1/4. A severe case of ovarian hyperstimulation syndrome with liver dysfunction and malnutrition.ovarian hyperstimulation syndrome (OHSS) is a potentially fatal condition associated with the use of ovulation-inducing drugs. We describe a 28-year-old woman who presented with ascites, oliguria and vomiting. Over 2 weeks, the combination of intractable vomiting, intravenous rehydration, paracentesis, hypercatabolism and proteinuria led to severe hypoalbuminaemia with gross oedema and progressively worsening liver function. The patient's albumin dropped to 9 g/l with liver function abnormalities peaking at: alanine aminotransferase, 462 IU/l; alkaline phosphatase, 706 IU/l; bilirubin, 26 micromol/l; and prothrombin time, 19 s. The judicious use of paracentesis and commencement of total parenteral nutrition coincided with a rapid clinical improvement. One month after discharge, the patient was asymptomatic with normal liver function. This case demonstrates the severity of malnutrition and liver dysfunction that can occur with severe OHSS. Increasing use of in-vitro fertilization techniques makes it mandatory for clinicians to be aware of the clinical features, complications and treatment of this condition, and we would suggest that patients with severe OHSS should be jointly managed by physicians and obstetricians.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
2/4. behavior modification in the treatment of rumination.Rumination is repeated regurgitation without nausea or associated gastrointestinal illness with concomitant weight loss and malnutrition. This paper describes a ruminating infant who was becoming severely malnourished. Hyperalimentation was used to provide necessary nutrition, and a paradigm of aversive behavior modification was instituted. This form of therapy was successful after less than four weeks, with no harmful side effects and no recurrence of the disorder.- - - - - - - - - - ranking = 0.2keywords = malnutrition (Clic here for more details about this article) |
3/4. Hypocaloric oral therapy during an episode of diarrhea and vomiting can lead to severe malnutrition.BACKGROUND: malnutrition associated with diarrhea and vomiting can be prevented if the focus of treatment is on nutritional requirements. Some pediatricians inappropriately continue to recommend clear liquids followed by dilute feedings or hypocaloric diets until the diarrhea clears. methods: medical records were retrospectively reviewed, and the literature was reviewed. RESULTS: Severe malnutrition occurred in two children with diarrhea and vomiting who were treated with clear liquids followed by restricted nutrient intake. CONCLUSION: Severe malnutrition associated with diarrhea and vomiting can occur when the prescribed treatment is bowel rest followed by hypocaloric diets until diarrhea clears. malnutrition can be prevented if the focus of treatment is on nutritional requirements. Current American Academy of pediatrics recommendations for treatment of diarrhea and vomiting are discussed.- - - - - - - - - - ranking = 1.2keywords = malnutrition (Clic here for more details about this article) |
4/4. starvation injury after gastric reduction for obesity.Gastric reduction operations are designed to control body weight by establishing a small, meal-size juxtaesophageal, gastric pouch that empties into the jejunum (gastric bypass) or the larger portion of the stomach (gastroplasty). If the outlet of the pouch is too small, a patient may be limited to ingesting clear liquids. vomiting then occurs if heavier liquids or normal foods are taken. An occasional patient has difficulty eating properly and vomits even though the pouch volume and outlet are of optimum size. For a patient who reports vomiting, a distinction must be made between episodic improper eating and uncontrolled starvation. Three types of starvation injury are described: (1) sudden death from protein malnutrition; (2) refeeding syndrome; and (3) Wernicke-korsakoff syndrome. The mechanisms of the development, manifestations, prevention, and treatment of these complications are explained. Surgeons who treat severe obesity should be aware of these complications and be prepared to manage patients who have uncontrolled vomiting so that such complications either do not develop or are recognized and treated as early as possible before serious and irreversible injury occurs.- - - - - - - - - - ranking = 0.2keywords = malnutrition (Clic here for more details about this article) |