Absence Of Vomiting Research Articles

Importance of nausea

Oncology nurses and patients identify nausea and vomiting as the two most distressing side effects of chemotherapy. The onset and duration of nausea and vomiting in patients receiving chemotherapy may vary. Inadequate control of emesis in the first 24 h following chemotherapy can lead to anticipatory nausea and vomiting and poor control in subsequent cycles of treatment. It may also result in delays or refusal by the patient to have further treatment. In addition, excessive nausea, as well as vomiting, can lead to a multitude of physical, psychologic, and social problems. It is therefore important that nausea is controlled equally as well as vomiting. Recent clinical research into new antiemetic therapy has highlighted the need for standard criteria for the assessment of nausea and vomiting. Assessment should include nausea as a separate phenomenon that may occur in the absence of vomiting and can be equally, if not more, distressing. Objective measures are suitable for the assessment of vomiting, but are not available for assessment of nausea because it is a subjective phenomenon. The purpose of this article is to present evidence supporting the idea that patient reporting using a four-point scale may be a reliable indicator of the degree of nausea and antiemetic efficacy.

Dehydration in Infancy: Hospital Treatment

Dehydration of a degree severe enough to require intravenous replacement of water and electrolytes indicates (1) depletion of extracellular fluid sodium and water to such an extent that reduction of plasma volume results or (2) distortion of the composition of extracellular fluid with consequent disturbance of physiologic function. Such distortion may be marked hypernatremia, severe depletion of extracellular bicarbonate, or disturbances of potassium concentration resulting in either hyperkalemia or hypokalemia. In addition, hypocalcemia or hypomagnesemia may require specific replacement of these ions. EXTRACELLULAR FLUID DEPLETION WITH HYPOVOLEMIA The most important cause of extracellular fluid depletion in terms of frequency is loss of gastrointestinal secretions through either diarrhea or vomiting. In persons with lower intestinal obstruction, sequestration of gastrointestinal secretions in dilated loops of intestine may be sufficient to cause dehydration in the absence of vomiting. In infants with diarrhea, the onset of vomiting usually is an indication for intravenous replacement of electrolyte and water deficits. Oliguria is also an important item of information, indicating that dehydration is severe enough to require parenteral fluids. It has been estimated that hypovolemia and reduced glomerular filtration with oliguria results when about one third of extracellular fluid volume has been lost. In an infant, the normal extracellular fluid volume is 25% of body weight; therefore, a loss of 8% of body weight as extracellular fluid would result in the manifestation of severe dehydration with reduction of plasma volume.

Dehydration in Infancy: Hospital Treatment

Dehydration of a degree severe enough to require intravenous replacement of water and electrolytes indicates (1) depletion of extracellular fluid sodium and water to such an extent that reduction of plasma volume results or (2) distortion of the composition of extracellular fluid with consequent disturbance of physiologic function. Such distortion may be marked hypernatremia, severe depletion of extracellular bicarbonate, or disturbances of potassium concentration resulting in either hyperkalemia or hypokalemia. In addition, hypocalcemia or hypomagnesemia may require specific replacement of these ions. EXTRACELLULAR FLUID DEPLETION WITH HYPOVOLEMIA The most important cause of extracellular fluid depletion in terms of frequency is loss of gastrointestinal secretions through either diarrhea or vomiting. In persons with lower intestinal obstruction, sequestration of gastrointestinal secretions in dilated loops of intestine may be sufficient to cause dehydration in the absence of vomiting. In infants with diarrhea, the onset of vomiting usually is an indication for intravenous replacement of electrolyte and water deficits. Oliguria is also an important item of information, indicating that dehydration is severe enough to require parenteral fluids. It has been estimated that hypovolemia and reduced glomerular filtration with oliguria results when about one third of extracellular fluid volume has been lost. In an infant, the normal extracellular fluid volume is 25% of body weight; therefore, a loss of 8% of body weight as extracellular fluid would result in the manifestation of severe dehydration with reduction of plasma volume.

Effective Control of Moderate-Dose Cisplatin-induced Emesis by a Short-Course Regimen Including Metoclopramide, Chlorpromazine and Hydrocortisone: Results of a Randomized Trial with Metoclopramide Alone

To improve the antiemetic effectiveness of a previously selected short regimen of moderate-dose metoclopramide (MCP), 80 patients were randomized to receive MCP either alone (regimen A) or in combination with low-dose chlorpromazine (CLP) and high-dose hydrocortisone (HDC) (regimen B) with the first course of cisplatin (50 mg/m2). The antiemetic effect was assessed over a 24-hour period only by objective means (duration and volume of vomiting in overnight fasting patients). The response was classified as follows: no emesis (absence of vomiting), partial protection (up to 100 ml of vomiting) and antiemetic failure (more than 100 ml). For regimen A, this study confirms the results previously reported over a 6-hour period. Regimen B provided better emetic control, significantly reducing the prevalence (p = 0.03) and severity (p = 0.02) of emesis, as well as the median volume (p less than 0.006) and duration (p less than 0.02) of vomiting. Except for the higher incidence of sedation, neither limiting nor unexpected toxicities were observed with the multidrug regimen. The male sex and antiemetic regimen B were the only favorable independent prognostic factors recognized by means of a multivariate analysis using a logistic model. This study therefore shows the usefulness of combining a lower dose of MCP and CLP, together with a high-dose HDC in a short regimen, suitable for outpatients receiving moderate-dose cisplatin. The better emesis control in the highly resistant group of female patients warrants further studies and a more aggressive approach.

Community-acquired Pneumonia in Adults in British Hospitals in 1982–1983: A Survey of Aetiology, Mortality, Prognostic Factors and Outcome

Four hundred and fifty-three adults in 25 British hospitals entered a prospective study of community-acquired pneumonia. A microbiological diagnosis was established in 67 per cent; Streptococcus pneumoniae (34 per cent). Mycoplasma pneumoniae (18 per cent) and Influenza A virus (7 per cent) were the commonest microorganisms. Our observations support the view that most of those in the microbiologically negative group (33 per cent) had S. pneumoniae infection. In addition to cultures of blood and sputum the most useful initial tests were for sputum pneumococcal antigen and serum mycoplasma specific IgM. Twenty-six patients (5.7 per cent) died, seven within 48 h of admission. Multivariate analyses showed age, absence of chest pain, absence of vomiting, previous treatment with digoxin, tachypnoea, diastolic hypotension, confusion, leucopenia, leucocytosis, and raised blood urea levels were significantly correlated with death. Patients had a 21-fold increased risk of death if they had two of the following: admission respiratory rate ≥ 30/min, admission diastolic BP ≤ 60 mmHg, urea>7 mmol/1 during admission. Mortality was not related to aetiology except that all three patients with combined Influenza A virus and Staphylococcus aureus infection died. Nine patients had legionella pneumonia; none died. No patients who died from pneumococcal pneumonia, mycoplasma pneumonia or staphylococcal pneumonia had received an appropriate antibiotic before admission. Such deaths are possibly preventable. Assisted ventilation was used in 22 patients of whom 14 survived. Hospital stay in survivors averaged 10.8 days; after six weeks 79 per cent were fit for normal activities, and 55 per cent showed resolution of radiographic signs of pneumonia. We recommend that antibiotics should be given as early as possible and chosen always to cover S. pneumoniae, and in addition M. pneumoniae during outbreaks, and S. aureus during influenza epidemics.

Standardized test meals in assessment of eating behavior in bulimia nervosa: Consumption of feared foods when vomiting is prevented

This study contrasted the amount of food eaten in the absence of vomiting by normal-weight bulimia nervosa patients and matched normal controls. Subjects were instructed to eat as much food as they comfortably could without vomiting afterwards in three standardized test meals: a complete dinner eaten in a laboratory situation, and spaghetti and candy eaten at home. Bulimia nervosa subjects ate a very small amount of food in each test meal when compared with control subjects. Bulimia nervosa subjects also reported greater anxiety and urge to vomit after eating. A content analysis of tape-recorded thoughts showed that bulimia nervosa subjects were more preoccupied with eating and expressed more negative food-related thoughts. The results support the hypothesis that women with bulimia nervosa are unable to eat normal amounts of “frightening” foods when they do not plan to vomit. This behavioral test of eating behavior appears to be useful for the assessment of bulimia nervosa.

Standardized test meals in the assessment of bulimia nervosa

This study contrasted the amount of food eaten in the absence of vomiting by normal weight bulimia nervosa patients and matched normal controls. Another purpose was to compare food consumption in test meals with eating records at home and with questionnaires of psychological distress and eating disturbance. Subjects were instructed to eat as much food as they comfortably could without vomiting afterwards in three standardized test meals: complete dinner eaten in a laboratory situation and spaghetti and candy eaten at home. Bulimia nervosa subjects ate a very small amount of food in each test meal when compared with the consumption of food by control subjects. Bulimia nervosa subjects also reported greater anxiety and urge to vomit after eating. A content analysis of tape recorded thoughts showed that bulimia nervosa subjects were more preoccupied with eating and emitted more negative food related thoughts. In addition, bulimia nervosa patients who ate little or nothing in test meals had a more severe pattern of binge-eating and vomiting at home and for the entire sample, the amount eaten in test meals, when vomiting was prevented, was negatively correlated with scores on questionnaires of eating and psychological disturbance. The results support the hypothesis that women with bulimia nervosa are unable to eat normal amounts of ‘frightening’ foods when they do not plan to vomit. This behavioral test of eating behavior appears to be useful for the assessment of bulimia nervosa.

Transient neonatal diabetes mellitus in half sisters.

THE SYNDROME of transient diabetes mellitus in the newborn has been well documented by Cornblath and Schwartz 1 who collected and summarized 15 case reports. Aside from the fact that recovery is complete after weeks or months, the syndrome meets the diagnostic requirements of true diabetes mellitus: hyperglycemia, glycosuria, and control with exogenous insulin. Ketonuria, however, is not the rule. These neonates are wasted although alert in appearance, and rapidly become dehydrated in spite of adequate food intake and the absence of vomiting and diarrhea. The following cases are reported because of their unique familial relationship, the patients being paternal half sisters with a positive paternal family history of diabetes mellitus. These findings raised the question of possible genetic etiologic factors. Report of Cases Case1.—A white female, was delivered spontaneously at Mississippi Baptist Hospital on July 15, 1966, after 32 weeks' gestation, according to the mother's menstrual history. A

Esophageal rupture in absence of vomiting

Summary Two cases are reported to show that esophageal rupture may occur in the absence of vomiting. A history of dysphagia in a patient who presents with acute anterior chest or back pain while eating should alert the physician to the possibility of rupture. The etiology, role of esophagitis, motility factors, and significance of obstruction in the pathogenesis of esophageal rupture are discussed.

Solitary cecal diverticulitis

Solitary cecal diverticulitis is an infrequent condition which simulates acute appendicitis. It should be considered in the differential diagnosis of pain in the right lower quadrant of the abdomen. Clinical features which may suggest this diagnosis are absence of vomiting, moderate abdominal signs and occasionally a more prolonged history then one usually encounters in acute appendicitis. Recognition of the correct pathologic diagnosis at operation will determine the proper choice of procedure. Simple diverticulectomy is the treatment of choice when possible.

DIABETES INSIPIDUS IN INFANCY RESISTANT TO PITRESSIN

The present authors have presented the report of a 6½ month old Negro male who, shortly after birth, developed polyuria, polydipsia, fever, vomiting, dehydration, constipation and failure to gain weight. Investigations ruled out systemic infections as well as the common inflammatory and congenital renal diseases. Under "control" conditions (average fluid intake) there was a persistence of the fever, vomiting and constipation; the values for nonprotein nitrogen, serum sodium and chloride were elevated above normal. The polyuria, which was characterized by low specific gravity, rose to a value of 1.011 during periods of marked dehydration. During the "hydration test," a progressive increase of fluid intake above 2000 cc. daily resulted in normal temperature, absence of vomiting, increase of weight, and normal values for nonprotein nitrogen, serum sodium and chloride. There was no antidiuretic response either to intravenous infusion of hypertonic saline (Carter-Robbins' test) or to 0.1 unit pitressin intravenously. A normal control showed prompt antidiuresis during and following the infusion of hypertonic saline. Intramuscular administration of pitressin to the point of toxicity (4 units) had no effect on the volume or specific gravity of the urine. It is postulated that this syndrome of diabetes insipidus in infancy, resistant to pitressin, is the result of a failure of end-organ response in the kidney.