Cyclic vomiting

Description:

Syndrome of cyclic vomiting (Cyclic Vomiting Syndrome – CVS) - the disease of preferential children's age which is shown the stereotypic repeated episodes of vomiting which are replaced by the periods of full wellbeing. 2,3% of Australians and 1,9% of residents of Scotland have this illness. CVS - the reason of 0,51% of all hospitalization in children's departments of India.

Symptoms of Cyclic vomiting:

Syndrome of cyclic vomiting - morbid condition at which the patient tested at least three discrete attacks of vomiting each of which was followed more than four episodes of vomiting at the height of a disease. In typical cases it is observed no more, two episodes a week. The average duration of an attack of 24-48 hours (al least 2 hours), but can last within 10 days and more. Duration of intervals when the patient is free from vomiting and is almost healthy - it is various. At inspection the obvious reason of vomiting is not established.

Reasons of Cyclic vomiting:

Passed 2 centuries after the famous pediatrician Samuel Ge in 1882 described this state, but a pathogeny of it, not such a rare disease, finally is not defined, and the clinic is not rather studied. The points of view speak on CVS as a polyetiological disease which cornerstone disturbances гипоталамо - pituitary and adrenal system are (increase in secretion corticotropin-relizingfaktora) and vegetative regulation (sympathicotonia). It is established that stressorny activation гипоталамо - pituitary and adrenal system provokes vomiting attacks. The genetic proximity of CVS and migraine does not raise doubts that is confirmed by the increased occurrence of migraine at relatives of sick CVS. At migraine and CVS similar electrophysiologic changes are noted. Ideas of CVS as the "mitochondrial disease" connected with a mutation of DNA of mitochondrions (power stations of a cell) are perspective. Similarity of hormonal changes at CVS and menstrual headaches is revealed that is confirmed by efficiency of use of estrogen for prevention of attacks of vomiting. Nevertheless, the harmonious theory of an etiopathogenesis of CVS is absent now.

Treatment of Cyclic vomiting:

The complex of medical actions begins with clarification of the prime cause that quite often demands consultation of the neuropathologist, the psychologist or the psychoneurologist.
The corresponding diet with an exception fat, smoked, hot drinks, alcohol, carbonated drinks is recommended to patients. It is necessary to sleep with the raised head end of a bed, not to wear clothes with a hard belt, to avoid physical exercises with an overstrain of muscles of a prelum abdominale.
Beginning of an attack. A phase of aura during which the victim already knows that the episode comes nearer, but it is still capable to take medicine through a mouth. This phase can last from several hours to several minutes (or to be absent absolutely). Thanks to uniformity of a debut of a disease patients in most cases feel the coming attack. This feature of CVS needs to be used for holding preventive actions. If at the beginning of an attack the abdominal pain prevails, purpose of an ibuprofen or the drugs suppressing a kislotoobrazovaniye in a stomach can be recommended (омепразол or ranitidine). Sometimes purpose of an ondasetron prevents vomiting. If the beginning of a disease is followed by a headache, antimigrenozny drug суматриптан is effective.

Criminal period. It is characterized by unrestrained nausea and vomiting that makes impossible any drink and meal and medicines. Children are slowed down, sleepy, in process of strengthening of vomiting dehydration phenomena accrue. At this time isolation from parents is undesirable as it can strengthen displays of a disease.

The accruing dehydration demands purpose of intravenous administration of liquid and electrolytes. Against the background of infusional therapy appoint ондасетрон intravenously. As the deep sleep promotes stopping of attacks of Fleicher D. (2000) recommends to appoint a combination of Chlorpromazinum and diphenhydramine intravenously to the entire period of an attack each 3-4 hours. From our point of view deep sedation of the patient is fraught with aspiration of emetic masses and has to be carried out in the conditions of chamber of an intensive care.

In the period of recovery increase in activity of the child, appetite recovery, normalization of color of integuments is noted, positive emotions are returned, the water-salt balance is gradually recovered. During this period gradual recovery of water-salt balance and careful expansion of a diet is recommended in the natural way. Cases when the child immediately upon termination of an attack was returned to a physiological diet are known, but you should not risk nevertheless.

During the mezhpristupny period children feel well and often do not even want to speak and even to think of sufferings which they took out while were sick. During this period at a heavy current of CVS one of drugs the preventing repeated attacks can be appointed: cyproheptadine, amitriptyline or пропранол. After administration of drug it is desirable that the child was isolated in the dark, quiet place and it is desirable fell asleep. It is necessary to remember that doses of these medicines have to be selected strictly individually, taking into account their efficiency at the specific patient and possible side effects. So, пропранол children should not appoint suffering from a diabetes mellitus, bronchial asthma or disturbances of AV-of conductivity.