Zur Therapie des rekurrierenden ketonämischen Erbrechens

Zusammenfassung

Bei dem Krankheitsbild des ketonämischen Erbrechens liegt die Störung des Stoffwechsels mit größter Wahrscheinlichkeit an der Eingangsstelle zum Zitronensäure-Zyklus. Neben der Beruhigung der Kinder durch Luminal oder Megaphen ist Zucker- und Berolasezufuhr, gegebenenfalls noch Cortison, erforderlich. Zum Ausgleich der erheblichen Elektrolytverschiebungen müssen oral oder rektal Kaliumsalze gegeben werden. Unter dieser Therapie klingt das Krankheitsbild überraschend schnell ab.

Summary

It is believed that disturbances in the autonomic nervous system regulation of metabolism are the ultimate cause of ketonaemic vomiting. The chemical derangement occurs at the point where protein, fat and carbohydrate enter a common chemical pathway, most likely the citric acid cycle. As a result, water, chloride and potassium loss occurs, which requires immediate counter-measures. The first step in treatment is to combat hyperexcitability with barbiturates. Secondly, chemical equilibrium must be restored. Sugar, given in fruit juice, often suffices in light cases. To this is added 5 drops of HCl for each 100 cc of fluid given, to make up for the chloride loss. If vomiting has persisted for some time and dehydration is prominent, fluids (half Ringer's, half 10% glucose, with 1 Gm of HCl added to each 1000 cc) must be administered rectally or parenterally. To aid the metabolising of glucose and decrease the production of ketone bodies, 50 mg. of co-carboxylase are added to the fluid. These measures usually stop vomiting dramatically, within minutes or at most 2 hours. The addition of 10—20 mg. of cortisone is occasionally practised to oppose hypoglycaemia. Thirdly, to maintain or establish potassium balance, potassium phosphate is given (2—3 Gm. daily) orally or by gastric drip in fluids.

Resumen

Sobre el tratamiento de los vómitos cetonémicos recidivantes

En el cuadro clínico de los vómitos cetonémicos se encuentra el trastorno del metabolismo, con la mayor probabilidad, al comienzo del ciclo del ácido cítrico. Aparte de calmar a los niños con luminal y megaphen, es indispensable suministrar azúcar y berolasa y, caso necesario, también cortisona. Para la compensación de las importantes desviaciones electrolíticas tienen que darse sales potásicas por vía oral o rectal. Bajo este tratamiento disminuye la sintomatología con rapidez.