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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty-five serious cases of diabetic ketoacidosis, representing 23 patients, with ages ranging from 4 to 15 years are reported. School agers and adolescents were the groups most affected without existing significant predilection for sex. In 40% there was no success in finding the precipitating cause of the crisis; 32% was attributed to infectious processes, specially of the respiratory ducts and the rest, due to negligence in the application of insulin. The clinical signs showed: vomiting, dehydration, Kussamaul's respiration, sopor, stupor and in 5 cases a state of coma. Determinations of glucose, were integrated in 88% within the range of 451 to 750 mg % and the rest in lower figures. The pH in most was reported below 7.10 and CO2 lower than 10 mEq/l. Electrolytes in blood were generally evaluated within normal limits. Potassium in 20% was reported high, but we consider this was due to dehydration and because of its influence we recommend an electrocardiographic evaluation. Our classification which attempts to correlate the clinic and the laboratory is reported and our therapeutic scheme is discussed as well as the possible causes in two patients who died.
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PMID:[Diabetic ketoacidosis in children and adolescents. Clinical and therapeutical considerations in 25 severe cases]. 2 Sep 2

Hypokalemia is seen most often with the use of diuretics and in patients with emesis. Other common clinical settings in which it may be significant include corticosteroid therapy, antibiotic usage, diarrhea, diabetic ketoacidosis, or psychiatric illness. Occasionally the cause may be obscure. In such situations the determination of urine potassium and arterial pH may prove helpful. Subclassification of hypokalemia into such categories as "acidosis", "alkalosis", "extra-renal", or "renal" loss is then possible. The cases discussed demonstrate the utilization of these methods to define the etiology and to understand the pathophysiology in hypokalemia.
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PMID:Mechanisms in hypokalemia: clinical correlation. 35 75

Hypophosphatemia is common in hospitalized patients and occurs under a variety of circumstances other than parathyroid hormone excess. Charts of 100 inpatients with hypophosphatemia were reviewed and the patients divided into five groups on the basis of serum phosphate level: 18, 2.1 to 2.4 mg/dL; 49, 1.6 to 2.0 mg/dL; 20, 1.1 to 1.5 mg/dL; 12, 0.6 to 1.0 mg/dL; 1, 0.1 to 0.5 mg/dL. The effect of glucose ingestion on serum phosphate level was shown in one normal patient. Whenever carbohydrate was administered intravenously (45 cases), this was considered the primary cause of the hypophosphatemia. Other causes were as follows: diuretics, hyperalimentation, alcoholism, respiratory alkalosis, dialysis, insulin, corticosteroids, diabetic ketoacidosis, vomiting, phosphate-binding antacid, Gram-negative sepsis, primary hyperparathyroidism, saline, epinephrine, gastrointestinal malabsorption, and unknown. Hypophosphatemia in hospitalized patients may have multiple causes.
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PMID:Hypophosphatemia in hospitalized patients. 44 90

Magnesium deficiency can occur in congestive heart failure, after diuresis with furoxemide, ethacrynic acid and mercurials, and with digitalis intoxication, diabetic acidosis, acute and chronic alcoholism, delerium tremens, cirrhosis, malabsorption syndromes, protracted postoperative cases, open heart surgery, the diuretic phase of acute tubular necrosis, and with hypoparathyroidism, primary aldosteronism, juxta-glomerular hyperplasia and pancreatitis. Two cases of serious ventricular arrhythmias associated with magnesium depletion are described. Clinical manifestations are vague but center around neurologic symptoms such as weakness, tremors, stupor, coma, nausea, vomiting and anorexia. Serious cardiac arrhythmias also occur with magnesium depletion. Magnesium appears to be very useful in hypomagnesemic or digitalis-toxic tachyarrhythmias. Magnesium may also be valuable in normomagnesemic tachyarrhythmias. Ten to fifteen milliliters of a 20 percent magnesium sulfate solution, given intravenously over 1 minute, followed by a slow 4 to 6 hour infusion of 500 ml of 2 per cent magnesium sulfate in 5 per cent dextrose in water is recommended. Recurrence of arrhythmias is common and a second infusion of magnesium sulfate may be necessary. Hypermagnesemia occurs frequently in renal insufficiency, and magnesium therapy may then be contraindicated. Serum levels above 5.5 meq/liter should be avoided. Loss of deep tendon reflexes and a decrease in respiratory rate can be used as guides to magnesium therapy. A plea is made for frequent analysis of serum magnesium so that more knowledge can be gained regarding this important biologic element in cardiovascular disorders.
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PMID:Magnesium deficiency and cardiac disorders. 80 29

The authors report two cases of coexistent pneumomediastinum and diabetic ketoacidosis. One patient had pneumothorax as well. Hyperpnea or vomiting, or a combination of the two, may be the etiologic agent in such cases. The prognosis is excellent and there is prompt regression of the pneumomediastinum following correction of the ketoacidosis.
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PMID:Subcutaneous emphysema, pneumomediastinum, and pneumothorax in diabetic ketoacidosis. 80 50

3 episodes of alcoholic ketoacidosis were observed in one female patient over a period of 19 months. The clinical picture consisted of vomiting, dehydration, hyperventilation and abdominal pain. Predominant laboratory findings were acidosis (pH less than 7) and hyperglycaemia, with blood glucose values of 354, 330 and 147 mg/dl. This disorder is an important cause of metabolic acidosis, but especially in the German literature there are only rare reports on this issue. The picture of ketoacidosis in mostly chronically malnourished alcoholics reflects not only the complex abnormalities of acid-base balance caused by excessive cumulation of ketoacids, but also the related severe depletion of electrolytes and extracellular volume. Adequate acute therapy (as for diabetic ketoacidosis) and thorough follow-up treatment of any concurrent conditions result in rapid reversal of the syndrome in most cases. Since there are few reports of repeated episodes in one patient, an overview of this disorder is presented concerning management and differential diagnosis of the basis of our case report.
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PMID:[Alcoholic ketoacidosis--3 episodes in one patient]. 150 41

A retrospective review was conducted of all women with diabetic pregnancies admitted in diabetic ketoacidosis (DKA) to hospitals affiliated with the State University of New York at Buffalo between 1980 and 1990. The experience was combined with a literature review of similar patients described between 1970 and 1990, for a total of 37 admissions for DKA during pregnancy. Emesis and the use of beta-sympathomimetic drugs were considered etiologic in 57% of cases, while patient noncompliance and physician management errors were considered etiologic in 24% and contributory in 16%. Thirty percent of patients admitted with emesis had a prepregnancy history of diabetic gastroenteropathy, thus identifying that group as at particularly high risk for DKA. In the context of modern management, the causes of DKA in pregnancy are related uniquely to pregnancy, and the disorder is largely preventable during pregnancy.
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PMID:Clinical variables associated with diabetic ketoacidosis during pregnancy. 168 93

A 13-year-old spayed Doberman Pinscher with acute vomiting of 24 hours' duration and concurrent 2-week history of polyphagia with weight loss had diabetic ketoacidosis complicated by acute pancreatitis and exocrine pancreatic insufficiency. Diagnostic testing for exocrine pancreatic insufficiency, by determining serum trypsin-like immunoreactivity, revealed an unexpectedly high result when a low result was anticipated. High trypsin-like immunoreactivity was attributed to acute pancreatic inflammation.
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PMID:High serum trypsin-like immunoreactivity secondary to pancreatitis in a dog with exocrine pancreatic insufficiency. 210 25

A case of isovaleric acidemia appearing as diabetic ketoacidosis with acute encephalopathy and pancytopenia was reported. A three-year-old male patient, with mild psychomotor retardation, had recurrent bouts of acute encephalopathy and pancytopenia after episodes of upper respiratory infection. At admission, he had vomiting associated with dehydration, acidosis, ketonuria, coma and a pungent, rather unpleasant odor. Laboratory features included hyperglycemia, hyperammonemia, hyperamylasemia, hypocalcemia, neutropenia, thrombocytopenia and subsequent anemia. Urine organic acid profiles showed profuse amount of 3-beta-hydroxyisovaleric acid (295 mg/ml) and isovalerylglycine (616 mg/ml) by gas chromatography-mass spectrometry. Levels of amino acids in the serum and urine were normal. The patient received treatment with rehydration and insulin, with rapid improvement. After the acute illness, blood glucose levels returned to normal. The patient was doing well on a low-protein diet in recent 3 months.
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PMID:Isovaleric acidemia: report of one case. 212 76

This paper describes the clinical course of a young diabetic primigravida who presented to her physician with vomiting and abdominal pain. Despite the conventional doses of intravenous fluid and insulin that were used to treat her suspected diabetic ketoacidosis, she remained severely acidotic and developed increasing abdominal pain. Two hundred twenty units of regular insulin over a 5-hour period were required to reverse the lipolysis, acidemia, and abdominal pain, which characterized her severe episode of diabetic ketoacidosis. This discussion emphasizes the importance of insulin in the reversal of the hyperglycemia and acidosis that accompany a diabetic crisis. The roles of bicarbonate, phosphorous, magnesium, insulin, potassium, and fluids are discussed along with conditions such as pregnancy, infection, pancreatitis, and abdominal pain, which can complicate the management of diabetic ketoacidosis.
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PMID:Diabetic ketoacidosis and pregnancy. 216 29


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