Clin Diabetes
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Clouse, R. E.
Right arrow Articles by Lustman, P. J.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Clouse, R. E.
Right arrow Articles by Lustman, P. J.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
Clinical Diabetes 20:39-41, 2002
© American Diabetes Association ®, Inc., 2002

Case Study

Case Study: Chronic Vomiting in a Patient With Type 2 Diabetes

Ray E. Clouse, MD and Patrick J. Lustman, PhD


   Presentation
 
A.M. is a 54-year-old woman who was diagnosed as having type 2 diabetes 8 years ago. She has mild hypertension but no evidence of coronary artery disease or other complications of diabetes. She is managed with insulin and has poor control of hyperglycemia; recent HbA1c concentrations range from 10 to 12%.

One year ago, the patient began having episodic nausea and vomiting. The problem increased in frequency, and for the past 6 months some degree of nausea and vomiting has been present daily. Symptoms occur most commonly in the morning and with eating, when early satiety, bloating, and fullness also are present. Metabolic regulation has worsened, although her weight has remained stable.

Physical examination was normal with the exception of mild obesity. Investigation with endoscopy, hepatobiliary ultrasound, abdominal CT scan, and routine laboratory was unrevealing. A solid-phase gastric emptying study showed mild delay with abnormal radionuclide retention at 2 h. Metoclopramide was transiently effective, and erythromycin produced no benefits.


   Questions
 

  1. Does A.M. have gastroparesis?
  2. Would a more detailed neuropsychiatric evaluation be helpful?
  3. What additional management options could be tried?


   Commentary
 
Chronic nausea and vomiting are particularly detrimental for diabetic patients. The symptoms not only are stressful and uncomfortable, but also interfere with daily functioning and promote deterioration of metabolic control. Vomiting is a source of high hospitalization costs and health care utilization by diabetic patients.

Does A.M. have gastroparesis?
Gastroparesis is defined by the presence of delayed gastric emptying without mechanical obstruction. The abnormality can be demonstrated by retained food on imaging studies or endoscopy following an overnight fast . . . [Full Text of this Article]

Would a more detailed neuropsychiatric evaluation be helpful?
What additional management options could be tried?

   Clinical Pearls
 

   Footnotes
 

   SUGGESTED READINGS
 

Add to CiteULike CiteULike   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Diabetes Diabetes Care Clinical Diabetes Diabetes Spectrum
Copyright © 2002 by the American Diabetes Association.