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Query: UMLS:C0042963 (vomiting)
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The authors report the case of a 58 year old female patient with rheumatoid arthritis. About 4 hours after each intramuscular injection of Myochrysin (Sodium-auro-thiomalate 5%) she showed undesired reactions such as sialorrhea, nausea, vomiting, abdominal pain, diarrhea, apathy, weakness, head ache, breast swelling, perspiration, feeling of incident death. The following day these symptoms declined, the joint pain, however, increased. The reaction recurred with each of the 5 Sodium-auro-thiomalate injections, but not after injections of 5% Solganal (Aurothioglucose). It is supposed that these side effects are connected with the quick absorption of the Sodium-auro-thiomalate in aqueous solution. The Aurothioglucose in oil suspension would not cause such reactions after an intramuscular injection because of its slower absorption.
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PMID:[Reactions against sodium-auro-thiomalate in the treatment of rheumatoid arthritis]. 11 3

The outcome of administering ORT (oral rehydration therapy) to 62 infants admitted to a Costa Rican hospital with acute rotavirus or bacterial diarrheas and with 5-10% dehydration was described. 94% of the infants were successfully treated by administering only ORT. There were no significant differences in the success rates for rotavirus diarrhea patients and for various bacterial diarrhea patients. Success rates were 92% for rotavirus patients, 93% for Escherichia coli patients, 96% for idiopathic diarrhea patients, and 100% for salmonella and shigella patients. Upon admission, the average duration of diarrhea was 2.9 days, vomiting was present 88% of the cases, and all patients exhibited some signs of dehydration. The infants were administered the oral formula recommended by the World Health Organization. Patients received 400 ml of oral solution followed by 200 ml of water. The treatment was repeated until skin tuger was normal. 34% of the infants were rehydrated within 6 hours and 76% within 20 hours. Patients were admitted with a variety of electrolyte abnormalies. 24% had hyponatraemia, 27% had hypokalaemia, and 23% had hypernatraemia. Sodium levels were improved within 24 hours for all patients except for 5 hyponataemia patients. Although rotavirus patients had higher stool glucose concentrations than the other patients, they apparently absorbed enough of the solution to rehydrate successfully. Specific data on changes in weight, plasma protins, hematocrit, blood composition, and stool composition and on therapeutic failures was provided. Investigators concluded that ORT was a safe and effective form of therapy for both rotavirus and bacterial diarrhea and for severe cases of dehydration.
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PMID:Oral rehydration and maintenance of children with rotavirus and bacterial diarrhoeas. 22 48

Dehydration, in childhood as in adulthood, may origin from an inadequate water ingestion or an excessive water elimination. Causes may be found in fever, vomiting, scalds, pulmonary hyperventilation, diabetes. Water loss during acute diarrhea in children can be even 6-7 times higher in comparison with an healthy child. Together with water, electrolytes are lost. We differentiate dehydration in isonatremic d. (70% of cases), hyponatremic d. (10%) and hypernatremic d. (20%) basing on Sodium loss. Important dehydration causes severe clinical symptoms as shock, renal and cardiocirculatory failure, convulsion, coma. Symptoms at the central nervous system level derivate both from hyperosmolarity in brain cells and from thrombosis or hemorrhages in subdural sites. Dehydration, following acute diarrhea, is slight when weight loss is lower than 5%. The child health conditions still remain good. Dehydration become moderate if weight loss reaches 5% and the child starts suffering. When the weight loss reaches 10%, dehydration is now severe and circulatory deficiency becomes evident. When it is higher than 10%, prognosis is very severe and shock and coma may be observed. In the present work, we illustrate the different ways of rehydration after acute diarrhea. Initially, oral rehydration must be established with one of the oral solutions, differing each other for amount of electrolytes and glucose. Recently, a new solution, "supersolution", has been presented differing from the other ones for electrolytes concentration and for the presence of rice starch instead of glucose. In most cases of diarrhea, oral rehydration appears adequate but sometimes an intravenous rehydration becomes necessary, e.g. in case of vomiting, CNS depression and in any case of severe gastroenteric symptomatology.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Dehydrated child]. 189 82

Type I pseudohypoaldosteronism (PHA) is a hereditary disease characterized by salt wasting resulting from target organ unresponsiveness to mineralocorticoids. We have studied two kindreds including a total of nine patients with PHA. In kindred I, the propositus presented with renal salt wasting in infancy (vomiting, failure to thrive, short stature, hyponatremia, hyperkalemia) and responded dramatically to a high salt diet (2.5 g/day). Sodium supplementation was discontinued at the age of two. In seven additional family members from three generations, clinical expression of PHA varied from asymptomatic to moderate. In affected members (propositus, mother, and two brothers), hyperaldosteronism persisted over 13 yr; however, the PRA decreased gradually to near normal values. Persistent hyperaldosteronism in the face of a decrease in PRA indicated the development of tertiary hyperaldosteronism due to autonomously functioning zona glomerulosa. The pedigree was consistent with an autosomal dominant mode of transmission with variable expression. In kindred II, the propositus, who was the product of a consanguineous marriage, developed severe renal salt losing at age 9 days. She had also increased salivary and sweat electrolytes consistent with PHA resulting from multiple organ unresponsiveness to mineralocorticoids. Life threatening episodes of salt wasting recurred beyond the age of 2 yr. At 5 yr of age she still requires high amounts of salt supplements (14 g/day). A sister died at 9 days of age with PHA symptoms. Six close relatives (parents, three siblings, maternal uncle) showed no biochemical abnormalities. This pedigree was consistent with an autosomal recessive mode of inheritance. In view of the findings on these two kindreds and the analysis of those in the literature, we conclude that type I PHA includes two clinically and genetically distinct entities with either renal or multiple target organ defects.
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PMID:Type I pseudohypoaldosteronism includes two clinically and genetically distinct entities with either renal or multiple target organ defects. 193 32

Infantile diarrhea in France is usually benign and self limiting, but in rare cases dehydration or malnutrition with continuing diarrhea can occur. Dehydration may almost always be prevented and treated with an oral solution containing glucose and electrolytes. Rapid feeding adapted to the age of the child can help prevent nutritional problems. The need for antibiotics and other medications is very limited. Intestinal infection is the cause of most cases of infantile diarrhea. 10-15% of cases are caused by bacteria of various types and the vast majority of the remainder by viruses, with the rotavirus alone accounting for around 1/2 of cases. Oral rehydration can compensate for the exaggerated loss of water and electrolytes. No matter how serious the diarrhea or its cause, some potential for absorption of water and sodium is always retained. Sodium absorption is facilitated by the concomitant presence of glucose in the intestines. Oral rehydration solutions commercially available in France have an electrolyte content adapted to the average fecal loss locally observed in acute diarrhea. Oral rehydration solution is offered to infants at short intervals in a bottle, allowing the child to drink as the need arises. Significant quantities may be absorbed in the 1st 24 hours. Any vomiting usually ceases after administration of a small amount of glucose. Traditional dietary preparations for diarrhea such as carrot soup and products based on rice have essentially an absorbent power and do not diminish intestinal loss of water and electrolytes. In cases of severe dehydration with weight loss of over 10% and unconsciousness, intravenous rehydration is indicated. Whether oral or parietal, rehydration should always be rapid so that feeding can begin. Feeding should start after 24 or at most 48 hours of rehydration to maintain the nutritional state. Rapid feeding is usually well tolerated, but there may be a transitory intolerance to lactose or a secondary sensitivity to proteins in cow's milk. Breast feeding should not be interrupted, but bottle feedings should be stopped for 24-48 hours and reintroduced for infants under 3 months with protein formula not based on cow's milk and for those over 3 months with diluted formula.
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PMID:[Current treatment of acute diarrhea in infants]. 314 1

Sodium dichromate ingestion in children is uncommon and potentially lethal. The most appropriate management is uncertain because of the lack of sound data contained in the few reports of successfully treated patients. Immediate treatment should include urgent induction of emesis, administration of ascorbic acid as an antidote, followed by supportive treatment.
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PMID:Acute chromium poisoning in a 2 year old child. 397 93

The effects of four different irrigation solutions for preparation of colonoscopy were assessed in 64 patients. Using saline lavage solutions similar to plasma led to predominant symptoms of volume overload. Body weight transitorily increased by 1.7 +/- 0.2 kg, water and electrolytes were retained. Time until appearance of clear lavage fluid was 145 +/- 5 min. Irrigation by mannitol solution was badly tolerated and frequently led to vomiting. Body weight decreased and loss of water and electrolytes was reflected in changes of blood composition. Lavage with a hypertonic salt and mannitol solution (415 mosmol/l) was tolerated somewhat better. It led to minimal loss of weight, sodium (230 +/- 27 mmol) and chloride (270 +/- 24 mmol) were retained. Colonic cleansing was achieved after only 84 +/- 6 min. Isotonic saline mannitol solution with 105 mmol/l sodium, 93 mmol/l chloride, 10 mmol/l potassium and 22 mmol/l bicarbonate as well as 70 mmol/l mannitol (or 70 mmol/l polyethylene glycol) was tolerated best. There was a minimal weight increase (0.5 +/- 0.2 kg). Sodium metabolism was balanced (-2 +/- 7 mmol), chloride was retained to a slight extent (+ 115 +/- 29 mmol). Colonic cleansing was completed by 110 +/- 8 min.
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PMID:[Prograde colonic irrigation without disturbance of the water-electrolyte balance]. 641 6

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

Intradialytic vascular instability continues to be one of the most frequent complications in elderly haemodialysis patients. Signs of impending hypotension such as sweating, apprehension, tachycardia, nausea, or vomiting may be infrequent in the geriatric population. The onset of hypotension in the elderly may be sudden and profound and may lead to serious consequences such as myocardial infarction, stroke, or aspiration if not treated promptly. Prevention of vascular instability is extremely important in the elderly. Avoiding rapid ultrafiltration sedatives, or antihypertensive medications and food intake may be beneficial. Optimal dialysate composition (dialysate sodium, bicarbonate, and calcium concentration) is important. Dialysate sodium profiling may be useful in the elderly to reduce intradialytic hypotension. Step sodium profiles result in better plasma volume refilling in early dialysis, while linear dialysate sodium profiles have greater plasma volume in late dialysis, suggesting that dialysate sodium profiles may need to be individualized for optimal response. Sodium profiling could also result in sodium retention, and long-term studies are needed in the elderly before their widespread use is recommended. Use of newer modalities such as continuous monitoring of plasma volume with Crit Line, and determination and monitoring of body-fluid compartments with bioimpedance may further improve vascular stability in the elderly.
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PMID:Sodium profiling in elderly haemodialysis patients. 904 40

Sodium ramping has been introduced as a technique to decrease side effects occurring during hemodialysis. We studied sodium ramping in 414 dialysis sessions in 23 patients by randomizing 2-week blocks of dialysis to either steady dialysate sodium of 140 mEq/L, linear sodium ramping during dialysis from 155 mEq/L to 140 mEq/ L, or stepwise ramping (sodium of 155 mEq/L for 3 hours and 140 mEq/L for 1 hour). We studied the number and severity of hypotensive and hypertensive episodes. A hypotensive episode was defined as an abrupt decline of systolic blood pressure of more than 50 mm Hg, a decrease in blood pressure accompanied by symptoms requiring intervention, or systolic blood pressure of less than 90 mm Hg even without symptoms. A hypertensive episode was defined as a sudden increase in systolic blood pressure of over 30 mm Hg. We also recorded other side effects (headache, cramps, nausea, vomiting, dizziness, thirst, fatigue, weight gain, and blood pressure) during, immediately after, and between dialysis sessions. There was no major difference between the two ramping protocols, but compared with standard dialysis, both decreased total number of side effects from 4.0 to 3.0 (P = 0.057); the number of hypotensive episodes decreased from 1.3 to 0.7 (P = 0.036). The lowest blood pressure was 114/66 mm Hg during control and 123/69 mm Hg during ramping (P < 0.0001). The frequency of cramps during dialysis decreased from 0.9 to 0.5 (P = 0.006). There was no difference in headache, nausea, or vomiting. The number of hypertensive episodes increased from 0.045 to 0.086 during ramping (P = 0.125). Of 23 patients, only five (22%) had a marked decrease in symptoms; two of the three most symptomatic patients showed no significant improvement. Between dialysis sessions, patients complained of more fatigue and thirst (P < 0.0001 and P = 0.0028, respectively), and interdialytic weight gain following ramping was 5.1% of body weight compared with 4.4% without ramping (P < 0.0001). Blood pressure also increased following ramping, from 143/79 mm Hg to 152/81 mm Hg (P = 0.001). Ramping can decrease the overall number of side effects, but increases interdialytic symptoms, weight gain, and hypertension. In most instances, it simply changes the time the side effects occur. Only 22% of patients have significant benefit. These patients can be identified only through trial and error, as no model of these patients can be created.
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PMID:Sodium ramping in hemodialysis: a study of beneficial and adverse effects. 915 99


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