Zusammenfassung
Bei dem Krankheitsbild des ketonämischen Erbrechens liegt die Störung des Stoffwechsels
mit größter Wahrscheinlichkeit an der Eingangsstelle zum Zitronensäure-Zyklus. Neben
der Beruhigung der Kinder durch Luminal oder Megaphen ist Zucker- und Berolasezufuhr,
gegebenenfalls noch Cortison, erforderlich. Zum Ausgleich der erheblichen Elektrolytverschiebungen
müssen oral oder rektal Kaliumsalze gegeben werden. Unter dieser Therapie klingt das
Krankheitsbild überraschend schnell ab.
Summary
It is believed that disturbances in the autonomic nervous system regulation of metabolism
are the ultimate cause of ketonaemic vomiting. The chemical derangement occurs at
the point where protein, fat and carbohydrate enter a common chemical pathway, most
likely the citric acid cycle. As a result, water, chloride and potassium loss occurs,
which requires immediate counter-measures. The first step in treatment is to combat
hyperexcitability with barbiturates. Secondly, chemical equilibrium must be restored.
Sugar, given in fruit juice, often suffices in light cases. To this is added 5 drops
of HCl for each 100 cc of fluid given, to make up for the chloride loss. If vomiting
has persisted for some time and dehydration is prominent, fluids (half Ringer's, half
10% glucose, with 1 Gm of HCl added to each 1000 cc) must be administered rectally
or parenterally. To aid the metabolising of glucose and decrease the production of
ketone bodies, 50 mg. of co-carboxylase are added to the fluid. These measures usually
stop vomiting dramatically, within minutes or at most 2 hours. The addition of 10—20
mg. of cortisone is occasionally practised to oppose hypoglycaemia. Thirdly, to maintain
or establish potassium balance, potassium phosphate is given (2—3 Gm. daily) orally
or by gastric drip in fluids.
Resumen
Sobre el tratamiento de los vómitos cetonémicos recidivantes
En el cuadro clínico de los vómitos cetonémicos se encuentra el trastorno del metabolismo,
con la mayor probabilidad, al comienzo del ciclo del ácido cítrico. Aparte de calmar
a los niños con luminal y megaphen, es indispensable suministrar azúcar y berolasa
y, caso necesario, también cortisona. Para la compensación de las importantes desviaciones
electrolíticas tienen que darse sales potásicas por vía oral o rectal. Bajo este tratamiento
disminuye la sintomatología con rapidez.
