Understand safety issues around vomiting before treating it — Transcript

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1. 0:05from our previous discussions regarding
2. 0:07the loss of fluids and electrolytes in
3. 0:10other ways you've probably already
4. 0:12predicted that there's going to be
5. 0:13safety issues that are associated with
6. 0:16the acid-base regulation the loss of
7. 0:19electrolytes and the loss of fluids as
8. 0:22one vomits repeatedly indeed as one
9. 0:25vomits the acid is excreted that's the
10. 0:29hydrogen ion and if that occurs multiple
11. 0:32times the entire body could become too
12. 0:35alkaline and the pH of the system
13. 0:37therefore increases the metabolic
14. 0:39alkalosis and dehydration are going to
15. 0:42occur those types of imbalances can then
16. 0:45lead to neurologic symptoms and then
17. 0:48spiral out of control very very quickly
18. 0:51so it's really important to monitor the
19. 0:53situation make sure that the problem has
20. 0:56not occurred for a long enough period of
21. 0:58time for that type of complication to
22. 1:00occur
23. 1:01but there's also safety issues regarding
24. 1:04the condition that is causing the
25. 1:06vomiting because in many cases the
26. 1:09underlying condition will need to be
27. 1:12treated before the vomiting stops
28. 1:15when we think about vomiting we normally
29. 1:17think oh some bacteria some toxin in the
30. 1:19gut something down there is causing that
31. 1:22feeling but it isn't always bacteria and
32. 1:25it's not always something down there
33. 1:27that's causing the vomiting for instance
34. 1:30intestinal obstruction
35. 1:32appendicitis gallstones and perforated
36. 1:36bowel are all digestive system causes of
37. 1:39vomiting and none of those will resolve
38. 1:42by medications that relieve vomiting and
39. 1:45it's important to consider other causes
40. 1:48beyond the digestive system
41. 1:50one of the important things to remember
42. 1:52is that when the levels of glucose
43. 1:55electrolytes or toxins in the body are
44. 1:58altered that changes perceived at the
45. 2:01level of the chemoreceptor trigger Zone
46. 2:04the chemoreceptor trigger zone is next
47. 2:07to the vomiting Center and it detects
48. 2:09chemicals and imbalances and responds by
49. 2:12sending a message to the vomiting Center
50. 2:14to initiate vomiting for instance the
51. 2:18raised glucose levels in a child who's
52. 2:20just developed Diabetes Type 1 will be
53. 2:24perceived at that area and in turn it'll
54. 2:27signal the vomiting Center to initiate
55. 2:30vomiting and often the vomiting is the
56. 2:34first symptom in this kind of imbalance
57. 2:38the buildup of toxins from kidney
58. 2:40failure any condition of pH
59. 2:43abnormalities and also thyroid problems
60. 2:46can all present with vomiting as being
61. 2:48one of the first symptoms and once again
62. 2:51in those instances the imbalance is
63. 2:54perceived at the chemoreceptor trigger
64. 2:57Zone and the message to initiate the
65. 3:00vomiting is sent to the vomiting Center
66. 3:09let's take a clinical scenario a 13 year
67. 3:12old boy presents with his father
68. 3:15he's vomited after breakfast the past
69. 3:18two days and has been off his food for
70. 3:20the remainder of the day
71. 3:22what's the best approach
72. 3:24a give him Pepto-Bismol or B smell his
73. 3:29breath
74. 3:31and I didn't really expect you to be
75. 3:33able to answer this one but just
76. 3:35thinking about it will help you remember
77. 3:37a safety issue regarding the presenting
78. 3:40complaint of Diabetes Type 1. in that
79. 3:44condition the child or young adult is
80. 3:47going to have very high levels of
81. 3:49glucose in their system and they're
82. 3:51going to have very high levels of
83. 3:53ketones in their blood as well
84. 3:56the ketones are sweet smelling so the
85. 3:59person with high levels of ketones will
86. 4:02have sweet smelling fruity breath and
87. 4:05sweet smelling fruity urine
88. 4:08obviously in this case the boy would
89. 4:10have to undergo a couple simple blood
90. 4:12tests to be diagnosed properly but you
91. 4:15can see how vomiting due to this cause
92. 4:17is one of the many instances where the
93. 4:20underlying problem is not going to be
94. 4:23resolved by resolving the vomiting
95. 4:26right now we're going to get a really
96. 4:28good clear picture of the four Pathways
97. 4:31to the vomiting Center and the
98. 4:33medications that are best in each
99. 4:35instance