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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44; </span></p><p class="elsevierStylePara">Cyclic vomiting syndrome &#40;CVS&#41; is a functional gastrointestinal disorder characterised by episodes of severe&#44; unpredictable&#44; and explosive vomiting&#44; separated by intervals of perfect health&#46;<span class="elsevierStyleSup">1</span> The start of these symptoms can occur in infancy&#44; and it normally appears between the ages of three and seven years&#44; although cases have been described when symptoms commence in adulthood&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">The aetiology and pathogenesis of this condition are still unknown&#44; although the hypothesis has been put forward of a disorder of the cerebro-intestinal communication&#44; which is activated by certain stimuli &#40;stress&#44; infection&#44; some foods&#41;&#46;<span class="elsevierStyleSup">3</span> The most common duration of an episode can be one to four days&#44; and may last as long as 14 days&#46; During each episode&#44; vomiting occurs as frequently as every 10 to 15 minutes&#44; and can occur anywhere from several times a year to several times per month&#44; with a regular recurrence rate&#46;</p><p class="elsevierStylePara">The symptoms include vomiting preceded by forceful gagging and abdominal muscular contractions&#44; accompanied by uncontrollable nausea and extreme fatigue&#46; Patients suffer a sort of &#8220;conscious coma&#8221; during each episode&#44; and describe themselves as being in a state of stupor until the episode passes&#46;<span class="elsevierStyleSup">4</span> Among the most common complications are dehydration&#44; electrolyte disorders&#44; improper secretion of anti-diuretic hormone &#40;ADH&#41;&#44; and oesophagitis&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">The optimal treatment for this condition consists of establishing prophylaxis with anti-migraine medications such as amitriptyline along with propranolol&#46; In the prodromal phase&#44; we must attempt to abort the episode using ketorolac or sumatriptan&#46; In the acute phase&#44; ondansetron or lorazepam are used&#44; with chlorpromazine&#44; promethazine&#44; or intravenous morphine as the possible alternatives&#46;<span class="elsevierStyleSup">4</span> The patient occasionally must be sedated in order to assuage the unstoppable vomiting&#46;</p><p class="elsevierStylePara">Here we present the case report of a 31-year old&#160; male who has suffered from crises of nausea&#44; uncontrollable vomiting&#44; and abdominal distress associated with prodromal nervousness since infancy &#40;three-five years old&#41;&#44; frequently related to triggering factors such as emotional stress and infections&#46; The patient later had symptom-free periods with variable frequency&#46; He was diagnosed with periodical functional syndrome with uncontrollable vomiting and erosive oesophagitis at the age of 14 years&#44; which persisted in spite of treatment with chlorpromazine&#46; After being examined by several different specialists&#44; the patient was diagnosed three years ago with CVS&#46; The patient takes a prophylactic dose of 20mg propranolol &#40;half at breakfast&#44; half at dinner&#41; and 75mg amitriptyline &#40;half tablet at dinner&#41;&#44; abortive therapy consists of microenemas with diazepam&#44; and during acute crises he takes ondansetron at 4mg every 8 hours&#44; one vial of lorazepam every 8 hours&#44; and one vial of chlorpromazine intravenously every six-eight hours or promethazine at 50mg every six-eight hours&#44; in the hospital&#46;</p><p class="elsevierStylePara">Since one year ago the patient has required three hospitalisations due to complicated crises with hydroelectric imbalance and acute renal failure&#46; The last episode caused intense dehydration with prerenal acute renal failure&#44; with creatinine of 2&#46;2mg&#47;dl&#44; K at 2&#46;9mEq&#47;l&#44; metabolic alkalosis&#44; and a urinary infection that may have triggered the episode&#46; We started the patient on aggressive hydration therapy and antibiotics&#44; and had to sedate him with chlorpromazine at half a vial every eight hours and ondansetron at 4mg every eight hours for two days in order to prevent the uncontrollable vomiting and worsening of the dehydrated state&#46; During his stay in the hospital&#44; the patient&#8217;s hydroelectric imbalance was corrected&#44; along with creatinine levels that reached 1&#46;1mg&#47;dl upon discharge&#46;</p><p class="elsevierStylePara">Here we have discussed the case of prerenal acute renal failure secondary to dehydration&#44; a very common pathology in our daily practice&#44; but that was caused by CVS&#44; a very uncommon and rarely seen phenomenon amongst adult nephrologists&#46; This review&#44; illustrated by our case report&#44; serves to show how to effectively approach the treatment of a patient with this syndrome&#46; We must highlight that the treatment of these patients does not only consist of rehydration&#44; but also abortive therapy for vomiting crises with sedation in order to avoid the perpetuation of acute renal failure&#46;<span class="elsevierStyleSup">5&#44;6</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p>"
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Acute renal failure secondary to cyclic vomiting syndrome
Fracaso renal agudo secundario a síndrome de vómitos cíclico
M.J.. Izquierdo Ortiza, V.. Mercado Valdiviab, P.. Abaigar Luquina
a Sección de Nefrología, Complejo Asistencial Universitario de Burgos,
b Sección de Nefrología, Complejo Asistencial Universitario de Burgos
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44; </span></p><p class="elsevierStylePara">Cyclic vomiting syndrome &#40;CVS&#41; is a functional gastrointestinal disorder characterised by episodes of severe&#44; unpredictable&#44; and explosive vomiting&#44; separated by intervals of perfect health&#46;<span class="elsevierStyleSup">1</span> The start of these symptoms can occur in infancy&#44; and it normally appears between the ages of three and seven years&#44; although cases have been described when symptoms commence in adulthood&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">The aetiology and pathogenesis of this condition are still unknown&#44; although the hypothesis has been put forward of a disorder of the cerebro-intestinal communication&#44; which is activated by certain stimuli &#40;stress&#44; infection&#44; some foods&#41;&#46;<span class="elsevierStyleSup">3</span> The most common duration of an episode can be one to four days&#44; and may last as long as 14 days&#46; During each episode&#44; vomiting occurs as frequently as every 10 to 15 minutes&#44; and can occur anywhere from several times a year to several times per month&#44; with a regular recurrence rate&#46;</p><p class="elsevierStylePara">The symptoms include vomiting preceded by forceful gagging and abdominal muscular contractions&#44; accompanied by uncontrollable nausea and extreme fatigue&#46; Patients suffer a sort of &#8220;conscious coma&#8221; during each episode&#44; and describe themselves as being in a state of stupor until the episode passes&#46;<span class="elsevierStyleSup">4</span> Among the most common complications are dehydration&#44; electrolyte disorders&#44; improper secretion of anti-diuretic hormone &#40;ADH&#41;&#44; and oesophagitis&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">The optimal treatment for this condition consists of establishing prophylaxis with anti-migraine medications such as amitriptyline along with propranolol&#46; In the prodromal phase&#44; we must attempt to abort the episode using ketorolac or sumatriptan&#46; In the acute phase&#44; ondansetron or lorazepam are used&#44; with chlorpromazine&#44; promethazine&#44; or intravenous morphine as the possible alternatives&#46;<span class="elsevierStyleSup">4</span> The patient occasionally must be sedated in order to assuage the unstoppable vomiting&#46;</p><p class="elsevierStylePara">Here we present the case report of a 31-year old&#160; male who has suffered from crises of nausea&#44; uncontrollable vomiting&#44; and abdominal distress associated with prodromal nervousness since infancy &#40;three-five years old&#41;&#44; frequently related to triggering factors such as emotional stress and infections&#46; The patient later had symptom-free periods with variable frequency&#46; He was diagnosed with periodical functional syndrome with uncontrollable vomiting and erosive oesophagitis at the age of 14 years&#44; which persisted in spite of treatment with chlorpromazine&#46; After being examined by several different specialists&#44; the patient was diagnosed three years ago with CVS&#46; The patient takes a prophylactic dose of 20mg propranolol &#40;half at breakfast&#44; half at dinner&#41; and 75mg amitriptyline &#40;half tablet at dinner&#41;&#44; abortive therapy consists of microenemas with diazepam&#44; and during acute crises he takes ondansetron at 4mg every 8 hours&#44; one vial of lorazepam every 8 hours&#44; and one vial of chlorpromazine intravenously every six-eight hours or promethazine at 50mg every six-eight hours&#44; in the hospital&#46;</p><p class="elsevierStylePara">Since one year ago the patient has required three hospitalisations due to complicated crises with hydroelectric imbalance and acute renal failure&#46; The last episode caused intense dehydration with prerenal acute renal failure&#44; with creatinine of 2&#46;2mg&#47;dl&#44; K at 2&#46;9mEq&#47;l&#44; metabolic alkalosis&#44; and a urinary infection that may have triggered the episode&#46; We started the patient on aggressive hydration therapy and antibiotics&#44; and had to sedate him with chlorpromazine at half a vial every eight hours and ondansetron at 4mg every eight hours for two days in order to prevent the uncontrollable vomiting and worsening of the dehydrated state&#46; During his stay in the hospital&#44; the patient&#8217;s hydroelectric imbalance was corrected&#44; along with creatinine levels that reached 1&#46;1mg&#47;dl upon discharge&#46;</p><p class="elsevierStylePara">Here we have discussed the case of prerenal acute renal failure secondary to dehydration&#44; a very common pathology in our daily practice&#44; but that was caused by CVS&#44; a very uncommon and rarely seen phenomenon amongst adult nephrologists&#46; This review&#44; illustrated by our case report&#44; serves to show how to effectively approach the treatment of a patient with this syndrome&#46; We must highlight that the treatment of these patients does not only consist of rehydration&#44; but also abortive therapy for vomiting crises with sedation in order to avoid the perpetuation of acute renal failure&#46;<span class="elsevierStyleSup">5&#44;6</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p>"
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Article information
ISSN: 20132514
Original language: English
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Idiomas
Nefrología (English Edition)