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As ship’s doctors who travel on tall ships and cruise ships we feel compelled to disagree with the relevant article (1) in various points.

Sea sickness is not an individual illness but a mass illness. In rough seas, some 100 or more patients will all present to the ship’s hospital at once. The sensation of sickness is enormous; many “want to die.” Because of the occasionally overwhelming degree of suffering, help needs to be given immediately, in the form of effective medications. If these are given by mouth they will be vomited out immediately. In this scenario of a multitude of people ill at the same time, a standardized approach is helpful: the intramuscular administration of dimenhydrinate, also in combination with metoclopramide (MCP). In some patients, the rectal application of dimenhydrinate will suffice. Often in such a scenario, nursing staff will have to be involved for the purposes of triage, administration of medication, and documentation.

The risk when faced with so many sick people lies in overlooking those who have different illnesses with similar symptoms or who may experience complications of their underlying illness because of nausea and vomiting.

The authors of the article recommend administration of scopolamine. But who knows two hours in advance that they are going to be sea sick? The risk was not mentioned: the side effects of the substance cannot be distinguished clinically from a cerebral hemorrhage in patients with a craniocerebral trauma. Cinnarizine is not licensed for the treatment of sea sickness in Germany; furthermore, we are not aware of any preparation that can be given parenterally.

In our opinion, treating sea sickness on ships requires the following measures:

  • Administration of dimenhydrinate and if needed also MCP—both substances are mostly administered intramuscularly—and, additionally
  • bed rest for several hours, because during sleep the blood concentration of the trigger substance histamine falls.

DOI: 10.3238/arztebl.2019.0175b

Dr. med. Karsten Mülder, Berlin , karsten@muelder.info

Prof. Dr. med. Hans-Detlef Stober, Berlin

Dr. med. Walter Hamacher, Berlin

Dr. med. Gernot Spiewok, Schwerin

Dr. med. Katrin Pätel, End- und Dickdarmpraxis, Sindelfingen

Conflict of interest statement

All signatories works as self-employed physicians on cruise ships.

1.
Koch A, Cascorbi I, Westhofen M, Dafotakis M, Klapa S, Kuhtz-Buschbeck JP: The neurophysiology and treatment of motion sickness. Dtsch Arztebl Int 2018; 115: 687–96 VOLLTEXT
1.Koch A, Cascorbi I, Westhofen M, Dafotakis M, Klapa S, Kuhtz-Buschbeck JP: The neurophysiology and treatment of motion sickness. Dtsch Arztebl Int 2018; 115: 687–96 VOLLTEXT

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