vitamin-b-12 and Vomiting

Topics: Adult; Anemia, Hemolytic; Diagnosis, Differential; Fatigue; Female; Humans; Vitamin B 12; Vitamin B 12 Deficiency; Vomiting

Previous studies have shown that ipecac-induced emesis, even if instituted very early, removes only a mean of 28% to 45% of an ingested tracer. Because vomiting is an ancient reflex that occurs in mammals, reptiles, and other animals, we speculated that, in humans, maintaining a sitting rather than a horizontal posture during induced emesis might decrease the efficacy of gastric emptying. To test this hypothesis, 20 normal fasting adult subjects underwent induced emesis in the knee-chest position on one day and in the sitting position on another. Twenty-five 100-micrograms tablets of cyanocobalamin were ingested as a tracer along with 250 mL tap water. Ten minutes after tracer ingestion, 30 mL ipecac syrup and 640 mL tap water were swallowed. All resulting vomitus was homogenized, frozen, and later assayed for cobalt using atomic absorption spectrophotometry. There was no difference in mean tracer recovery with the two positions: knee-chest, 47.2% v sitting, 46.9% (paired t test, P greater than .95). Analysis of cobalt recovery for all 40 episodes of emesis revealed a mean of 51.2 +/- 23.7 (SD) micrograms out of 108.7 micrograms total cobalt ingested (95% Cl, 43.6 to 58.7 micrograms). This represented 47.1% of the administered tracer dose (95% Cl, 40.1% to 54.0%). Even if initiated only ten minutes after an ingestion, ipecac-induced emesis removes an average of less than half of an ingested tracer dose, with a high degree of intersubject variability. Horizontal patient positioning does not appear to improve the efficacy of this procedure.

Topics: Adult; Cobalt; Gastric Emptying; Humans; Ipecac; Knee; Posture; Random Allocation; Spectrophotometry, Atomic; Thorax; Vitamin B 12; Vomiting

Ipecac-induced emesis and gastric lavage are the two procedures most widely used to evacuate the stomachs of patients who have ingested poisons. To resolve a long-standing controversy over the relative efficacy of these two methods, the authors carried out a controlled study in which they administered 25 100-micrograms tablets of cyanocobalamin (vitamin B12) to 18 fasting normal adult volunteers on two separate days. On one day, each subject had emesis induced with 30 ml of ipecac syrup followed by 1,000 ml of tap water; on another day, each underwent gastric aspiration and lavage with a 1.1-cm orogastric tube using 3 l of fluid. Both procedures were begun 10 minutes after the ingestion. The recovered vomitus or gastric washings from each procedure were then analyzed for elemental cobalt using atomic absorption spectrophotometry. The mean rate of recovery of the ingested tracer with ipecac-induced emesis was only 28%, whereas gastric lavage resulted in retrieval of 45% (paired t-test, P less than 0.005). In this study, carefully performed gastric lavage was the more effective method of gastric evacuation of tablets in the adult subject.

Topics: Adult; Clinical Trials as Topic; Cobalt; Female; Gastric Lavage; Humans; Ipecac; Male; Poisoning; Spectrophotometry, Atomic; Vitamin B 12; Vomiting

A 26-year-old man presented at the emergency department with confusion and decreased consciousness after several days of vomiting. In the preceding 6 months, he had used a 2-litre tank of nitrous oxide (N

Topics: Adult; Brain Diseases, Metabolic; Confusion; Consciousness Disorders; Diagnosis, Differential; Gastrointestinal Agents; Humans; Hyperammonemia; Lactulose; Male; Nitrous Oxide; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex; Vomiting

Transcobalamin II deficiency is one of the rare causes of inherited vitamin B12 disorders in which the patients have characteristically normal or high vitamin B12 levels related to the transport defect of vitamin B12 into the cell, ending up with intracellular cobalamin depletion and high homocysteine and methylmalonic acid levels.. Herein, we describe the findings at presentation of four patients who were diagnosed to have transcobalamin II deficiency with novel mutations.. These patients with transcobalamin II deficiency were found to have novel mutations, of whom 2 had the same large deletion (homozygous c.1106+1516-1222+1231del).. Transcobalamin II deficiency should be considered in differential diagnosis of any infant with pancytopenia, failure to thrive, diarrhea, and vomiting.. Amaç: Transkobalamin II eksikliği nadir bir kalıtsal B12 vitamini bozukluğudur. Defektin B12 vitamininin transportu ile ilgili olması nedeniyle hastalar normal ya da yüksek B12 vitamini düzeylerine eşlik eden yüksek homosistein ve metilmalonik asit düzeylerine sahiptir. Gereç ve Yöntemler: Bu çalışmada transkobalamin II eksikliği tanısı alan dört hasta sunulmuştur. Bu hastalarda daha önce bildirilmemiş yeni mutasyonlar saptanmıştır. Bulgular: Hastaların ikisinde aynı büyük delesyon olduğu görülmüştür (homozigot c.1106+1516-1222+1231del). Sonuç: Pansitopeni, büyüme geriliği, ishal ya da kusması olan tüm bebeklerde transcobalamin II eksikliği ayırıcı tanıda düşünülmelidir.

Topics: Anemia, Megaloblastic; beta-Thalassemia; Bone Marrow; Chromosomes, Human, Pair 22; Codon, Nonsense; Consanguinity; Failure to Thrive; Female; Folic Acid; Frameshift Mutation; Genotype; Humans; Hydroxocobalamin; Infant; Male; Mutation; Mutation, Missense; Pancytopenia; Sequence Deletion; Transcobalamins; Vitamin B 12; Vomiting

The Imersland-Gräsbeck Syndrome (IGS) is a rare inherited disorder characterized by megaloblastic anemia due to a selective Vitamin B₁₂ malabsorption in association with mild proteinuria. This syndrome can be diagnosed and treated easily. Herein, we describe an infant with IGS as a rare etiology of growth retardation with diarrhea, vomiting and therapy-resistant proteinuria.

Topics: Anemia, Megaloblastic; Diarrhea, Infantile; Growth Disorders; Humans; Infant; Malabsorption Syndromes; Male; Proteinuria; Recurrence; Respiratory Tract Infections; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex; Vomiting

The newborn's vitamin B12 storage exclusively comes from placenta transfer, later from animal food. We relate 3 observations of infants (3-11-13 months) with failure to thrive, anorexia, vomiting and for the two olders refusal of weaning, associated with psychomotricity regression and hypotony. Blood cell count showed a macrocytosis without anemia (case 2-3) and a severe microcytic anemia for the first case caused by a mild alpha-thalassemia, with megaloblastic bone marrow. Vitamin B12 levels were very low associated with increased methylmalonic acid and homocysteine serum levels which confirm the diagnostic . Cerebral imaging showed diffuse cortical atrophy. Cobalamin deficiency was caused by strict vegetarian diets mothers of breastfed infants (cases 2-3) and for younger by mother's unrecognized pernicious anemia. 3 mothers had no anemia and normal B12 's levels at diagnosis. Vitamin B12 supply lead to a rapid clinical and hematologic improvement. In two cases, neurologic recovery was incomplete. About one hundred case of B12 deficiency 's infant are reported, 2/3 are breast-fed by vegetarian mothers, and 1/4 have mothers with pernicious anemia. The failure to thrive is due to anorexia, refusal of weaning and partial villous atrophy. Neurologic manifestations are secondary to cerebral disorders, sometimes revealed by an exposure to anesthetic nitrous oxyd. The macrocytic anemia is inconstant. The etiologic research of developmental delay in an infant may include vitamin B12's deficiency, even if there is no haematologic signs, especially if breast-fedding 's mothers is vegetarian.

Topics: Atrophy; Brain; Failure to Thrive; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Psychomotor Disorders; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex; Vomiting

The methylmalonic aciduria is an organic acidemia, inherited as autosomic recessive trait, caused by a deficiency of the methylmalonyl-CoA mutase, or by defects in the biosynthesis of the cofactor adenosylcobalamin. Regarding the enzymatic defect, there are two forms: mut(o) with no detectable enzymatic activity and mut(-) with reduced activity. Its clinical presentation may vary from a severe neonatal form with acidosis and death, up to a progressive chronic form. Here we describe the case of a four year-old boy, with diagnosis of methylmalonyl-CoA mutase deficiency type mut(-) with an acute presentation. Molecular analysis of MUT gene identified two mutations c.607G>A (G203R) and c.2080C>T (R694W), later confirmed in the parents. The aim of this report is to highlight the importance of including the organic acid analysis in urine among the first line exams in acutely and severely ill children with undefined etiology. The definitive diagnosis is important because it may allow a specific treatment and a favorable evolution to prevent the secuelae.

Topics: Acidosis; Amino Acid Substitution; Child, Preschool; Coma; Diet, Protein-Restricted; Diseases in Twins; Fertilization in Vitro; Genes, Recessive; Humans; Male; Metabolism, Inborn Errors; Methylmalonic Acid; Methylmalonyl-CoA Mutase; Mutation, Missense; Point Mutation; Twins, Dizygotic; Vitamin B 12; Vomiting

A six-month-old beagle was presented with a three-month history of failure to gain weight, lethargy, intermittent vomiting and seizures. Hypoglycaemia, portosystemic shunt, lead intoxication, gastrointestinal diseases and hereditary metabolic disorders were considered. Laboratory test results of low serum cobalamin (Cbl) concentrations, anaemia, leucopenia and methylmalonic aciduria while the dog was receiving a balanced commercial canine diet were suggestive of a congenital selective Cbl malabsorption. Treatment with repeated injections of parenteral cyanocobalamin (CN-Cbl) at 50 microg/kg every two weeks corrected the Cbl-deficient state and reversed all the clinical abnormalities. Selective Cbl malabsorption has previously been described in giant schnauzers and border collies and represents a unique readily treatable hereditary metabolic disorder.

Topics: Anemia; Animals; Dogs; Leukopenia; Male; Seizures; Vitamin B 12; Vitamin B 12 Deficiency; Vomiting; Weight Gain

A case of methylmalonic acidemia with intermittend homocystinuria is described. Special attention is given to the early symptoms of this inborn error of metabolism, like lethargy, muscular hypotony, poor feeding, ketoacidosis, and recurrent vomiting. Furthermore, the necessary diagnostic steps, the pertinent differential diagnosis (septicemia, duodenal stenosis, other inborn errors of metabolism), and the possible treatment are discussed.

Topics: Homocystinuria; Humans; Infant; Infant, Newborn; Lipid Metabolism, Inborn Errors; Male; Malonates; Methylmalonic Acid; Muscle Hypotonia; Propionates; Vitamin B 12; Vomiting

Topics: Ataxia; Child; Diet; Dimercaprol; Edetic Acid; Female; Fungicides, Industrial; Hemoglobins; Humans; Iraq; Leukocyte Count; Male; Mercury Poisoning; Methylmercury Compounds; Neurologic Manifestations; Pyridoxine; Thiamine; Triticum; Tropical Climate; Vitamin B 12; Vomiting

Topics: Adult; Aged; Alkaline Phosphatase; Anemia, Hypochromic; Binding Sites; Calcium; Diarrhea; Dumping Syndrome; Female; Folic Acid; Follow-Up Studies; Gastrectomy; Hemoglobins; Humans; Iron; Male; Methods; Middle Aged; Phosphorus; Postoperative Complications; Serum Albumin; Serum Globulins; Stomach Ulcer; Vitamin B 12; Vomiting

Topics: Amino Acids; Ammonia; Carbon Dioxide; Carbon Radioisotopes; Cells, Cultured; Child, Preschool; Cobamides; Diet Therapy; Dietary Proteins; Female; Fibroblasts; Genetic Counseling; Humans; In Vitro Techniques; Infant; Isomerases; Liver; Male; Malonates; Metabolism, Inborn Errors; Pregnancy; Prenatal Diagnosis; Propionates; Succinates; Vitamin B 12; Vomiting

Topics: Adolescent; Adult; Aged; Anemia, Hypochromic; Blood Proteins; Body Weight; Bone Diseases; Calcium; Drainage; Dumping Syndrome; Duodenal Ulcer; Female; Folic Acid; Follow-Up Studies; Gastrectomy; Hemoglobinometry; Humans; Malabsorption Syndromes; Male; Middle Aged; Peptic Ulcer Hemorrhage; Postgastrectomy Syndromes; Postoperative Complications; Prospective Studies; Recurrence; Tuberculosis, Pulmonary; Vagotomy; Vitamin B 12; Vomiting

Topics: Humans; Infant; Male; Methods; Vitamin B 12; Vomiting

Topics: Acidosis; Amino Acid Metabolism, Inborn Errors; Female; Genes, Recessive; Glycine; Hepatomegaly; Humans; Infant; Infant, Newborn; Intellectual Disability; Male; Malonates; Pedigree; Vitamin B 12; Vomiting

Topics: Alcoholism; Anemia; Anemia, Macrocytic; Anorexia Nervosa; Ascorbic Acid; Avitaminosis; Celiac Disease; Deficiency Diseases; Diet; Diet Therapy; Female; Folic Acid; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Pregnancy Complications; Sprue, Tropical; United Kingdom; Vitamin A; Vitamin B 12; Vitamin B Complex; Vitamin D; Vitamin K; Vitamins; Vomiting

Topics: Anemia; Anemia, Pernicious; Cardia; Esophageal Diseases; Esophagus; Hematinics; Vitamin B 12; Vomiting

Topics: Acetone; Child; Corrinoids; Hematinics; Humans; Infant; Nausea; Vitamin B 12; Vomiting

Topics: Child; Hematinics; Humans; Infant; Ketone Bodies; Vitamin B 12; Vomiting

Topics: Female; Gastritis; Humans; Hyperemesis Gravidarum; Pregnancy; Pregnancy Complications; Vitamin B 12; Vitamin B Complex; Vomiting

Topics: Child; Hematinics; Humans; Infant; Ketones; Vitamin B 12; Vomiting