Distinguishing Clinical Features of Cannabinoid Hyperemesis Syndrome and Cyclic Vomiting Syndrome: A Retrospective Cohort Study.

OBJECTIVE: To identify clinical characteristics that distinguish cannabinoid hyperemesis syndrome (CHS) from cyclic vomiting syndrome (CVS), 2 conditions marked by episodes of nausea, vomiting, and abdominal pain. STUDY DESIGN: We performed a retrospective chart review of patients admitted to a large children's health care system from 2015 through 2022. Patients with CHS and CVS were identified by the electronic medical record using International Classification of Diseases, Ninth and Tenth Revision codes. RESULTS: Of 201 patients screened, 125 were included. Patients with CHS were older than those with CVS (mean [SD] 18.06 [1.41] vs 14.50 [2.91] years, P < .001). There were no significant differences in sex, race, ethnicity, or hospital length of stay between groups. Patients with CHS were more likely to have a positive urine drug screen (86% vs 2.9%, P < .001), lower mean (SD) serum potassium (3.62 [0.77] vs 3.88 [0.49], P < .001), and greater mean (SD) serum creatinine (0.83 (0.41) vs 0.63 (0.17), P < .001). The average (SD) systolic blood pressure was significantly greater in patients with CHS (systolic blood pressure 124.46 [10.66] vs 118.55 [10.99], P = .032) compared with children of comparable age range with CVS. Imaging was obtained in 36% of all patients, and only 2.4% had abnormalities. CONCLUSIONS: Clinical features including older age, greater systolic blood pressure, positive urine drug screen, and select electrolyte findings might distinguish CHS from CVS. Abdominal imaging in both conditions is of low yield. These findings may allow for early recognition and appropriate therapy in CHS patients.

Predictors of Hospital Admission for Pediatric Cyclic Vomiting Syndrome.

OBJECTIVES: To identify predictors of hospitalization in pediatric patients presenting to an emergency department (ED) for a cyclic vomiting syndrome (CVS) attack. STUDY DESIGN: We retrospectively reviewed patients with CVS seen at our institution between 2015 and 2018 and included those who met the Rome IV criteria for CVS. We identified all CVS-related ED visits and subsequently performed a case-control analysis, utilizing multivariate logistic regression, to identify clinical and demographic factors that may predict hospitalization. RESULTS: In total, 219 patients with CVS (using International Statistical Classification of Diseases and Related Health Problems, 10th Revision) were identified, of which 65% met the inclusion criteria (median age 11 years). We identified 152 CVS-related ED visits, of which 62% resulted in hospitalization. Factors found to predict hospitalization using multivariate analyses included male sex (P = .04), younger age (P = .027), delayed presentation (>24 hours) to the ED (P < .001), and longer wait time prior treatment with antiemetics (P = .029). CONCLUSION: One-quarter of all patients with CVS had presented to the ED and nearly two-thirds of these ED visits resulted in hospitalization. A delayed presentation to the ED following the onset of symptoms was the strongest independent predictor of hospital admission, alongside male sex, younger age, and longer ED wait times before treatment with antiemetics. These findings suggest that early intervention may be key to successfully mitigating the risk of hospitalization for a CVS attack.

Coexistence of emphysematous cystitis and bilateral emphysematous pyelonephritis: a case report and review of the literature.

Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by the production of gas in the renal parenchyma, collecting system or perirenal tissue. Meanwhile, emphysematous cystitis (EC) is a clinical entity characterized by the presence of gas inside and around the bladder wall. Interestingly, although both diseases are common in patients with diabetes mellitus, these are rarely combined. We report a rare case of a 56-year-old diabetic male suffering from fever, headache and vomiting and in which a diagnosis of septic shock was established due to coexistence of EC and bilateral EPN. The emphysematous diseases improved with a conservative treatment approach using antibiotic therapy and glycemic control, we highlight that the nephrectomy was not necessary in our patient despite the fact that he presented risk factors that predict the failure of conservative treatment.

Manejo farmacológico do vômito em felinos – revisão / Pharmacological management of vomiting in feline patients - a review / Manejo farmacológico del vómito en felinos – revisión

O vômito é um reflexo protetor complexo mediado pelo centro emético, região do sistema nervoso central, que recebe impulsos provenientes de outros e a noradrenalina são os principais mediadores do vômito, tendo a histamina, a dopamina, a acetilcolina e as encefalinas um papel secundário. Em vista de variações na fisiologia do vômito e na farmacologia entre as espécies, ressalta-se a importância de estudos focados em felinos. Entre os agentes indutores do vômito, os adrenérgicos alfa-2 agonistas, de que são exemplos a dexmedetomidina e a xilazina, são os mais estudados na espécie com essa finalidade. O maropitant e a ondansetrona estão entre os fámacos antieméticos mais recentes. A mirtazapina pode ter utilidade na prevenção do vômito crônico.

Vomiting is a complex protective reflex mediated by the emetic center, a region of the central nervous system that receives impulses from other central and peripheral afferent areas. In cats, substance P, serotonin and norepinephrine are the main mediators of vomiting, with histamine, dopamine, acetylcholine, and enkephalins having a secondary role. In view of variations in the physiology of vomiting and pharmacology across species, the importance of studies focused on felines is emphasized. Among the emetic agents, alpha-2-adrenergic agonists, such as dexmedetomidine and xylazine, are the most studied in the species for this purpose. Maropitant and ondansetron are the more recent antiemetic drugs. Mirtazapine may be useful to prevent chronic vomiting.

El vómito es un reflejo protector complejo mediado por el centro del vómito, una región del sistema nervioso central que recibe impulsos de otras áreas centrales y periféricas aferentes. En los gatos, los principales mediadores de la emesis son la sustancia P, la serotonina y la noradrenalina, mientras que la histamina, la dopamina, la acetilcolina y las encefalinas cumplen un papel secundario. Teniendo en cuenta que la fisiología y la farmacología del vómito varían de acuerdo a las diferentes especies, cabe resaltar la importancia de ciertos estudios realizados en felinos. Entre los agentes inductores del vómito más estudiados en felinos están los adrenérgicos alfa-2 agonistas como dexmedetomidina y xilacina. El maropitant y el ondansetron se encuentran entre los fármacos más recientemente introducidos. La mirtazapin puede ser útil en la prevención del vómito crónico.

Manejo farmacológico do vômito em felinos revisão / Pharmacological management of vomiting in feline patients - a review / Manejo farmacológico del vómito en felinos revisión

O vômito é um reflexo protetor complexo mediado pelo centro emético, região do sistema nervoso central, que recebe impulsos provenientes de outros e a noradrenalina são os principais mediadores do vômito, tendo a histamina, a dopamina, a acetilcolina e as encefalinas um papel secundário. Em vista de variações na fisiologia do vômito e na farmacologia entre as espécies, ressalta-se a importância de estudos focados em felinos. Entre os agentes indutores do vômito, os adrenérgicos alfa-2 agonistas, de que são exemplos a dexmedetomidina e a xilazina, são os mais estudados na espécie com essa finalidade. O maropitant e a ondansetrona estão entre os fámacos antieméticos mais recentes. A mirtazapina pode ter utilidade na prevenção do vômito crônico.(AU)

Vomiting is a complex protective reflex mediated by the emetic center, a region of the central nervous system that receives impulses from other central and peripheral afferent areas. In cats, substance P, serotonin and norepinephrine are the main mediators of vomiting, with histamine, dopamine, acetylcholine, and enkephalins having a secondary role. In view of variations in the physiology of vomiting and pharmacology across species, the importance of studies focused on felines is emphasized. Among the emetic agents, alpha-2-adrenergic agonists, such as dexmedetomidine and xylazine, are the most studied in the species for this purpose. Maropitant and ondansetron are the more recent antiemetic drugs. Mirtazapine may be useful to prevent chronic vomiting.(AU)

El vómito es un reflejo protector complejo mediado por el centro del vómito, una región del sistema nervioso central que recibe impulsos de otras áreas centrales y periféricas aferentes. En los gatos, los principales mediadores de la emesis son la sustancia P, la serotonina y la noradrenalina, mientras que la histamina, la dopamina, la acetilcolina y las encefalinas cumplen un papel secundario. Teniendo en cuenta que la fisiología y la farmacología del vómito varían de acuerdo a las diferentes especies, cabe resaltar la importancia de ciertos estudios realizados en felinos. Entre los agentes inductores del vómito más estudiados en felinos están los adrenérgicos alfa-2 agonistas como dexmedetomidina y xilacina. El maropitant y el ondansetron se encuentran entre los fármacos más recientemente introducidos. La mirtazapin puede ser útil en la prevención del vómito crónico.(AU)

Use of Warning Signs for Dengue by Pediatric Health Care Staff in Brazil.

OBJECTIVE: The aim of this study was to describe the use of dengue warning signs by pediatric healthcare staff in the Brazilian public health care system. METHODS: Cross-sectional study (2012) with physicians, nurses, and nurse technicians assisting children in five health care facilities. Participants reported the use and importance of dengue warning signs in pediatrics clinical practice through a structured questionnaire. Differences in the use of signs (chi-square test) and in the ranking assigned to each of them (Kruskal-Wallis) were assessed according to health care occupation and level of care (p<0.05). RESULTS: The final sample comprised 474 participants (97%), mean age of 37 years (standard deviation = 10.3), mainly females (83.8%), physicians (40.1%) and from tertiary care (75.1%). The majority (91%) reported using warning signs for dengue in pediatrics clinical practice. The most widely used and highly valued signs were major hemorrhages (gastrointestinal, urinary), abdominal pain, and increase in hematocrit concurrent or not with rapid decrease in platelet count. Persistent vomiting as well as other signs of plasma leakage such as respiratory distress and lethargy/restlessness were not identified as having the same degree of importance, especially by nurse technicians and in primary or secondary care. DISCUSSION: Although most health care staff reported using dengue warning signs, it would be useful to extend the training for identifying easily recognizable signs of plasma leakage that occur regardless of bleeding.

Bilious Vomiting Syndrome in Dogs: Retrospective Study of 20 Cases (2002-2012).

Bilious vomiting syndrome (BVS) is a condition historically associated with early morning vomiting of bile, but it is otherwise poorly characterized. The vomiting is thought to result from a reflux of duodenal fluid into the gastric lumen causing mucosal irritation. Medical records from Colorado State University Veterinary Teaching Hospital (CSUVTH) were searched for "canine" and "bilious vomiting syndrome" between 2002 and 2012. Visual inspection confirmed a diagnosis of BVS during the case history. The diagnosis remained BVS for the duration of the dog's contact with the hospital in 17 cases. Therapy involved frequent feedings, late evening meals, gastric acid reducers, prokinetics, and gastroprotectants. Twelve dogs improved with therapy. Five dogs did not improve or were lost to follow-up. The diagnosis of BVS was supplanted in three cases with gastric adenocarcinoma, dietary indiscretion, and hepatopathy. The patient most likely given a diagnosis of BVS would be a young, mixed-breed, castrated male dog with a chronic history of vomiting bile. Response to therapy suggests abnormal gastrointestinal motility, local gastritis, gastric pH, or stimulation of the emetic center may be important factors in BVS. Dogs diagnosed with BVS rarely received a diagnostic evaluation sufficient to qualify it as a diagnosis of exclusion.

Nausea, vomiting and quality of life of patients with cancer undergoing antineoplastic treatment: an evaluation by pharmacists.

OBJECTIVE: This study aims to evaluate the frequency and severity of nausea and vomiting using two different instruments and relate them to quality of life (QOL) in patients with cancer receiving antineoplastic treatment. METHODS: Severity of chemotherapy-induced nausea and vomiting (CINV) was measured by Common Terminology Criteria for Adverse Events (CTCAE) and a numerical scale. QOL was assessed using the Functional Assessment of Cancer Therapy-General questionnaire. KEY FINDINGS: Of the 50 patients studied, 60.0% reported nausea (40.0% CTCAE grade 1; 66.7% moderate intensity on numerical scale) and 30.0% reported vomiting (46.7% CTCAE grades 1 and 2, each; 66.7% moderate intensity on numerical scale). CINV did not influence overall QOL. CONCLUSION: The frequency of CINV was high. There was no association between nausea/vomiting and overall QOL.

Náuseas y vómitos: evaluación y manejo / Nausea and vomiting: assessment and management

Vomiting is a reflex action of motor and autonomous responses, resulting in violent expulsion of gastric contents through the mouth, triggered by humoral and neural stimuli. It must be distinguished from regurgitation or gagging. Nausea, on the other hand, is a subjective uncomfortable feeling that most people have experienced and is generally described as an imminent need to vomit, felt in the epigastrium and throat. These can be symptoms of a series of pathologies, and represent a reason for frequent consultation at emergency health care units. Both acute and chronic occurrence must be assessed carefully to identify its etiological agent in order to administer proper treatment focused on the symptoms. Nausea and vomiting during pregnancy, after chemotherapy, and cyclic vomiting syndrome will be further developed. In addition, nausea and vomiting treatment in the emergency room is reviewed.

El vómito es un reflejo coordinado de respuestas motoras y autonómicas que resulta en la expulsión violenta del contenido gástrico por la boca, activado por estímulos humorales o neuronales. Debe distinguirse de regurgitación o arcadas. La náusea, por otro lado, es una sensación subjetiva desagradable que la mayoría de las personas han experimentado en algún momento de su vida y, por lo general, reconocen como una sensación de inminente vómito, en el epigastrio o garganta. Son un síntoma de una pléyade de diversas patologías, y corresponde a un motivo de consulta frecuente en servicios de urgencia. Tanto su presentación aguda, como crónica deben ser evaluadas en forma integral de modo de identificar la etiología y poder brindar un tratamiento, tanto sintomático como dirigido. Las náuseas y vómitos en el embarazo, en relación a quimioterapia, y el síndrome de vómito cíclico serán abordados en profundidad. Del mismo modo se realiza una revisión del tratamiento de náuseas y vómitos indiferenciados, en el servicio de urgencia.

Safety and retention rate of rufinamide in 300 patients: a single pediatric epilepsy center experience.

OBJECTIVE: Reports of studies evaluating rufinamide as an add-on therapy in children and adolescents with refractory epilepsy are restricted to a few publications. Prospective multicenter studies including children and adults have yielded important information about several types of epilepsies and syndromes. We evaluated the use of rufinamide in a single pediatric center with a large cohort and long-term follow-up period. METHODS: We retrospectively included patients taking rufinamide from November 2008 to March 2013. Response was defined by a seizure reduction of ≥50% compared to baseline. RESULTS: Three hundred patients with a median age of 9.1 years (range 0.4-29.6 years) were reviewed. Median follow-up was 9 months (range 1-37 months). Epilepsy etiology was classified as genetic (23.7%), structural/metabolic (41%), and unknown cause (35.3%). Overall, rufinamide treatment led to a median seizure frequency reduction of 59.2% from responders to baseline. Seizure reduction was greater in patients with genetic etiology compared to structural/metabolic (66.2% vs. 45.5% responders, p = 0.005). Rufinamide was discontinued in 110 (36.7%) of 300 patients: 63 (21%) due to unsatisfactory response, 47 (15.7%) due to side effects, and in 18 (6%) of those due to both. Most common adverse effects were sleepiness, vomiting, mood changes, nausea, and loss of appetite. Median time to loss of efficacy was 11.6 months (range 3-28 months). SIGNIFICANCE: Rufinamide provides satisfactory seizure reduction as an adjunctive treatment in refractory epilepsy. Results need to be interpreted in the setting of data acquisition, including inherent biases of retrospective studies. Patients with a known genetic etiology may have better responses than patients with structural/metabolic etiology.

Migraine equivalents in childhood.

Migraine equivalents are a group of periodic and paroxysmal neurologic diseases. Because headache is not a prominent symptom, the diagnosis might be challenging. The objective of the study was to evaluate the frequency and outcome of migraine equivalents. This was a retrospective study. We included benign paroxysmal torticollis of infancy, benign paroxysmal vertigo of infancy, abdominal migraine, cyclic vomiting, aura without migraine, and confusional migraine. We evaluated the frequency of events, treatment, and outcome. Out of 674 children with headache, 38 (5.6%) presented with migraine equivalents. Twenty-one were boys and the mean age was 6.1 years. Fifteen had abdominal migraine, 12 benign paroxysmal vertigo, 5 confusional migraine, 3 aura without migraine, 2 paroxysmal torticollis, and 1 cyclic vomiting. Prophylactic treatment was introduced in 23 patients; 4 lost follow-up and 19 had significant improvement. We conclude that the correct diagnosis of migraine equivalents enables an effective treatment with an excellent outcome.

Health-related quality of life in children and adolescents with cyclic vomiting syndrome: a comparison with published data on youth with irritable bowel syndrome and organic gastrointestinal disorders.

OBJECTIVE: To evaluate health-related quality of life (HRQoL) in children with cyclic vomiting syndrome (CVS) and to compare child self-reports with those of their parents and with published reports of children with irritable bowel syndrome (IBS), children with organic gastrointestinal disorders, and a healthy control group. STUDY DESIGN: Sixty-eight children aged 5-18 years with CVS confirmed in a gastroenterology clinic completed the Pediatric Quality of Life Inventory (PedsQL). Eighty-two parents completed the parent-proxy PedsQL for children aged 2-18 years. These results were compared with published data for children with IBS, organic gastrointestinal disorders, and a healthy control group using ANOVA. Intraclass correlation was used to evaluate concordance between child and parent reports of HRQoL. RESULTS: HRQoL reported on the PedsQL by children with CVS was lower than that reported by children with IBS (P < .01) and healthy controls (P < .001), but did not differ from that reported by children with organic gastrointestinal disorders. Children with CVS also had lower HRQoL compared with healthy controls by parent-proxy report on the PedsQL (P < .001). Correlations between HRQoL reports by parents and children were moderate to good (intraclass correlation coefficients, 0.504-0.805; P < .01). Duration of CVS episodes, delay in CVS diagnosis, and number of school days missed due to CVS were associated with lower parent-rated HRQoL (P = .01). CONCLUSION: Children with CVS reported lower HRQoL compared with those with IBS, and both parents and children reported lower HRQoL compared with healthy controls. Parent and child ratings of HRQoL converged. Improved recognition of CVS and school support might help mitigate the impact of CVS on HRQoL.

Náuseas, vómitos, diarrea, estreñimiento e hiporexia en la alimentación del niño con cáncer / Nausea, vomiting, diarrhea, constipation and decreased appetite in feeding the child with cancer

Entre las manifestaciones digestivas que se presentan en el tratamiento del niño con cáncer, bien sea por la quimioterapia, la radioterapia, los medicamentos subyacentes a estas terapias o a la misma enfermedad per sé, se encuentran las náuseas, los vómitos, la diarrea, el estreñimiento y la disminución del apetito. Todos ellos, junto con la pérdida de la actividad física y los cambios en los hábitos alimentarios, pueden conllevar a malnutrición. Es necesario así entonces realizar algunas sugerencias preventivas nutricionales y de puericultura, para evitar la morbilidad secundaria a ello.

Among the digestive symptoms that occur in the treatment of children with cancer, either gy chemotherapy, radiotherapy, drug therapy or underlying these the same disease per se, include nausea, vomiting, diarrea, constipation and the decline and loss of appetite. They, along with the loss of physycal activit and changes in eating habits, can lead to malnutrition. Need and then make some suggestions preventive nutrition and childcare, to avoid the morbidity secondary to it.

Náuseas y vómitos durante el embarazo / Nausea and vomiting during pregnancy

Se hace una revisión de la etiología, fisiopatología y factores de riesgo de las náuseas y vómitos que ocurren durante el embarazo, así como del impacto, en casos severos o persistentes, en la salud de la madre, y del feto y del recién nacido. Se revisan los tratamientos propuestos, farmacológicos unos, no farmacológicos otros, resaltando el evidente beneficio terapéutico de la combinación de piridoxina con doxilamina y la evidencia de su inocuidad, que estuvo en entredicho a principio de la década de 1980...

Vômitos de causas neurológicas na infância / Neurological causes of vomiting in childhood

O vômito, definido como a expulsão violenta e forçada do conteúdo gástrico, precedida ou não de náuseas, é uma resposta reflexa a vários estímulos coordenados pelo sistema nervoso central. Sua fisiopatologia está intrinsecamente ligada à etiologia do mesmo, a qual é dividida em neurológica e não neurológica. Entretanto, as causas neurológicas dos vômitos não devem ser negligenciadas, visto que o tempo decorrido entre o diagnóstico e o tratamento interfere no prognóstico, principalmente nos casos de tumores intracranianos. Além das neoplasias do sistema nervoso central, epilepsias, pseudotumor cerebral, metástases, hematomas cerebrais, uso de drogas como anticolinérgicos, adrenérgicos, AINEs, quimioterápicos e radioterápicos estão incluídos no grupo das causas neurológicas dos vômitos. Dessa forma, na presença de vômitos, associados ou não à cefaleia, mas sem déficits neurológicos e/ou queixas intestinais, deve-se levantar a suspeita de causas neurológicas.