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

Diarrhea is one of the most common causes of morbidity and mortality in infants and children less than 5 years old in developing countries. Diarrheal diseases are a major cause of childhood malnutrition. Toxin-producing bacteria are responsible for many acute diarrheas. Oral rehydration solution (ORS) treats dehydration caused by acute diarrheal episodes. WHO promotes the use of a single oral rehydration formula which contains 3.5 g sodium chloride, 2.5 g sodium bicarbonate or 2.9 g trisodium citrate dihydrate, 1.5 g potassium chloride, and 20 g glucose to 1 liter of water. This ORS formula can safely be used for all age groups and all etiologies of diarrhea. ORS replaces the lost fluid and electrolytes and maintains fluid and electrolytes. Pediatricians in most developed countries do not accept this ORS formula in cases of rotavirus-caused diarrhea because rotavirus blunts some absorptive villi and reduces the activity of lactase and other disaccharidase, resulting in reduced absorption. Yet, the unaffected villus cells may absorb enough water and electrolytes to be effective. In cases of vomiting, ORS should be administered in small amounts and slowly. Some health workers are concerned that 90 mmol/l sodium in the WHO formula causes hypernatremia in neonates and young infants who have low sodium levels in their stools. Specialists suggest ORS with 30-60 mmol/l or additional water administered in a 2:1 ratio for these young infants. Hypernatremia is also a concern for malnourished children, but studies show that WHO's ORS is safe and effective in treating malnourished children. Bottle fed children are more vulnerable to hypernatremia than breast fed children. Hypernatremia has neurological effects. Hyponatremia is more common in developing countries than developed countries. It also has neurological effects. In severe dehydration cases, intravenous fluid or ORS delivered via a nasogastric tube should be given immediately.
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PMID:Usefulness of ORT in certain special situations of diarrhoeal diseases. 783 95

The study aimed at evaluating an incidence of hypo- and hypernatremia in the elderly and the results of therapy. Hyponatremia. The studies involved 18 patients aged 69.8 +/- 5.9 years with hyponatremia of 126.8 +/- 2.7 mmol/L. The main causes of hyponatremia were: diuretics, diarrhoea, and vomiting. Sodium deficit was calculated prior to the treatment in all patients. An analysis of hyponatremia incidence indicates that hyponatremia was diagnosed in 1.39% of patients over 60 years, hospitalized within 1989-1990. Sodium deficit in this group was 495.5 +/- 167.7 mmol. Sodium chloride solution was given intravenously to 12 patients, according to the "free correction" principle (a mean increase in serum sodium level was 0.17 +/- 0.07 mmol/L per hour). Mortality in such treated patients was 33%. Sodium chloride was not given to 6 out of examined patients. In 12 patients (66.6%) hyponatremia developed prior to hospitalization, in 6 patients (33.3%) during hospitalization. Mortality rate was 16.6% and 50%, respectively. This confirms higher mortality rate of the rapidly developing hyponatremia in the hospitalized elderly patients. In some cases hyponatremia may constitute iatrogenic complication, especially in the elderly given diuretics in an uncontrollable way. Own experience suggests that elderly patients with a risk of hyponatremia require close monitoring and early compensation of the electrolyte disorders. Hypernatremia. The studies involved 20 patients aged 71.4 +/- 7.7 years with hypernatremia of 155.6 +/- 8.4 mmol/L. A total water deficit (DH20) was calculated in this group. An analysis of hypernatremia incidence showed that this state was diagnosed in 1.55% of patients treated at the Department of Arterial Blood Hypertension within 1989-1990. Total water deficit was 3.9 +/- 1.9 L. A 5% glucose was given intravenously to 15 patients whereas oral fluid therapy was carried out in 5 patients. A mean corrected DH2O in the first day was 46.0 +/- 21.0%. Mortality rate in this group was 65%. It is worth mentioning that 37% of patients with chronic hypernatremia which developed prior to hospitalization died while in case of the acute hypernatremia developed in the hospital mortality rate was 83%. A significant effect on the results of therapy plays an early correction of hypernatremia. Mortality rate in case of DH2o supplementation below 30% during the first 24 hours is about 66%., if DH2o supplementation is 31-60%, a mortality rate is 63%, and in DH2o supplementation over 60% mortality rate is 100%. The obtained results suggest that hypernatremia in the elderly is related to the high mortality rate (65%). An early decrease of water deficit increases mortality rate in patients with hypernatremia.
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PMID:[Hyponatremia and hypernatremia in the elderly]. 786 86

In children, the treatment of acute diarrhoea with the World Health Organization (WHO) standard oral rehydration solution (ORS) provides effective rehydration but does not reduce the severity of diarrhoea. In community practice, carob bean has been used to treat diarrhoeal diseases in Anatolia since ancient times. In order to test clinical antidiarrhoeal effects of carob bean juice (CBJ), 80 children, aged 4-48 months, who were admitted to SSK Tepecik Teaching Hospital with acute diarrhoea and mild or moderate dehydration, were randomly assigned to receive treatment with either standard WHO ORS alone or a combination of standard WHO ORS and CBJ. Three patients were excluded from the study because of excessive vomiting. In the children receiving ORS + CBJ the duration of diarrhoea was shortened by 45%, stool output was reduced by 44% and ORS requirement was decreased by 38% compared with children receiving ORS alone. Weight gain was similar in the two groups at 24 h after the initiation of the study. Hypernatraemia was detected in three patients in the ORS group but in none of those in the ORS + CBJ group. The use of CBJ in combination with ORS did not lead to any clinical metabolic problem. We therefore conclude that CBJ may have a role in the treatment of children's diarrhoea after it has been technologically processed, and that further studies would be justified.
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PMID:Carob bean juice: a powerful adjunct to oral rehydration solution treatment in diarrhoea. 962 May 67

Symptoms can markedly influence the hemodialysis patients well-being and quality of life. The aim of this paper is to study the frequency of symptoms at home and how these relate to biochemical and treatment variables. Seventy-three hemodialysis patients were questioned on the absence, occasional presence or daily recurrence (score = 0, 1, 2) of 14 symptoms and a record was made of their biochemical parameters, age, time on treatment and KtIV as a function of each symptom. The following relationships were detected: thirst with high Osm and BUN; asthenia with old age and hypoalbuminemia; insomnia with hypercalcemia; hypersomnia with hypoxemia and hypernatremia; anorexia with hypokalemia; dyspnea with old age, hypernatremia and hypokalemia; dysgeusia with hypoxemia; nausea with alkalemia, hypoxemia and low BUN; vomiting with alkalemia. Pruritus, arthralgia, restless legs syndrome, cramp and tremor showed no relationships. Monitoring acid-base balance and plasma electrolytes could help to alleviate symptoms and ameliorate quality of life of hemodialysis patients.
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PMID:Symptoms in hemodialysis patients and their relationship with biochemical and demographic parameters. 998 55

Ingestion of sodium hypochlorite bleach is usually benign, leading most poison centers to advocate conservative, home management. We report a rare, fatal case of household bleach ingestion. A 66-y-old female ingested an unknown quantity of regular CLOROX bleach (5.25% sodium hypochlorite, pH = 11.4). Upon discovery, she was vomiting spontaneously, and had slurred speech and oral mucosal discoloration. On hospital arrival the patient became unresponsive with shallow respirations. Laboratory studies revealed hypernatremia (169 mEq Na/L), hyperchloremia (143 mEq Cl/L), and metabolic acidosis (5 mmol total CO2/L). Radiographic evaluation showed bilateral pneumothoraces and pneumoperitoneum. The patient was intubated and ventilated, hypotension was treated with fluid resuscitation, and metabolic acidosis corrected with sodium bicarbonate. Naloxone and flumazenil were given without effect, and thoracostomy tubes were placed. Rapid deterioration of vital signs and mental status ensued, with cardiorespiratory arrest from which she was resuscitated. A second cardiac arrest resulted in death. Autopsy revealed esophageal and gastric mucosal erosions, perforation at the gastroesophageal junction, and extensive necrosis of adjacent soft tissue. Stomach contents contained sodium hypochlorite, and pleural and peritoneal fluid had the aroma of bleach. Postmortem vitreous humor Na was 187 mEq/L and Cl was 169 mEq/L. Toxicologic analysis revealed meprobamate metabolites in the urine, and lidocaine in the blood. The literature regarding fatal bleach ingestion is reviewed.
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PMID:Fatal ingestion of sodium hypochlorite bleach with associated hypernatremia and hyperchloremic metabolic acidosis. 1019 36

In a clinical prospective 3-year study of 158 children aged 2 weeks to 14 years with hypernatraemic dehydration (serum sodium 150 mmol/l or more), infants predominated (61.4%). The 158 children with hypernatraemia accounted for 13.7% of all children admitted with gastroenteritis over the same period, and significant aetiological factors included the use of artificial feeds, differences between the children with hypernatraemia and those with normo- or hyponatraemia, P < 0.001, P < 0.001, respectively; the use of breast milk, P < 0.001, P < 0.001, respectively; nutritional status, P < 0.001, P < 0.001, respectively; and clinical state of mild to moderate dehydration P < 0.001; P < 0.001, respectively; but not with patients considered severely dehydrated. There was also a significant difference between the presence of neurological features in hyper- and normonatraemic patients P < 0.001; in hyper- and hyponatraemic patients P < 0.05, and in mortality rate between hyper- and normonatraemic patients, P < 0.05 but not between hyper- and hyponatraemic patients. A history of refusal to feed or vomiting was obtained in 41 children (25.9%). The mean serum sodium was 155.5 mmol/l (range 150-189 mmol/l); mean serum urea 7.7 mmol/l (range 1-18.9 mmol/l). Hypernatraemic dehydration remains an important and serious complication of childhood gastroenteritis in our area of study. The use of artificial milk feeds is contributory, and well-nourished babies appear more at risk. We recommend more liberal water intake during gastroenteritis and the public should also be educated on and made more aware of this condition.
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PMID:A prospective clinical study of patients with hypernatraemic dehydration. 1045 91

A 42-year-old man came to our emergency room hyperthermic (oral temperature, 42.4 degrees C), diaphoretic, and delirious. Other findings included labile blood pressure, sinus tachycardia (heart rate, 138/min), tachypnea (respiratory rate 34/min), muscle rigidity, and incontinence. Two days earlier, he had gone to a local clinic with complaints of abdominal pain, nausea, and vomiting. Promethazine was prescribed, and this was the patient's only medication on admission. Laboratory studies showed leukocytosis, hypernatremia, metabolic acidosis, elevated creatinine phosphokinase level, elevated transaminase levels, azotemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and myoglobulinuria. The clinical and laboratory findings were characteristic of the neuroleptic malignant syndrome, with promethazine as the offending agent.
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PMID:Neuroleptic malignant syndrome due to promethazine. 1054 78

A 7-month-old infant presented to the emergency department with diarrhea, vomiting, and decreased activity. The infant was febrile, tachycardic, tachypneic, lethargic, and had a prolonged capillary refill. Initial serum sodium was 197 mmol/L. Ultimately, the infant was diagnosed with central diabetes insipidus complicated by severe dehydration secondary to rotavirus infection. A brief review of infant hypernatremia and its evaluation and treatment in the emergency department follows.
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PMID:Infant hypernatremia: a case report. 1090 64

We describe an 18-year-old female who complained of general weakness, nausea, vomiting, headache, and lightheadedness. On physical examination, she was euvolemic without visual or neurological deficits. The striking biochemical abnormality was hyponatremia (125 mmol/l). This hyponatremia met the laboratory diagnostic criteria for the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Two litres of normal saline were given per day for 4 days and this did not correct her hyponatremia. A spontaneous diuresis (6.6 l) developed in 1 day, causing a rise in her PNa of 26 mmol and a final PNa of 152 mmol/l. Magnetic resonance imaging revealed a dumbell-shaped intrasellar and suprasellar cyst. During transsphenoidal surgery, a Rathke's cleft cyst (RCC) lined with columnar epithelium containing mucoid material was resected. We speculate that the growing RCC may have produced critical compression over the stalk, thus contributing to the transition from SIADH with hyponatremia to transient central diabetes insipidus with hypernatremia.
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PMID:Rathke's cleft cyst presenting with hyponatremia and transient central diabetes insipidus. 1271 31

An adolescent boy returned home from a party and told his parents he may have taken some pills while there. He was given saltwater to drink, in an effort to induce emesis. He vomited numerous times, then seized. Hypernatremia (195 mmol/L) was diagnosed at the community hospital, and he was transferred to a pediatric intensive care facility. He suffered numerous complications and died from cerebral herniation. This case is presented to remind physicians of the dangers of this obsolete therapy.
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PMID:Fatal hypernatremia from saltwater used as an emetic. 1467 97


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