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Iron-Induced Nausea — SCE Palliative Medicine MCQ

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EasyNausea & VomitingIron-Induced NauseaSCE Palliative Medicine

A 58‑year‑old man with advanced gastric cancer develops nausea and a metallic taste after starting oral iron supplementation for anaemia. He is also on morphine MR 30 mg BD. What is the simplest first step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Stop or switch the oral iron preparation

Explanation lettering: C = shown as A · A = shown as B · E = shown as C · B = shown as D · D = shown as E

The timing and nature of the symptoms – nausea and metallic taste after starting oral iron – strongly implicate the oral iron as the cause. UK palliative symptom‑control guidance specifies that drug‑induced nausea should be managed by stopping or switching the offending agent unless essential. This is the simplest and most direct first step. Increasing morphine (B) risks worsening opioid‑induced nausea. Adding a PPI (C) or ondansetron (D) treats symptoms but not the cause. Switching brand (E) is less effective than stopping when intolerance is clear. Afterwards, reassess anaemia management – consider alternate dosing or IV iron if oral is contraindicated or poorly tolerated.

Reference: Palliative Care Pain & Symptom Control Guidelines for Adults, NHS England (2020); Side effects of ferrous sulfate, NHS.uk (2023)