section Severe motion sickness below.

Prophylactic administration 6-8 hours before start of journey, for individuals with history of severe motion sickness

Mild Motion Sickness

 

 

 

 

 

Dimenhydrinate ( tabl., chewable tabl.)

Dose according to package insert (usually 25 - 50 mg).

Details:

Refer to section severe motion sickness below.

Specific side effects:

Chewing tablets may cause a sensation of numbness in the mouth.

 

Refer to section severe motion sickness below.

Moderate Motion Sickness

 

 

 

 

 

Meclizine

(tabl., chewable tabl., suppository; e.g. Dramamine IIÒ, AntivertÒ, etc.)

Dosing according to package insert, e.g. adult + pediatric dose: 25 - 50 mg once a day as needed (ideally 1 h prior to travel)

Contraindications:

Hypersensitivity to ingredients

Caveats:

Caution in patients with asthma, glaucoma, enlarged prostate gland Side effects:

Drowsiness, dry mouth.

Drug interactions: Alcoholic beverages to be avoided while on meclizine.

Children:

NOT to be used in children younger than 12 years. 

Pregnancy: Overall a favorable anti-emetic drug (FDA pregnancy category B= no proven risk in humans).

Occupational:

Patients to be cautioned against operating dangerous machinery.

 

Metoclopramide (MCP)

(tabl., liquid)

Dose according to package insert (usually up to 3-4x/d). Caution when administering to children (not before age of 2 yrs, no tablets before age of 14)!

Contraindications:

Acute GI ulcerations, epilepsy, pheochromocytoma

Side effects:

Drowsiness, headache, vertigo, anxiety, exanthema, restlessness, dyskinetosis

Drug interactions: Concomitant scopolamine may reduce MCP efficacy

Add-on of MCP to meclizine or dimenhydrinate is a feasible option to increase efficacy.

Severe Motion Sickness

 

 

 

 

 

Scopolamine transdermal patch (e.g. TranscopÒ 1.5 mg, available from Italy via international pharmacy)

Administer 1 patch behind an ear, onset of clinical efficacy after approx. 1-3 hours (full efficacy after 6 hours), drug release for 72 hours.

Contraindications: Glaucoma, hypersensitivity to ingredients

Caveats:

Acute asthma attack, prostatic hyperplasia, pylorus stenosis, arrhythmia, bradycardia, cerebral sclerosis, renal impairment, hepatic impairment, increased intraocular pressure, diabetes

Side effects:

Dry eyes, dry mouth, blurred vision (if only one eye is affected -> due to contamination via fingers touching the patch´s drug side!), drowsiness (less than seen with antihistamines) tachycardia, urinary dysfunction, acute glaucoma.

Drug interactions with: H2-antagonists (further gastric acid reduction), antihistamines (may increase anticholinergic effects). Concurrent alcohol intake may increase side effects.

Children:

NOT to be given to children younger than 10 years.

Pregnancy:

Restricted to rare very severe refractory motion sickness only, e.g. when appropriate medication (e.g. meclizine) is not available and fluid loss needs to be stopped (individual benefit risk assessment required)

Therapy:

Though most controlled studies have been conducted to prove efficacy of scopolamine in prevention of motion sickness, practical experience also supports the use in established motion sickness.

 

 

Promethazine

Dosing according to package insert. Tablets (e.g. 20 mg); oral liquid; injectable liquid (e.g. 25 mg, i.m., i.v.).

 

Contraindications: hypersensitivity to ingredients, history of malignant neuroleptic syndrome, hematological disorders, intoxication with centrally depressing agents (opiods, alcohol etc.) 

Caution warranted:

History of seizures, increased risk of stroke, coronary artery disease, MI, severe asthma, COPD, glaucoma, sleep apnea, GI ulceration or obstruction, prostate enlargement or problems with urination, pheochromocytoma, hypocalcemia, arrthythmia, hypertension  

Side effects:

dizziness, drowsiness, anxiety, blurred vision, dry mouth, stuffy nose,

uncontrollable movements, tremor, urinary retention, problems with balance or walking; feeling restless, seizures; hallucinations, aching muscles, confusion, sweating, fast or uneven heartbeats, rapid breathing; fainting, obstipation. leucopenia

 

 

Drug interactions with: other antihistamines, antidepressants (esp. tricyclics), anticholinergics, analgensics. Concurrent alcohol intake may increase side effects.

Pregnancy: FDA pregnancy category C (risk cannot be ruled out).

Children: No use before age of 2 years.

Elderly:

Adjust to lower doses in elderly patients.

Further comments: Administration of the injectable drug formulation should be strictly intramuscularly or intravenously (slow infusion only), otherwise pain and tissue damage may result.

A dose of 0.5 mg per kg body weight per day must not be exceeded.

 

 

Dimenhydrinate

Suppositories (e.g. Vomex-A Ò Supp. ,150 mg); i.v. fluid (e.g. 62 mg 10 ml vial)

Contraindications: Glaucoma, sensitivity to ingredients, acute asthma attack, porphyria, pheochromocytoma, prostatic hyperplasia with urinary retention, eclampsia, epilepsy, long QT-syndrome.

Caution warranted:

Arrhythmia, hepatic impairment, bradycardia, hypomagnesiamia, hypocalemia, chronic asthma, pylorus stenosis,comedication with drugs prolonging QT-interval (e.g. antimalarials, antihistamines)

 

Drug interactions with:

Anticholinergics (scopolamine!), sedatives, hypnotics. Alcohol may increase side effects.

Pregnancy: FDA pregnancy category B (no proven risk in humans). Should be avoided though in last weeks before delivery (may promote onset of labor)

Children:

NOT to be used in children younger than 14 years.

Further comments: Should NOT be combined with scopolamine.

 

 

 

 

 

 

 

 

 

H(Histamine)1-receptor-antagonists have shown efficacy in motion sickness models [56] including reduction of symptoms and of gastric tachyarrhythmia, e.g.:

 

  • Dimenhydrinate (tablets, suppositories, injectable; e.g. Dramamine®, Vomex®) is a salt consisting of diphenhydramine (H1-antagonist) and 8-chlorotheophylline (a stimulant to counteract drowsiness). Interestingly drowsiness was more frequently observed in dimenhydrinate when compared to placebo exposure (intra-individual cross-over design), thus motion-sickness induced drowsiness seems to be less severe than dimenhydrinate-mediated drowsiness. The authors conclude that dimenhydrinate works by depressing central nervous system activity and possibly by suppressing abnormal gastric myoelectric activity. Recent data indicate that dimenhydrinate may have a favourable role in antagonizing the loss of body heat in seasick subjects [40]. Patients are prone to vomiting in established motion sickness grade MIIa (Table 1a) and beyond, thus parenteral adminstration via suppositories or i.v. fluid is more appropriate under these circumstances. This is reflected for instance by the ship medicine chest standard inventory defined by the German Federal Naval Authorities [57], which lists dimenhydrinate in the form of tablets, suppositories and i.v. vials.
  • Meclizine (tablets, suppositories), another antihistamine, is considered to cause less drowsiness (marketed e.g. as Postafen™, Bonamine™, Dramamine II™). A controlled study in healthy volunteers in a ship motion simulator concluded that meclizine was superior in preventing motion sickness when compared to placebo, however being less potent than transdermal scopolamine [58]. Meclizine is widely used on ships carrying US passengers. It shows a comparatively favorable risk-benefit profile and thus meclizine may be considered a first choice antihistamine in motion sickness, which may also be administered to pregnant women and children beyond age of 12 years.
  • Cinnarizine (tablets) is chemically related to first generation antihistamines and thus it also shares typical side effects such as drowsiness. Its utility is limited by relevant contraindications including history of myocardial infarction, asthma, depression, prostate gland hyperplasia, glaucoma, epilepsy, bradycardia, hypokalemia, use of aminoglycoside antibiotics, long QT-syndrome, alcohol abuse and Parkinson´s disease. Furthermore it must not be used during pregnancy or lactation. I should not be given to children below the age of 18 unless individual risk-benefit assessment would turn out positive, which is unlikely given other alternatives. As with other antihistamines, combination or subsequent administration of anticholinergic drugs (scopolamine) is contraindicated. Still cinnarizine is commonly used on UK-based cruise ships, whereas it is not available in the U.S. or Canada.
  • Promethazine (liquid; injectable for i.m. shots) also acts as an anti-H1 antihistamine and has formerly been used as an antipsychotic drug. Promethazine has sedative, anti-motion-sickness, anti-emetic, and anti-cholinergic effects. Meanwhile promethazine is also being used as a motion sickness remedy and is even available over the counter in some countries, whereas e.g. in the US and Germany it still requires prescription. Noteworthy, there is controversial data on the dose response which does not seem to be linear: One study showed no clear increase in motion sickness tolerance vs. placebo by 50 mg promethazine in contrast to a 25 mg dose [59], whereas a former study [ 60 ] found the best relief from established (!) motion sickness by 50 mg promethazine given i.m.. Another relevant finding was that the 50 mg dose strongly impaired mental performance to a degree similar to 0.137 % blood alcohol. Given in effective doses promethazine seems to have a swift onset of action even in established motion sickness [61]. As with cinnarizine a range of caveats should be carefully regarded as detailed in the package leaflet, including co-morbidities such as leucopenia, prostate hyperplasia, hypertension, dementia, and glaucoma. Given this profile usage of promethazine may be considered in patients with advanced motion sickness, who are not expected to perform complex tasks thereafter. Promethazine i.m. is commonly administered in particular on cruise ships carrying U.S.-passengers. In general promethazine should be reserved for established motion sickness, the use as prophylaxis is not supported by its risk-benefit ratio. Special caution should be given to an appropriate administration of the drug which should be strictly intramuscular or intravenous (slow infusion only), otherwise pain and tissue damage may result.
  • So called second generation antihistamines with less central activity such as cetirizine or fexofenadine seem to be insufficient to prevent or treat motion sickness [62].  

 

The dopamine antagonist metoclopramide has both central (anti-dopamine-2 and anti-serotonin 5-HT3) as well as peripheral (serotonin 5-HT4-agonistic) properties. The former is deemed to reduce nausea and the latter to promote coordinated gastric propulsion, both quite desirable effects in imminent or established motion sickness. Thus MCP reduces intragastric pressure and normalizes gastrointestinal motility. In contrast to treatment of established nausea, metoclopramide does not seem to work well in prophylaxis of motion sickness [63]. Furthermore oral metoclopramide may not always be efficacious in a treatment setting either. However, a combination with other motion sickness remedies like scopolamine or dimenhydrinate may improve response rates. Another option to maximise onset of action and efficacy is intravenous administration, as commonly practised in on cruise ships with Scandinavian medical staff.

 

Ginger root and ginger preparations (Tablets, e.g. Zintona™) show (in particular prophylactic) potency against nausea and vomiting, confirmed in controlled clinical trials [64]. Grøntved et al. conducted a study on ginger root in naval cadets showing that the tendency to vomiting and cold sweating could be significantly reduced after ingestion of blinded ginger medication compared to placebo [65]. Lien et al. have shown that ginger ingestion (1000 mg) provided significant protection against gastric dysrhythmias as well as vasopressin elevations in volunteers [36]. Though the majority of studies has confirmed the efficacy of ginger and ginger preparations, an experimental study by Wood et al. [53] failed to demonstrate a significant effect. Meanwhile, the pharmacological properties of ginger ingredients (gingerols and shogaols) have been further studied, detecting effects on the 5-HT3-receptor ion-channel complex, potential activity on substance-P receptors and on muscarinic receptors [66]. Other investigators have identified gingerol-binding TRPM8- type nociceptors in the middle ear.

 

A range of preparations is being promoted for use as prophylaxis against motion sickness, however some remedies are still lacking scientific proof of efficacy, including for example:

  • Homeopathic preparations containing low quantities of vermouth (artemisia absinthum) such as NausynÒ (tablets). This preparation also contains very low quantities of Ipecacuanha (D4) and Cocculus (D4), which both are pro-emetic in allopathic doses. A placebo-controlled rotation chair study by Huber [67] could not find a significant anti-emetic effect of NausynÒ (tablets) when compared to placebo or dimenhydrinate.
  • Vitamin C intake (e.g. ascorbinic acid tablets) has been promoted in order to reduce systemic histamine levels, however no conclusive scientific or clinical evidence to support this rationale has been provided yet.

 

Further investigational drugs against motion sickness comprise 5-HT-1A-serotonin-agonists, neurokinin-type1-receptor-antagonists [68], and specific vasopressin-antagonists, however clinical data are still scarce. Further research is also warranted with regard to:

  • Ondansetron: Despite already being listed in the international medical guide for ships for “preventing vomiting and sea-sickness” the anti-emetic drug, a 5HT3-receptor-antagonist primarily used in chemotherapy-induced nausea, has recently been in investigated in a clinical motion sickness study, showing no significant effect [42].
  • Modafinil: This stimulant (increasing norepinephrine, dopamine and histamine levels in the CNS) is approved for treatment of narcolepsy in the EU. Modafinil has been investigated in a controlled study vs. placebo and a combination with oral scopolamine and failed to show protective effects against motion sickness [69].
  • Baclofen: This drug is known for its muscle-relaxing, anti-spastic, and anxiolytic properties, and data indicate potential utility in motion sickness [70].

 

 

Interactions between motion sickness remedies: Given similarities of potential undesirable drug effects, in particular drowsiness and anticholinergic effects, scopolamine and dimenhydrinate (or meclizine, promethazine, or any other antihistamine) should NOT be co-administered, or be given subsequently, unless sufficient time for washout is warranted, e.g. 10-12 hours after ingestion of a dimenhydrinate tablet. In younger patients (< 45 yrs) with known high susceptibility to develop severe motion-sickness, scopolamine would be the drug of first choice, since starting with dimenhydrinate would prevent later use of the more potent alternative. Generally these issues are more relevant in middle-aged and elderly patients and special caution should be taken with regard to the contraindications and caveats listed in table 3.

 

 

Pharmacotherapy (prophylaxis and treatment) of seasickness in specific patient groups

 

  • Phamacotherapy of motion sick children may prove difficult since many caveats and restrictions have to be regarded concerning the most widely used medications (in particular antihistamines, scopolamine, cinnarizine, and metoclopramide; table 3). Thus precautionary measures (see 10.13.5 Prophylaxis) become even more important here, including ginger preparations (age of 3-5 years: freshly brewed tea from 1g of ginger, add sugar or honey; from age of 6 years onwards: preferably ginger tablets) and acupressure bands. Scopolamine patches may be given from the age of 10 years onwards, meclizine and dimendydrinate are labelled for use from the age of 12 years. Children in particular should not play games or watch videos on tiny screens (e.g. Nintendo, iPod Touch etc.), whereas listening to their favorite music with eyes closed can be very helpful. Severely motion sick children need special attention and care, including sufficient rehydration and effective protection against risk of falling (over board) or other injury.
  • Likewise pharmacotherapy of women during pregnancy and lactation requires special caution (e.g. regarding contraindications for use of cinnarizine and to some extend promethazine). Given their current FDA B-ratings (no proven risk in humans), meclizine and dimenhydrinate may be considered appropriate, if ginger and non-pharmacological approaches have failed. In pregnancy scopolamine should be reserved for very severe refractory motion sickness only, e.g. when more appropriate medication has failed and fluid loss needs to be stopped. Overall meclizine may be regarded the treatment of choice during pregancy [71].
  • Elderly passengers often represent the majority on cruise ships and when getting motion sick, these patients may also pose a challenge in choosing the appropriate medication. Given the vast number of caveats with promethazine and cinnarizine these drugs should be avoided. Also scopolamine should be used with caution, in particular regarding common co-morbidities such as urinary retention, diabetes, arrhythmia, hepatic impairment or glaucoma. A more favourable overall risk-benefit ratio in this age-group may be offered by meclizine and/or metoclopramide.
  • Though ship crew members will most often be well adapted to motion stimuli, treatment for seasickness may become necessary. Medical staff should inquire how specific anti-seasickness medication has worked and been tolerated by the crew member on past incidences and if and how the individual performance was affected. The choice of pharmacotherapy should account for the specific tasks of the crew member: In case of dangerous workplaces like engine rooms or deck areas, drugs associated with a high rate of drowsiness or dizzyness (e.g. certain antihistamines) ought to be avoided. Similarly in pharmacotherapy of crew with mental tasks to perform and a high level of responsibility (e.g. navigation officers, watch officers, VHF operators) such drugs should be avoided. Ginger, metoclopramide or scopolamine would be preferred options. Meclizine is considered to cause less drowsiness than other antihistamines and thus should be a feasible option as well. Add-on treatment with ephedrine may be considered in crew with tasks requiring high mental performance [72].

 

Severely motion sick patients who have vomited repeatedly need special care and attendance

  • Most importantly the patient must be removed from areas of the ship with risk of falling overboard (e.g. deck areas) or places with increased risk of injury (e.g. engine room).
  • The motion sick person should be taken off duty and be replaced by a deputy (back up)
  • Vomit should be wiped away immediately, and dry clean clothes be put on
  • The patient should be offered sips of water to rinse the mouth, thereafter fresh (non-sparkling) water to drink
  • Repeatedly offer special drink for rehydration (oral electrolyte solution, table 4)
  • In case of sustained vomiting with signficant fluid loss and apathy consider infusion of sterile 0.9 % NaCl solution.
  • Appropriate medication should be considered
  • The patient should be offered to lay down and rest in a bunk, eyes closed
  • A designated person should be looking after the seasick patient if number of crew allows for
  • Offer a Music-Player (MP3, iPod, CD-Player) with favorite music
  • Keep telling the patient reassuringly that symptoms will improve

 

 

Table 4: Oral Rehydration Solution (ORS)*

 

1 liter of water or tea, dissolve therein**:

- 40g (2 Spoons) Sugar (saccharose)

- 3,5 g (1 Teaspoon) Table salt (NaCl)

- 2 g (1/2 Teaspoon) Baking powder

 

*Alternatively, use prefab rehydration solution powder (e.g. ElotransÒ) and dissolve in water

** The WHO 2006 ORS recipe would also contain trisodium citrate for compensation of diarrhea mediated acidosis. Since not acidosis but alcalosis is the issue in motion sickness due to loss of acids via vomit this additive is not required here.