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

Theoretically, absorption of an ingested dose of paraquat may be reduced by gastric lavage, induced emesis, whole-gut lavage or by the oral administration of absorbent substances. Animal experiments suggest that paraquat is absorbed poorly from the stomach and absorbed incompletely (less than 5%) from the small intestine over a 1-6 h period. Although gastric lavage would therefore seem a logical way to ameliorate the toxicity of an ingested dose of paraquat, peak plasma concentrations are attained rapidly and evidence for the efficacy of gastric lavage in man is poor. In 1977, a potent emetic (PP796) was added to liquid and solid formulations of paraquat because experiments in primates had demonstrated a fivefold reduction in toxicity. In man, ingestion of formulations containing an emetic is more likely to cause spontaneous vomiting within 30 min than non-emetic preparations. However, definite evidence of benefit, as judged by improved patient prognosis, has yet to be established. Gut lavage has been shown to remove only a small proportion of an ingested dose of paraquat. At the flow rates employed in man (75 ml/min), approximately 0.5-1.0 litres of lavage fluid/h may be absorbed across the intestinal wall. Since there is a theoretical risk of increasing paraquat absorption, the use of whole-gut lavage cannot be recommended. Bipyridilium herbicides are absorbed by soil and clay minerals, and montmorillonite in particular has been shown to be a strong binding agent in vitro. Accordingly, the use of Fuller's Earth (calcium montmorillonite) and Bentonite (sodium montmorillonite) for the treatment of poisoning has been investigated in animal models.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Treatment of paraquat poisoning in man: methods to prevent absorption. 354 86

The currently recognized toxic effects of quinine in humans are identified and the problems of management of overdosage of quinine are discussed. Quinine, available therapeutically as sulphate or hydrochloride salts, also is widely used in tonic water, and there are several case reports of allergic reactions to the drug when a patient has consumed the drug in this way. Another unintentional source of poisoning is its use as an adulterant in heroin for "street" use. This appears to be a problem in the US. Quinine, termed a "general protoplasmic poison" is toxic to many bacteria, yeasts, and trypanosomes, as well as to malarial plasmodia. Quinine has local anesthetic action but also is an irritant. The irritant effects may be responsible in part for the nausea associated with its clinical use. In addition it has a mild antipyretic effect. Several features are common to both an acute single overdose in self-poisoning and accumulation of quinine during therapy for malaria: together they are termed cinchonism. Auditory symptoms, gastrointestinal disturbances, vasodilatation, sweating, and headache occur with moderately elevated plasma quinine concentration. As these rise, increasingly severe visual disturbances and then cardiac and neurologic features occur. Mild nausea may be the only symptom, but with large overdoses profuse vomiting, abdominal pain, and diarrhea may occur. These result from a combination of the local irritant effect of quinine on the gut and the central effects of quinine on the chemoreceptor trigger zone. Vasodilatation and sweating are well recognized, and tinnitus is common. Visual symptoms usually are delayed, and blindness may not be discovered for a day or more. Aspirin-sensitive patients, and others, may develop angioedema by nonimmunological mechanisms in response to drugs, and quinine has been reported to produce pseudo-allergic reactions in aspirin-sensitive patients. Quinine also can cause drug-induced thrombocytopenia and purpura. In patients suffering with malaria due to "Plasmodium falciparum," anemia and acute intravascular hemolysis with renal failure are recognized complications. There appears to be little evidence in the literature in support of the folk tradition of quinine as an inducer of abortion. Quinine is known to cause deterioration in patients with myasthenia gravis and erythema multiforme, to stimulate insulin release in patients receiving treatment for falicparum malaria, and to be responsible at times for ataxia following moderate overdosage. Clinically, quinine poisoning is observed in 3 situations: self-poisoning; accidentally; and following use of quinine in excessive doses in the hope of achieving abortion. Treatment courses are reviewed.
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PMID:Quinine toxicity. 354 70

Prolonged oral or parenteral administration of antibiotics has led to the development of resistant strains of microorganisms. Bacteria acquire drug resistance by mutation, conjugation and transduction. Oral antibiotics by a process of selection pressure facilitate the proliferation of resistant population of bacteria. Drug resistant bacteria are capable of transferring their resistance to drugs to other bacteria by the process of transferable drug resistance (TDR). This can lead to multiple resistance to a vast number of therapeutically useful antibiotics which will, therefore, become ineffective for treatment. TDR can occur between pathogenic organism, between organism of different species, such as E. coli, Salmonella and Shigella; and also between pathogenic and non-pathogenic organisms. Faecal contamination of meat during slaughter may result in the transfer of antibiotic resistant E. coli to the meat. In the human gut this E. coli could transfer resistance to other gut flora, namely E. coli or Salmonella. Antibiotic-resistant coliforms have been isolated from carcases, fresh and cooked meat, raw meat handlers and livestock handlers. Handling of raw market meat by buyers in Nigeria could also lead to contamination of meat with resistant microorganisms. Veterinary drugs are sold and used without much control in Nigeria. This practice may have created a population of resistant bacteria in the meat animals. The presence of antibiotic residues in meat, milk and their products pose potential health hazards for man. Allergic skin conditions, nausea, vomiting, anaphylactic shock and even death have resulted from the ingestion of residues. Cooking and freezing have minimal effect on residues. Resistance to antibiotics have been detected in food poisoning bacteria, namely Salmonella typhimurium, Staphylococcus aureus and Clostridium perfringens. Some epidemiological link has been established between S. typhimurium of calves and food poisoning in man. Judicious use of antibiotics, public education on the health risks of the promiscuous use of drugs in livestock production; and hygienic slaughter at the slaughter houses, will help to reduce bacterial drug resistance in man and animals.
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PMID:Bacterial drug resistance in meat animals: a review. 354 99

Diabetes mellitus has been associated with a variety of gastrointestinal motor disturbances. Pyloric activity, however, has not been specifically investigated. We have quantified the pyloric manometric profile in 24 diabetics with recurrent nausea or vomiting, or both, without evidence of mechanical obstruction. Twelve healthy volunteers served as controls. A multilumen pneumohydraulic perfusion assembly with five side openings, each 1 cm apart, was positioned fluoroscopically across the antroduodenal junction and used to monitor pressure activity for 5 h (3 h fasting and 2 h fed). Three patterns of pyloric activity were defined and quantified: (a) baseline elevation of greater than or equal to 3 mmHg for greater than or equal to 1 min (tonic pattern); (b) antral-type phasic pressure activity mixed with duodenal phasic activity (phasic pattern); and (c) phasic pattern superimposed on tonic activity (combined tonic-phasic pattern). The duration of the total pyloric activity before and after the meal was greater in diabetics than in controls (p less than 0.005). Furthermore, episodes of unusually prolonged (greater than or equal to 3 min) and intense (greater than or equal to 10 mmHg) tonic contraction, "pylorospasm," were observed in 14 of 24 diabetics but in only 1 control (p = 0.025). In diabetics, episodes of pylorospasm had a peak amplitude of tonic activity of 13 +/- 1 mmHg and a duration of 7 +/- 0.7 min (mean +/- SE). We conclude that pyloric dysmotility forms part of the widespread disruption of gut motility that affects some patients with diabetes.
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PMID:Pyloric dysfunction in diabetics with recurrent nausea and vomiting. 369 9

Prior to vomiting, two gastrointestinal contractile events occur in succession: a giant contraction that propagates retrograde from mid-small intestine to the antrum (RGC) and a series of phasic contractions that occur at all levels of the gastrointestinal tract. We quantitatively examined the gastrointestinal myoelectric events associated with vomiting and correlated them with the previously defined contractile events. Twelve dogs of either sex were implanted with electrical or contractile recording devices implanted on the stomach and small intestine. After an overnight fast, gut activity was recorded before and after apomorphine administration (2.5-15 micrograms/kg, iv). We found that the RGC was correlated with two successive electrical events: disruption of electrical control activity (ECA) cycling and a potential change occurring at the upstroke of the RGC. However, the initial myoelectric event associated with vomiting was ECA frequency slowing of the antrum and lower half of the small intestine. The post-RGC phasic contractions were associated with ECA-dependent response activity and occurred during the period of ECA frequency slowing. Atropine (100 micrograms/kg iv) blocked the RGC and its associated electrical events but not the slowing of ECA frequency. Supradiaphragmatic vagotomy eliminated all gastrointestinal contractile and myoelectric events but antral ECA frequency slowing. Spontaneous occurrences of the myoelectric correlates of vomiting were not different from those activated by apomorphine. These results suggest that ECA disruption may be important for retrograde propagation of the RGC. The function of ECA frequency slowing, however, remains unknown.
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PMID:Gastrointestinal myoelectric correlates of vomiting in the dog. 378 49

Chronic intestinal pseudo-obstruction is a disorder of gut motility resulting in severe abdominal pain, bloating, nausea, and vomiting after eating. The avoidance of food in order to minimize symptoms causes malnutrition. To date, no medical or surgical treatment has been shown to be of lasting benefit. We treated 10 patients disabled by chronic intestinal pseudo-obstruction using home parenteral nutrition. All were rendered minimally symptomatic as long as they refrained from significant oral intake. Nine of the 10 patients were malnourished prior to the institution of treatment. Home parenteral nutrition increased mean total body weight from 74.7 +/- 2.9 to 93.5 +/- 3.7% (p less than 0.001), mean lean body mass from 78.4 +/- 6.5 to a mean of 92.7 +/- 2.6 (p less than 0.02), and mean body fat from 57.1 +/- 8.8 to 83.8 +/- 8.2% of expected values (p less than 0.05). Mean total body potassium increased from 68.8 +/- 13.1 to 80.5 +/- 10.7 g (p less than 0.05). We conclude that in chronic intestinal pseudo-obstruction, home parenteral nutrition coupled with minimal oral intake effectively relieves symptoms and significantly improves the nutritional depletion.
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PMID:Successful management of chronic intestinal pseudo-obstruction with home parenteral nutrition. 392 33

In the search for a superior alternative to conventional bowel preparation which often gives unsatisfactory results in children, we have introduced whole-gut irrigation for pediatric use. After a pilot study on 15 children during which adjustments on the technique were made, we settled on an intensive regimen with some notable modifications from conventional adult practice: the use of warm Hartmann's solution, a relatively large fluid load (mean volume 5.3 l/kg body weight, range 3.0 - 12.0 l/kg) and a rapid infusion rate (1.5 ml/kg/min). We then evaluated its safety, effectiveness, and acceptability prospectively on 45 patients undergoing colonoscopy or colorectal surgery, age ranging from 4 months to 11 years, with a mean of 3.9 years. Subjective complaints were mild and included nausea/vomiting, 12 cases (26.7 percent); abdominal colic, two (4.4 percent); and distending discomfort, three (6.7 percent). There was a mean weight gain of 4.0 percent but no gross electrolyte disturbances. Results of bowel preparation were satisfactory in 33 (73.3 percent), adequate in ten (22.2 percent) and poor in two (4.4 percent). Compared with our previous method, in which inadequate preparation occurred in 4/20 patients, (20 percent) by conventional measures, whole-gut irrigation represents a statistically significant improvement (P less than 0.05). In addition, whole-gut irrigation shortened hospital stay and obviated the traditional need of two to three days' dietary restrictions.
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PMID:Whole-gut irrigation in infants and young children. 394 16

We have reviewed 53 cases of allergic disorders of the gastrointestinal tract in children, including 15 with principal effects in the rectum (allergic proctitis) and 38 with dominant involvement of the upper and mid portions of the gut (allergic gastroenteritis). Most cases of allergic proctitis had their onset at less than 6 months of age, and all were under 2 years old when they presented with rectal bleeding alone or in combination with diarrhea. Rectal mucosal biopsy revealed in most cases a diffuse increase of eosinophils in the lamina propria together with a focal infiltration of the epithelium by eosinophils. Cases of allergic gastroenteritis affected all age groups and had a lower frequency of overt rectal bleeding. More common were other symptoms (vomiting, pain, and weight loss), an allergic history, anemia, blood eosinophilia, and increased serum IgE. Mucosal biopsy abnormalities were present in the gastric antrum in all cases sampled, the small intestine in 79%, the esophagus in 60%, and the gastric corpus in 52%. The lesions were usually diffuse and marked in the antrum and esophagus; in contrast, they tended to be focal and mild in the small intestine and gastric corpus. All cases of proctitis responded to a dietary change by cessation of symptoms without recurrences, whereas most of those with gastroenteritis had multiple relapses and required corticosteroid therapy.
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PMID:Allergic proctitis and gastroenteritis in children. Clinical and mucosal biopsy features in 53 cases. 395 38

Pressure activity in the stomach and upper intestine was studied in 104 patients referred to the Mayo Clinic for evaluation of functional symptoms (nausea, vomiting, upper abdominal pain, or other dyspeptic symptoms in the absence of structural gut abnormalities). Manometric abnormalities were found in 75 patients. Forty-three of these had gastric abnormalities and 32 patients had both gastric and intestinal abnormalities. In the stomach, decreased antral phasic pressure activity after a solid meal was the most common abnormality. In the upper intestine, unpropagated bursts of phasic and tonic contractile activity were a relatively frequent abnormality but a number of other altered manometric patterns also were observed. Digestive tract symptoms were not good predictors of the presence or site of the gastrointestinal manometric abnormalities. Patients with associated neurologic, urologic, or metabolic (diabetes) disease were more likely to exhibit manometric abnormalities than were those without evidence of disease outside the gut. Almost two-thirds of the patients with symptoms and normal manometry presented features suggestive of psychiatric disease. We conclude that in patients with severe functional-type symptoms gastrointestinal manometry is a useful technique to evidence the underlying gut motor disturbance that is present in a relatively high proportion of these patients.
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PMID:Manometric evaluation of functional upper gut symptoms. 397 47

Necrotizing enterocolitis is an uncommon but dangerous disease in premature infants. Ten cases, seen over a three-year period at the Stanford University Medical Center, represented an incidence of 0.4 percent. The patients, six of whom died, derived from a general population, in contrast to the large series of patients reported in the literature in which the incidence was from 0.9 percent to 3.7 percent.(3-6)The initial symptoms-rapid respiration, periodic breathing, lethargy and irritability-were identical to those which occurred in numerous infants who had respiratory disease. Subsequent symptoms (abdominal distension, in 100 percent; vomiting, 80 percent; apneic spells, 70 percent; jaundice, 70 percent; guaic-positive stools, 60 percent) were those of nonspecific acute abdominal disease. The radiologist first made the diagnosis in 90 percent of cases. Interstitial air in the wall of the gut and the retroperitoneum, and portal vein gas were the most diagnostic radiographic features. Barium contrast studies were not helpful, and in one case led to the erroneous diagnosis of small bowel volvulus. Plain abdominal radiographs must be taken of all premature infants with symptoms of nonspecific acute abdominal disease. If the radiographs are negative, but symptoms continue, they should be repeated at frequent intervals, for early diagnosis is critical to institution of proper therapy.
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PMID:Neonatal necrotizing enterocolitis. Clinical and radiological features. 481 93


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