pituitrin and Vomiting

The functional characteristics of osmoregulated vasopressin secretion can be defined in terms of an osmotic threshold for its release and a sensitivity of the osmoreceptor and vasopressin-secreting unit. Osmotically stimulated thirst has features similar to osmoregulated vasopressin. There are wide individual variations in the functional characteristics of both thirst and vasopressin release in healthy humans, probably genetic in origin. The influence of aging appears to enhance the sensitivity of vasopressin secretion but blunt thirst appreciation. Yet in many physiological situations changes in osmoregulated vasopressin release and thirst occur in parallel. The fall in plasma osmolality associated with human pregnancy is accounted for entirely by a lowering of the osmotic thresholds for thirst and vasopressin release. Similar but less marked alterations accompany the ovulatory luteal phase of the menstrual cycle. A major nonosmotic stimulus to vasopressin secretion is hypotension and/or hypovolemia, mediated by high- (carotid sinus) and low- (left atrial) pressure receptors. Circulating catecholamines influence the release of vasopressin by alpha- and beta-adrenergic pathways. Drinking by hypertonic humans provides immediate reduction in thirst and vasopressin secretion probably mediated by pathways from the oropharynx. The modest but variable rise in plasma vasopressin in response to hypoglycemia appears to be due to cellular neuroglycopenia and is independent of parasympathetic pathways. Although osmotic and hemodynamic stimuli to vasopressin release do not act independently of each other, the precise subtle interactions between them and other nonosmotic stimuli remain to be clarified.

Topics: Drinking; Humans; Hypoglycemia; Nausea; Pressoreceptors; Thirst; Vasopressins; Vomiting; Water-Electrolyte Balance

Topics: Arginine Vasopressin; Blood Pressure; Blood Volume; Carbamazepine; Chlorpropamide; Chromatography, Gel; Diabetes Insipidus; Diuresis; Humans; Osmolar Concentration; Radioimmunoassay; Stress, Physiological; Stress, Psychological; Vasopressins; Vomiting; Water-Electrolyte Balance

The mechanism of the antiemetic actions of corticosteroids is not known. The purpose of this study was to evaluate if betamethasone can prevent nausea, vomiting or increase of vasopressin induced by apomorphine. Metoclopramide, a dopamine antagonist, was used as a control substance.. Ten healthy volunteers were studied on three occasions. In a randomized order they were allocated to receive pretreatment with betamethasone 8 mg iv, metoclopramide 10 mg iv, and normal saline 2 mL as placebo on the three different occasions, 15 min before the administration of apomorphine 30 microg x kg(-1) s.c.. After administration of apomorphine, episodes of vomiting were recorded, and the intensity of nausea was estimated by the subject on a visual analogue scale (VAS 0-10 cm). Blood samples for analysis of plasma concentrations of vasopressin were analyzed.. One volunteer decided to withdraw, as he experienced akathisia after receiving metoclopramide. During the first two hours after apomorphine, eight of nine volunteers vomited both after betamethasone and placebo. One volunteer did not vomit after betamethasone and placebo but he experienced nausea. None of the volunteers vomited after metoclopramide (P < 0.01 vs betamethasone and placebo). The maximum VAS for nausea was significantly higher after betamethasone and placebo compared to metoclopramide (P < 0.01). The vasopressin levels increased after betamethasone and placebo, but there was no increase in any volunteer after pretreatment with metoclopramide.. This study demonstrates that betamethasone does not prevent nausea, vomiting and increase of vasopressin induced by apomorphine, whereas metoclopramide prevents apomorphine-induced emesis. Our work suggests that betamethasone does not have dopamine-antagonistic effects.

Topics: Adult; Apomorphine; Betamethasone; Dopamine Agonists; Dopamine Antagonists; Female; Glucocorticoids; Humans; Male; Metoclopramide; Nausea; Pain Measurement; Reference Values; Severity of Illness Index; Time Factors; Treatment Outcome; Vasopressins; Vomiting

The aim of this study was to compare micropuncture laparoscopic cholecystectomy (MPLC), with three 3.3-mm cannulas and one 10-mm cannula with conventional laparoscopic cholecystectomy (CLC).. Patients were randomized to undergo either CLC or MPLC. The duration of each operative stage and the procedure were recorded. Interleukin-6 (IL-6), adrenocorticotropic hormone (ACTH), and vasopressin were sampled for 24 h. Visual analogue pain scores (VAPS) and analgesic consumption were recorded for 1 week. Pulmonary function and quality of life (EQ-5D) were monitored for 4 weeks. Statistical analysis was performed using the Mann-Whitney test or Fisher's exact test. Results are expressed as median (interquartile range).. Forty-four patients entered the study, but four were excluded due to unsuspected choledocholithiasis (n = 3) or the need to reschedule surgery (n = 1). The groups were comparable in terms of age, duration of symptoms, and indications for surgery. Total operative time was similar (CLC, 63 [52-81] min vs MPLC 74 [58-95] min; p = 0.126). However, time to place the cannulas after skin incision (CLC, 5:42 [3:45-6:37] min vs MPLC, 7:38 [5:57-10:15] min; p = 0.015) and to clip the cystic duct after cholangiography (CLC, 1:05 [0:40-1:35] min vs MPLC, 3:45 [2:26-7:49] min; p <0.001) were significantly longer for MPLC. Six CLC patients and one MPLC patient required postoperative parenteral opiates (p = 0.04). Oral analgesic consumption was similar in both groups (p = 0.217). Median VAPS were lower at all time points for MPLC, but this finding was not significant (p = 0.431). There were no significant differences in postoperative stay, IL-6, ACTH or vasopressin responses, pulmonary function, or EQ-5D scores.. The thinner instruments did not significantly increase the total duration of the procedure. MPLC reduced the use of parenteral analgesia postoperatively, which may prove beneficial for day case patients, but it did not have a significant impact on laboratory variables, lung function or quality of life.

Topics: Adrenocorticotropic Hormone; Adult; Analgesia; Cholecystectomy; Cholecystectomy, Laparoscopic; Gallbladder; Humans; Interleukin-6; Middle Aged; Nausea; Pain Measurement; Postoperative Complications; Punctures; Quality of Life; Respiratory Function Tests; Stress, Physiological; Vasopressins; Vomiting

Vasopressin's role in the sensation of nausea is incompletely understood. In this study, our goals were to investigate whether high intravenous vasopressin levels in normal subjects would induce nausea and vomiting and to determine the electrogastrographic (EGG) pattern which would develop at these concentrations.. EGG recordings were made on five fasting healthy subjects (three females, mean age: 27 years). Vasopressin was infused (0.15 or 0.3 U kg-1 h-1) for 1 h after a 30-min baseline recording. Serum vasopressin levels were measured every 15 min. Symptoms of nausea, cramping, retching, vomiting and bloating were graded from 0 to 5 (0 = none, 5 = most severe). Normal saline at the same rate was then infused for 1 h, with recording of symptoms and measuring blood levels of vasopressin as done previously.. EGG data showed a 43% reduction in the percentage of normal slow waves (96-53%) at a vasopressin rate of 0.3 U kg-1 h-1. A 29% reduction (88-59%) occurred at 0.15 U kg-1 h-1. The EGG dominant frequency decreased by 0.8 cpm (3.07-2.25) for the high dose, while only 0.2 cpm reduction (2.9-2.7) occurred at the lower dose. Bradygastria (< 2.4 cpm) rather than tachygastria (> 3.7 cpm) was the predominant abnormality with the high dose. Symptoms of nausea correlated with the infusion of vasopressin and significantly increased with the higher dose.. (i) At supraphysiological vasopressin levels, nausea was present in 80% of subjects but there was no retching or vomiting, (ii) bradygastria was the predominant dysrhythmia at these high vasopressin concentrations, (iii) increasing vasopressin levels correlated symptomatically with increases in nausea.

Topics: Adult; Electrophysiology; Female; Humans; Male; Stomach; Vasopressins; Vomiting

Cyclic vomiting syndrome is characterized by recurrent vomiting that is associated with increased adrenocorticotropic hormone and antidiuretic hormone levels during cyclic vomiting syndrome attacks. However, both prognosis and treatment remain unclear. We therefore evaluated the clinical features, prognosis, and effectiveness of the prophylaxis of cyclic vomiting syndrome as well as the relationship between symptoms and adrenocorticotropic hormone/antidiuretic hormone levels.. We included 31 patients with cyclic vomiting syndrome who were admitted to Teikyo University between 1996 and 2008. All patients were diagnosed with cyclic vomiting syndrome based on the criteria of the second edition of the International Headache Classification. The patients (25 of 31) were followed until 2013.. The median overall duration of the disorder was 66 (3-179) months. Follow-up was completed for 25 patients with cyclic vomiting syndrome, of whom 44% (n = 11) developed migraine. Valproic acid, valproic acid with phenobarbital, phenobarbital, and amitriptyline were effective in nine, four, three, and one patients, respectively. Abnormally high adrenocorticotropic hormone (n = 17) and antidiuretic hormone (n = 18) levels were found among the 25 patients for whom follow-up data were available. The following correlations were significant: attack duration and adrenocorticotropic hormone levels (correlation coefficient: 0.5153, P = 0.0084) and attack duration and antidiuretic hormone levels (correlation coefficient: 0.5666, P = 0.0031). Antidiuretic hormone levels in patients with bilious vomiting were higher than in those without bilious vomiting (P = 0.048).. Most patients with cyclic vomiting syndrome recovered completely and benefited from prophylactic therapy, although half of them developed migraines.

Topics: Adolescent; Adrenocorticotropic Hormone; Anticonvulsants; Child; Child, Preschool; Female; Humans; Infant; Longitudinal Studies; Male; Migraine Disorders; Retrospective Studies; Vasopressins; Vomiting

Diabetes insipidus (DI) is a rare clinical condition, which is usually caused by neurohypophyseal or pituitary stalk infiltration in cancer patients.. we present a 62-year old metastatic breast cancer woman with DI. She admitted to the hospital because of nausea, vomiting, polyuria and polydipsia, while she was on no cytotoxic medication. She had no electrolyte imbalance except mild hypernatremia. The CT scan of the brain yielded a suspicious area in pituitary gland. A pituitary stalk metastasis was found on magnetic resonance imaging (MRI) of pituitary. Water deprivation test was compatible with DI. A clinical response to nasal vasopressin was achieved.. Cancer patients who have symptoms such as nausea, vomiting, polyuria and polydipsia while they are not on chemotherapy should be evaluated for not only metabolic complications like hypercalcemia but also posterior pituitary or stalk metastasis MRI could be the choice of imaging for pituitary metastasis.

Topics: Administration, Intranasal; Breast Neoplasms; Diabetes Insipidus; Female; Humans; Magnetic Resonance Imaging; Nausea; Pituitary Neoplasms; Polyuria; Thirst; Vasopressins; Vomiting

Topics: Aquaporins; Brain Edema; Burns; Diarrhea; Fluid Therapy; Humans; Hypotonic Solutions; Inappropriate ADH Syndrome; Isotonic Solutions; Kidney; Neurons; Transcription Factors; Vasopressins; Vomiting; Water-Electrolyte Balance

Gastric electrical stimulation (GES) is known to improve vomiting with short pulses, normalize dysrhythmia with long pulses, and accelerate gastric emptying with 2 channels. The aim of this study was to assess the effects of a new method GES, namely, 2-channel GES with dual pulses on gastric emptying of solids as well as gastric dysrhythmia and emetic responses.. Seven beagle dogs implanted with 4 pairs of electrodes were studied. A novel method of GES was proposed: 2-channel dual-pulse GES in which each stimulus was composed of a short pulse followed with a long pulse, and stimulation was delivered at 2 different locations. The study was performed to test the effects of this new method of GES on vasopressin-induced delayed gastric emptying of solids, gastric dysrhythmia, and emetic responses.. (1) Vasopressin-induced gastric dysrhythmia and emetic responses, as well as delayed gastric emptying of solids (P < .01). (2) Two-channel, but not 1-channel, dual-pulse GES was able to accelerate vasopressin-induced delayed gastric emptying of solids. (3) Both 1- and 2-channel dual-pulse GES was capable of improving dysrhythmia and emetic responses (P < .01).. The novel method of 2-channel dual-pulse GES is capable of accelerating gastric emptying of solids and improving dysrhythmia and emetic responses induced by vasopressin. This new method of GES may have a potential for gastroparesis.

Topics: Animals; Dogs; Electric Stimulation; Female; Gastric Emptying; Motion Sickness; Myoelectric Complex, Migrating; Periodicity; Stomach; Time Factors; Vasopressins; Vomiting

The aims of this study were to investigate the effects and mechanisms of a novel method of gastric electrical stimulation on the prevention of vasopressin-induced emetic response and gastric dysrhythmias.. Fifteen dogs (10 normal, 5 vagotomized) chronically implanted with gastric serosal electrodes were used in a 3-session study (vasopressin, vasopressin plus 2-channel stimulation [DCS], and vasopressin plus dual-pulse stimulation [DPS]).. Vasopressin induced gastric dysrhythmias and motion sickness-like symptoms (P < .05) and these effects were blocked partially with vagotomy. Both methods of DCS and DPS were capable of preventing vasopressin-induced gastric dysrhythmias (P < .05) and motion sickness-like symptoms (P < .05). The antiemetic effects of the proposed methods of DCS and DPS were abolished by vagotomy but their antidysrhythmic effects were not blocked by vagotomy.. DCS and DPS are able to reduce vasopressin-induced gastric dysrhythmia and symptoms of nausea and vomiting. The vagal pathway is involved in the antiemetic effect but not the antidysrhythmic effect of the proposed methods of stimulation.

Topics: Animals; Dogs; Electric Stimulation Therapy; Female; Nausea; Stomach; Stomach Diseases; Vagotomy; Vasopressins; Vomiting

The aim of this study was to determine the most effective and efficient anti-emetic parameters of short-pulse gastric electrical stimulation (GES) in dogs. Seven female beagle dogs implanted with four pairs of gastric electrodes were studied in eight randomized sessions (saline, vasopressin, and six GES sessions with different parameters). Each session consisted of four 20-min recordings of gastric slow waves and symptoms. In sessions 1 and 2, saline and vasopressin, respectively, were infused during the second 20-min period. The protocol of the other six sessions was the same as session 2 except that GES was continuously applied. It was found that: (1) vasopressin induced gastric dysrhythmia and emetic response (P < 0.01, anova); (2) short-pulse GES with a frequency of 14 or 40 Hz and pulse width of 0.1 or 0.3 ms, but not 0.6 ms was able to reduce symptoms induced by vasopressin; (3) short-pulse GES with a pulse width of 0.3 ms was the most effective in preventing vasopressin-induced symptoms; (4) none of the tested GES methods improved vasopressin-induced gastric dysrhythmia. We conclude that vasopressin induces gastric dysrhythmia and symptoms. Short-pulse GES with a pulse width of 0.3 ms and frequency of 14 Hz is most effective and efficient in preventing vasopressin-induced emetic responses in dogs.

Topics: Animals; Dogs; Electric Stimulation; Electrodes, Implanted; Female; Gastrointestinal Motility; Myoelectric Complex, Migrating; Stomach; Vasoconstrictor Agents; Vasopressins; Vomiting

Although acupuncture has a significant clinical benefit, the mechanism of acupuncture remains unclear. Vasopressin, a posterior pituitary hormone, is involved in nausea and vomiting in humans and dogs. To investigate the antiemetic effects of acupuncture on vasopressin-induced emesis, gastroduodenal motor activity and the frequency of retching and vomiting were simultaneously recorded in conscious dogs. In seven dogs, four force transducers were implanted on the serosal surfaces of the gastric body, antrum, pylorus, and duodenum. Gastroduodenal motility was continuously monitored throughout the experiment. Vasopressin was intravenously infused at a dose of 0.1 U x kg(-1) x min(-1) for 20 min. Electroacupuncture (EA, 1-30 Hz) at pericardium-6 (PC6), bladder-21 (BL21), or stomach-36 (ST36) was performed before, during, and after the vasopressin infusion. To investigate whether the opioid pathway is involved in EA-induced antiemetic effects, naloxone (a central and peripheral opioid receptor antagonist) or naloxone methiodide (a peripheral opioid receptor antagonist) was administered before, during, and after EA and vasopressin infusion. Intravenous infusion of vasopressin induced retching and vomiting in all dogs tested. Retrograde peristaltic contractions occurred before the onset of retching and vomiting. EA (10 Hz) at PC6 significantly reduced the number of episodes of retching and vomiting. EA at PC6 also suppressed retrograde peristaltic contractions. In contrast, EA at BL21 or ST36 had no antiemetic effects. The antiemetic effect of EA was abolished by pretreatment with naloxone but not naloxone methiodide. It is suggested that the antiemetic effect of acupuncture is mediated via the central opioid pathway.

Topics: Acupuncture Points; Animals; Central Nervous System; Dogs; Electroacupuncture; Female; Gastrointestinal Motility; Male; Naloxone; Narcotic Antagonists; Quaternary Ammonium Compounds; Receptors, Opioid; Vagus Nerve; Vasopressins; Vomiting

The aim of this study was to investigate the acute effects of 3 different methods of electrical stimulation in the prevention of vasopressin-induced emetic response and gastric dysrhythmias.. Seven female hound dogs chronically implanted with 4 pairs of electrodes on gastric serosa were used in a 5-session study. Saline and vasopressin were infused in sessions 1 and 2, respectively. In the other 3 sessions with vasopressin infusion, 3 different methods of electrical stimulation (short-pulse stimulation, long-pulse stimulation, and electroacupuncture) were applied. Gastric slow waves and vomiting and behaviors suggestive of nausea were recorded in each session. In a separate study, additional experiments were performed in 5 vagotomized dogs to investigate vagally mediated mechanisms.. Vasopressin induced gastric dysrhythmias, uncoupling of slow waves, and vomiting and behaviors suggestive of nausea (P < 0.02, analysis of variance). Long-pulse stimulation, but not short-pulse stimulation or electroacupuncture, was capable of preventing vasopressin-induced gastric dysrhythmias and gastric slow wave uncoupling. Short-pulse stimulation and electroacupuncture, but not long-pulse stimulation, prevented vomiting and significantly reduced the symptom scores, which was not noted in the dogs with truncal vagotomy.. Long-pulse stimulation normalizes vasopressin-induced slow wave abnormalities with no improvement in vomiting and behaviors suggestive of nausea. Short-pulse stimulation and electroacupuncture prevent vomiting and behaviors suggestive of nausea induced by vasopressin but have no effects on slow waves, and their effects are vagally mediated.

Topics: Animals; Behavior, Animal; Dogs; Electric Stimulation Therapy; Electroacupuncture; Electrophysiology; Female; Nausea; Periodicity; Stomach; Stomach Diseases; Vagotomy; Vasopressins; Vomiting

This paper reports that vasopressin is emetogenic in the house musk shrew Suncus murinus. Either intravenous or intracerebroventricular administration of vasopressin caused vomiting within a few minutes. The ED50 of intravenous vasopressin was as high as 4.67 microg/kg, whereas intracerebroventricularly injected vasopressin was effective at a low dose of 20 ng/brain. The emetogenic target of vasopressin may therefore be present in the central nervous system. We propose the Suncus as a useful animal for investigation of vasopressin-mediated emesis, including motion sickness.

Topics: Animals; Dose-Response Relationship, Drug; Injections, Intravenous; Injections, Intraventricular; Male; Shrews; Vasopressins; Vomiting

Topics: Adrenocorticotropic Hormone; Child; Humans; Male; Melatonin; Sleep Wake Disorders; Vasopressins; Vomiting

We report the first case of the syndrome of periodic adrenocorticotropin (ACTH) and vasopressin (ADH) discharge associated with focal glomerulosclerosis. Approximately 30 cases of this syndrome have so far been reported in Japan, but no cases associated with renal dysfunction have yet been reported. The patient, a 10-year-old Japanese boy, was referred to our hospital because of recurrent attacks of vomiting. He was diagnosed as having this syndrome from clinical and laboratory findings. While various drugs were tried to manage his vomiting attacks, only valproic acid appeared to be effective in reducing the frequency of the attacks. Chronic nephritis was manifested when the patient was 12 years old, which required treatment with continuous ambulatory peritoneal dialysis. Valproic acid was proved to be effective in reducing the number of attacks over 4 months.

Topics: Adrenocorticotropic Hormone; Child; Glomerulosclerosis, Focal Segmental; Humans; Kidney Failure, Chronic; Male; Periodicity; Recurrence; Syndrome; Valproic Acid; Vasopressins; Vomiting

A 15-year-old boy with sequelae of perinatal asphyxia experienced intractable startle-induced epileptic seizures, which were transiently suppressed with episodic vomiting. His vomiting was associated with adrenocorticotropin and antidiuretic hormone discharge, and the alteration of urinary catecholamine excretion, which might modulate epileptic seizures. Because startle-induced epileptic seizures are resistant to conventional antiepileptic therapy, this case is informative for the treatment of startle epilepsy.

Topics: Adolescent; Adrenocorticotropic Hormone; Epilepsy; Humans; Male; Reflex, Startle; Secretory Rate; Vasopressins; Vomiting

delta-Aminolevulinic acid dehydratase deficiency porphyria (ALAD porphyria, ADP) with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in a 69-year-old woman is reported. The patient was admitted to our hospital complaining of slight cough with low-grade fever, and treated with piperacillin sodium, resulting in complete resolution of the symptoms, following a diagnosis of bronchopneumonia. Thereafter, however, she began to complain of vomiting, abdominal pain, facial numbness and paresis of the extremities with gait disturbance, and became comatose with hyponatremia (serum Na concentration 119 mEq/L) in a few days. Laboratory tests revealed an antidiuretic hormone (ADH) level of 13.5 pg/mL, plasma osmolality 218 mOsm/KgH2O, urinary osmolality 429 mOsm/KgH20, urinary Na concentration > 20 mEq/L, and no abnormalities of thyroid, adrenal or renal function. Neither edema nor dehydration was evident. These data indicated the presence of SIADH. No abnormalities suggestive of malignant or infectious diseases such as lung cancer, pneumonia and Guillain-Barré syndrome were evident from laboratory and roentgenographic findings. As the cause of SIADH, therefore, porphyria was suspected. Metabolites and activities of enzymes in the heme biosynthetic pathway were examined, and very low activity of delta-aminolevulinic acid dehydratase (ALA-D) (0.14 mumol PBG/mL RBC/h) was found. The patient was neither an alcoholic nor a heavy smoker, and she had no past history of heavy metal intoxication, photosensitivity or tyrosinemia. On the basis of these data and clinical features, she was diagnosed as having ADP. We consider this to be the first case of ADP reported in Japan.

Topics: Abdominal Pain; Aged; Coma; Female; Humans; Inappropriate ADH Syndrome; Japan; Osmolar Concentration; Paresis; Porphobilinogen Synthase; Porphyrias; Porphyrins; Sodium; Vasopressins; Vomiting

The Mallory-Weiss syndrome is characterized by repeated bouts of retching and/or vomiting followed by the sudden onset of hematemesis or melena. Bleeding arises from linear, nonperforating mucosal lacerations at the cardia, cardioesophageal junction, distal esophagus, or a combination of these sites. Hiatal hernia is often a coexisting finding. Severity of hemorrhage can vary from mild to severe (100 to 2,000 ml). The clinical course is usually benign. The diagnosis can be suspected from the history and confirmed by upper gastrointestinal endoscopy. In the majority of patients, medical management controls the bleeding. About 10% to 20% of unselected patients require surgical intervention. With the proper, prompt use of fiberoptic endoscopy in the diagnosis of upper gastrointestinal hemorrhage has come an increase in the number of cases of Mallory-Weiss syndrome being identified. This is true even in community hospitals. The result has been a decrease in surgical intervention and overall mortality.

Topics: Adult; Aged; Blood Transfusion; Diagnosis, Differential; Endoscopy; Female; Gastrointestinal Hemorrhage; Humans; Male; Mallory-Weiss Syndrome; Middle Aged; Prognosis; Therapeutic Irrigation; Vasopressins; Vomiting

Hyponatremia and hypo-osmolality developed in a 70-year-old patient. It was probably mediated by hypersecretion of antidiuretic hormone, which, in turn, was due to prolonged nausea and vomiting. Severe esophagitis was the cause of the nausea. The patient was not given large amounts of fluids intravenously, and it is likely that she continued to drink for nondipsetic reasons. In view of her medical history of neurosyphilis, the possibility of a disturbance in the mechanism of thirst regulation is discussed, but remains unproved.

Topics: Aged; Esophagitis, Peptic; Female; Humans; Hyponatremia; Nausea; Osmolar Concentration; Syndrome; Time Factors; Vasopressins; Vomiting; Water-Electrolyte Imbalance

Topics: Adrenocorticotropic Hormone; Child; Humans; Male; Periodicity; Vasopressins; Vomiting

An 8-yr-old girl is presented who had periodic attacks of vomiting, psychotic depression, drowsiness, and hypertension (160/110 mm Hg) for a period of 16 months after head injury. At the initiation of the attack, serum ACTH and vasopressin levels were prominently increased (610 pg/ml and 41 microunits/ml, respectively), followed by hypercortisolemia, hyponatremia, and hypoosmolality in plasma. Serum PRL also was elevated (91 ng/ml). Responses of GH and cortisol to insulin-induced hypoglycemia and those of TSH to TRH were reduced. Urinary excretion of epinephrine and norepinephrine were increased, while dopamine (DA) excretion was reciprocally decreased, resulting in a marked elevation of the epinephrine plus norepinephrine to DA ratio during the episodes (0.4-4.5); this was normalized on attack-free days (0.08-0.25). During the attack, the concentration of homovanillic acid, a major metabolite of DA in the brain, also was reduced in cerebrospinal fluids from 70 to 23 ng/ml. The administration of methyl-dopa and reserpine effectively suppressed the recurrence of the episode. Although the exact cause of this syndrome is unknown, a periodic metabolic dysfunction of catecholamine in the central nervous system might be postulated.

Topics: Adrenocorticotropic Hormone; Brain Concussion; Catecholamines; Child; Female; Humans; Hypertension; Insulin; Methyldopa; Periodicity; Pituitary Hormones, Anterior; Prolactin; Reserpine; Syndrome; Thyrotropin; Thyrotropin-Releasing Hormone; Vasopressins; Vomiting

The mechanisms underlying the frequent association of nausea and vomiting with elevations of plasma vasopressin(PAVP) were studied in man and rat. After oral water loads (N = 16), plasma osmolality fell in all human subjects and was associated with a decline in PAVP in 14 asymptomatic human subjects. In 2 human subjects, nausea occurred and was associated with increases in PAVP, without changes in blood pressure. During ethanol infusion (N = 28), PAVP was suppressed unless nausea supervened. In 4 nauseated human subjects, PAVP escaped from ethanol inhibition and rose to levels 10 times basal, despite the absence of hemodynamic changes. Apomorphine, a potent dopamine agonist and emetic agent, was administered to human volunteers in doses of 7 to 24 microgram/kg. There was no increase in PAVP in 3 human subjects who remained asymptomatic (7 to 16 microgram/kg). Ten human subjects experienced nausea after 16 microgram/kg, which was followed shortly by marked increases in PAVP. Emesis occurred in 5 human subjects given 16 to 24 microgram/kg, and was followed by PAVP levels similar to those seen with nausea alone. In 7 human subjects from the nausea group, the repeat study (16 microgram/kg) after pretreatment with dopamine antagonist (haloperidol, N = 4; fluphenazine, N = 3) resulted in complete blockage of apomorphine-induced AVP release. In rats, which lack an emetic reflex, apomorphine doses of 200 microgram/kg induced only slight increases in PAVP when compared to the response to 16 microgram/kg in man. These studies indicate that stimulation of the emetic reflex results in AVP-release in man. Nausea-mediated AVP release supervenes over concomitant osmolar or pharmacologic (ethanol) inhibition.

Topics: Alcohols; Animals; Apomorphine; Blood Pressure; Diuresis; Female; Humans; Male; Nausea; Rats; Vasopressins; Vomiting; Water

Topics: Adult; Aged; Autopsy; Beer; Blood Urea Nitrogen; Coma; Diarrhea; Electroencephalography; Feeding and Eating Disorders; Female; Hemiplegia; Humans; Hypokalemia; Hyponatremia; Male; Middle Aged; Nutrition Disorders; Sodium; Tremor; Vasopressins; Vomiting; Water Intoxication

Topics: Adult; Aged; Alkalosis; Bendroflumethiazide; Biological Assay; Blood Urea Nitrogen; Bromine; Carbon Dioxide; Chlorides; Chlorpropamide; Chlorthalidone; Creatinine; Diagnosis, Differential; Diuretics; Female; Furosemide; Humans; Hydrochlorothiazide; Hypokalemia; Hyponatremia; Hypopituitarism; Hypothyroidism; Male; Methyclothiazide; Middle Aged; Natriuresis; Osmolar Concentration; Polythiazide; Potassium Isotopes; Radioisotope Dilution Technique; Radioisotopes; Sodium Isotopes; Tritium; Vasopressins; Vomiting; Water-Electrolyte Balance

Topics: Age Factors; Aged; Blood Pressure; Electrocardiography; Female; Humans; Hydrocortisone; Injections, Intravenous; Middle Aged; Nausea; Psychiatric Status Rating Scales; Schizophrenia; Vasopressins; Vomiting