| Literature DB >> 19444262 |
Kiang Chong1, Ketan Dhatariya.
Abstract
BACKGROUND: A 31-year-old woman with an 11-year history of poorly controlled type 1 diabetes mellitus was admitted with severe vomiting and ketoacidosis. The patient had been admitted to hospital on 14 occasions in the past 3 years for diabetic ketoacidosis precipitated by intractable vomiting, and she had been diagnosed with gastroparesis 2 years previously. INVESTIGATIONS: Assessment of the patient's response to standard treatments for diabetic gastroparesis. These approaches involved tight glycemic control that included subcutaneous insulin infusion via a pump, correction of electrolyte disturbances, use of standard antiemetic and promotility agents, somatostatin-analog treatment, intrapyloric injection of botulinum toxin, and insertion of a percutaneous jejunal feeding tube. DIAGNOSIS: Severe diabetic gastroparesis refractory to standard treatments. MANAGEMENT: The neurokinin-receptor antagonist aprepitant was started and her vomiting stopped within 24 h. This treatment was successfully continued for 4 months until a gastric electrical stimulation device was inserted, which enabled aprepitant treatment to be withdrawn and the percutaneous jejunostomy feeding tube to be removed. This successful treatment led to a substantial improvement in the patient's quality of life and overall glycemic control.Entities:
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Year: 2009 PMID： 19444262 DOI： 10.1038/nrendo.2009.50
Source DB: PubMed Journal: Nat Rev Endocrinol ISSN： 1759-5029 Impact factor: 43.330