Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0017160 (gastroenteritis)
 11,398 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 35-year-old healthy Dutch woman went on a trek (Lang Tang) in Nepal up to an approximate altitude of about 3800 meters. She had no prior history of any medical problems except attacks of generalized epilepsy when she was 19 years old, which had been controlled with antiepileptic medications. She had had no attacks after the age of 20. A CT scan done around that time had apparently been normal. On this trek she had developed diarrhea which had been cured with norfloxacin 400 mg two times per day for 3 days. Two days later, while descending, she developed a grand mal seizure at an altitude of 3300 meters, after which she developed a classic postictal phase but gradually recovered. She developed grand mal seizures again the next day, but when she went to a travel clinic in Kathmandu, she had been seizure free for 72 hours. She also revealed that she had not suffered from acute mountain sickness on the trek. She also had a prior history of gastroenteritis at high altitude which improved significantly with norfloxacin, a quinolone antibiotic. This was corroborated by her party. Upon examination she was fully conscious and oriented to person, place and time. Her pulse was 70 beats per minute and her BP was 110/80 mm of Hg. Her fundi and cranial nerves exam were completely normal. Her abstract thinking, gait, power, tone, reflexes and other facets of her neurologic exam revealed absolutely no abnormalities. Her cardiovascular exam revealed a normal rhythm with no murmurs or bruits. The rest of her exam was also normal. She revealed that she played tennis on a regular basis and was an outdoor person. She had not trekked before in the Himalayas and it was uncertain if she had been to high altitude before. She was on no medications at the time. There was no history of drug abuse. She did not smoke and consumed few alcoholic beverages. She had not consumed any alcohol on the trek. She was advised to get a CT scan (she declined as she was going home to Holland in 2 days) and she was prescribed a loading dose of phenytoin 1 g orally spread over several hours and it was recommended she take 300 mg of phenytoin per day. She was going to see her neurologist in Holland on arrival there. She went to her hotel in Kathmandu while her friends went to fill the prescription of phenytoin. When her friends returned to the hotel she was having another grand mal seizure. Medical help was sought, but she died before the doctor arrived to control her seizures. When the doctor did arrive and carried out CPR for half an hour it was to no avail as she continued to have no pulse or blood pressure.
 ...
PMID:Fatal grand mal seizure in a Dutch trekker. 987

The purpose of this study was to assess the incidence of medical illness among members of trekking groups in the Nepal Himalaya. The design was a cohort study using interview and clinical examination by a single physician. The setting was the Manaslu area in the central Nepal Himalaya along a 22-day trekking route with elevations ranging from 487 m to 5100 m. Subjects were 155 members of commercial trekking groups: 102 Nepali porters, 31 Nepali trek staff, and 22 Western trekkers. We found that medical problems occurred in 45% of party members. The porter cohort contained the highest diversity and severity of illness. The relatively larger porter cohort experienced 77% of the medical problems recorded compared with 17% among Western trekkers and 6% among trek staff. The incidence of medical problems was not significantly different in the porter staff (52%) and Western trekkers (55%) and was significantly lower for the trek staff (13%). High-altitude pharyngitis/bronchitis was the most common illness in the party (12%) followed by acute mountain sickness (8%) and gastroenteritis (6%). Other conditions included anxiety (3%), cellulitis (3%), scabies (3%), snow blindness (3%), acute alcohol intoxication (2%), conjunctivitis (2%), fever (2%), lacerations (2%), and hemorrhoids (1%). Illness with infectious etiologies comprised 33% of the medical problems. The incidence of altitude illness was not significantly less in the Nepali porter staff than in the Western trekkers. Evacuation was required in 5% of party members, all from the porter group. This study should alert expedition medical providers and trip leaders of the need to be observant for and prepared to treat the frequent and diverse medical problems among the porter staff in their party, in addition to the Western members. Medical problems are common in remote mountainous areas, indicating that trip physicians should be experienced in primary care.
 ...
PMID:Medical problems of porters and trekkers in the Nepal Himalaya. 1199 Jan 44

Vomiting is a protective reflex that results in forceful ejection of stomach contents up to and out of the mouth. It is a common complaint and may be the presenting symptom of several life-threatening conditions. It can be caused by a variety of organic and nonorganic disorders; gastrointestinal (GI) or outside of GI. Acute gastritis and gastroenteritis (AGE) are the leading cause of acute vomiting in children. Important life threatening causes in infancy include congenital intestinal obstruction, atresia, malrotation with volvulus, necrotizing enterocolitis, pyloric stenosis, intussusception, shaken baby syndrome, hydrocephalus, inborn errors of metabolism, congenital adrenal hypoplasia, obstructive uropathy, sepsis, meningitis and encephalitis, and severe gastroenteritis, and in older children appendicitis, intracranial mass lesion, diabetic ketoacidosis, Reye's syndrome, toxic ingestions, uremia, and meningitis. Initial evaluation is directed at assessment of airway, breathing and circulation, assessment of hydration status and red flag signs (bilious or bloody vomiting, altered sensorium, toxic/septic/apprehensive look, inconsolable cry or excessive irritability, severe dehydration, concern for symptomatic hypoglycemia, severe wasting, Bent-over posture). The history and physical examination guides the approach in an individual patient. The diverse nature of causes of vomiting makes a "routine" laboratory or radiologic screen impossible. Investigations (Serum electrolytes and blood gases,renal and liver functions and radiological studies) are required in any child with dehydration or red flag signs, to diagnose surgical causes. Management priorities include treatment of dehydration, stoppage of oral fluids/feeds and decompression of the stomach with nasogastric tube in patients with bilious vomiting. Antiemetic ondansetron(0.2 mg/kg oral; parenteral 0.15 mg/kg; maximum 4 mg) is indicated in children unable to take orally due to persistent vomiting, post-operative vomiting, chemotherapy induced vomiting, cyclic vomiting syndrome and acute mountain sickness.
 ...
PMID:Management of a child with vomiting. 2334 Sep 85