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Clinical Diabetes 22:139-140, 2004
© American Diabetes Association ®, Inc., 2004

Case Study

Case Study: Atropine Ophthalmic Administration Unmasking Undiagnosed Diabetic Gastroparesis

Roger Kenneth Eagan, MD and Pninit Varol, MD

The first 20% of the full text of this article appears below.


   Presentation
 
R.R. is a 62-year-old white man with glaucoma and long-standing type 2 diabetes complicated by peripheral neuropathy and retinopathy. He presented to the emergency room with persistent nausea and vomiting. The patient was admitted with presumed symptomatic glaucoma. Three months earlier, he had undergone pars plana vitrectomy surgery for a vitreal hemorrhage secondary to a diabetic tractional retinal detachment. The patient had developed subsequent neovascular glaucoma and had been instructed to use his ophthalmic medications to control symptoms.

Several weeks before his emergency room visit, he began to experience left eye pain. The patient was seen by his ophthalmologist, who diagnosed increasing intraocular pressure (IOP). The ophthalmologist intensified his regimen and encouraged the patient to carefully follow the provided regimen. Soon after, R.R. began to suffer from progressive nausea and vomiting.

At the time of presentation, the patient had been unable to keep solids or liquids down for several days. He was admitted and treated with intravenous fluids and promethazine, then discharged after 24 hours with arrangements for surgery the following week. The following day, he returned with ongoing intractable nausea and vomiting with opthalmalgia. He underwent a successful shunt placement to relieve his IOP, which relieved his opthalmalgia. However, he continued to have severe nausea . . . [Full Text of this Article]


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Copyright © 2004 by the American Diabetes Association.