Gastrointestinal Tract

Alcoholic ketoacidosis is the build up of ketones in the blood. Ketones are a type of acid that form when the body breaks down fat for energy.

The condition is an acute form of metabolic acidosis.

Ketoacidosis - alcoholic

Alcoholic ketoacidosis is caused by excessive alcohol use. It is most often seen in a malnourished person who drinks large amounts of alcohol every day.

• Abdominal pain
• Agitation
• Altered level of alertness, which may lead to coma (unresponsiveness)
• Confusion
• Fatigue
• Slow, sluggish, lethargic movement
• Irregular deep, rapid breathing (Kussmaul's sign)
• Loss of appetite
• Nausea and vomiting
• Symptoms of dehydration, such as dizziness and light-headedness

• Arterial blood gases
• Blood alcohol level
• Blood chemistries, such as CHEM-20
• Toxicology (poison) screening
• Urine ketones

Treatment may involve fluids (salt and sugar solution) given through a vein. You may need to have your blood taken frequently.

People with this condition are admitted to the hospital, often to the intensive care unit (ICU).

Prompt medical attention improves the overall outlook.

This can be a life-threatening disorder. Patients with alcoholic ketoacidosis often have or develop gastrointestinal bleeding, pancreatitis (inflammation of the pancreas), and pneumonia.

If you or someone else has symptoms of alcoholic ketoacidosis, seek emergency medical help.

Limiting the amount of alcohol you drink may help prevent this condition.

Cho KC, Fukagawa M, Kurokawa K. Fluid and electrolyte disorders. In: McPhee SJ, Papadakis MA, eds. Current Medical Diagnosis and Treatment. 48th ed. New York, NY: McGraw-Hill; 2009:chap 21.

DuBose TD Jr. Acidosis and alkalosis. In: Fauci A , Kasper D, Longo DL, et al, eds. Harrison's Principals of Internal Medicine. 17th ed. New York, NY: McGraw Hill; 2008:chap 48.

ANSWER IS: Gastric secretion can be stimulated before food has entered the mouth.

A.Gastric secretion can be stimulated before food has entered the mouth.B.Gastric secretion is enhanced by very low pH (below a pH of 2)
C.The presence of food in the stomach prevents hormonal control of gastric secretion.
D.Vagus stimulation of the stomach results in decreased secretion of gastric juice.

Foodstuffs does not become feces until it is being acted on in the large intestines. Foodstuffs cannot travel backward because the body has special one-way doors called sphincters that keep one area closed so it cannot have backflow. So, no, feces cannot travel to your mouth.

Also, it does not matter if your body digests foodstuffs slowly or fast. Foodstuffs (the mush from food and liquid) will still only go one way--down--during digestion.

*If you vomit and see brown fluid with partially digested food, that is bile mixed with gastric juices. It comes from the stomach and is not feces (poop).

Angiodysplasia of the colon is enlarged and fragile blood vessels in the colon that result in occasional loss of blood from the gastrointestinal (GI) tract.

Vascular ectasia of the colon; Colonic arteriovenous malformation; Colonic angiomas

Angiodysplasia of the colon is mostly related to the aging and degeneration of the blood vessels. It usually occurs in older adults.

There are several theories about the cause. The most likely cause is that normal spasms of the colon lead to enlargement of blood vessels in the area. This swelling becomes so severe that a small direct passageway develops between a very small artery and vein. This is called an arteriovenous fistula. It is in this area of the colon wall that the patient is at risk for bleeding.

Angiodysplasia of the colon is very rarely related to other diseases of the blood vessels, including Osler-Weber-Rendu syndrome. It is not related to cancer, and is different than diverticulosis, another very common cause of intestinal bleeding in older adults.

The symptoms vary. Often, in elderly patients, the symptoms are weakness, fatigue, and shortness of breath due to anemia. There may not be any signs of bleeding directly from the colon. Others may have occasional mild or severe bleeding episodes with bright red blood coming from the rectum.

Some patients may have dark or black, tarry stools. There is no pain associated with angiodysplasia.

Tests that may be done to diagnose this condition include:

• Angiography(only useful if there is active bleeding into the colon)
• Complete blood count (CBC) to check for anemia
• Colonoscopy
• Stool guaiac test (a positive test result suggests bleeding from the colon)

When a person is bleeding from the colon, it is important to determine the source of the bleeding and how fast they are losing blood. The patient's condition must be evaluated continuously and may need to be admitted to a hospital's intensive care unit (ICU). Fluids may be given through a vein, and blood products may be required.

Treatment begins once the source of bleeding is found. Most patients stop bleeding on their own without any treatment.

If treatment is needed, it may involve:

• Angiography to help form a clot in the bleeding area or to deliver medicine to help cause the blood vessels to tighten to stop the bleeding
• Burning (cauterizing) the site of the bleed with heat or a laser using a colonoscope
• Using electrical energy (argon plasma coagulation) to stop bleeding

In some instances, surgery is the only option. Removal of the entire right side of the colon (right hemicolectomy) is the treatment of choice for someone with this condition who continues to bleed at a dangerously quick rate, despite several treatments by angiography and colonoscopy.

Patients who have bleeding related to this condition despite having had colonoscopy, angiography, or surgery are likely to have more bleeding in the future.

The goal of therapy is to reduce, if not totally eliminate, the number of bleeds, hospitalizations, and blood transfusions. Surgery may be a cure in some cases. The outlook remains good if the bleeding is controlled.

• Anemia
• Death from excessive blood loss
• Side effects from treatment
• Severe loss of blood from the GI tract

Call your health provider if rectal bleeding or black stools occur.

There is no known prevention.

Hauser S. Vascular diseases of the gastrointestinal tract. In: Goldman L, Ausiello D. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 146.

Lithium is a medication used to treat bipolar disorder (manic depression). This article focuses on lithium overdose, or toxicity.

• Acute toxicity occurs when you intentionally or accidentally swallow too much of a lithium prescription.
• Chronic toxicity occurs when you slowly take a little too much of a lithium prescription every day for a while. This is actually quite easy to do, as dehydration, other medications, and other conditions can easily interfere with lithium in your body and cause it to build up.
• Acute on chronic toxicity occurs when you take lithium every day for bipolar disorder, but one day you take an extra amount (as little as a couple of pills or as much as a whole bottle).

This is for information only and not for use in the treatment or management of an actual poison exposure. If you have an exposure, you should call your local emergency number (such as 911) or the National Poison Control Center at 1-800-222-1222.

See: Overdose

Eskalith toxicity; Lithane toxicity; Lithobid toxicity; Lithonate toxicity; Lithotabs toxicity

Lithium, a soft metal

Lithium is sold under various brand names, including:

• Cibalith
• Carbolith
• Duralith
• Eskalith
• Lithane
• Lithobid
• Lithonate

Note: Lithium is also commonly found in batteries, lubricants, high performance metal alloys, and soldering supplies. This article focuses only on the medication.

ACUTE TOXICITY

After taking too much lithium you will have symptoms such as:

• Diarrhea
• Dizziness
• Nausea
• Stomach pains
• Vomiting
• Weakness

You may also have some of the following nervous system symptoms, depending on how much lithium you took:

• Coma
• Hand tremors
• Incoordination of arms and legs (ataxia)
• Muscle twitches
• Seizures
• Slurred speech
• Uncontrollable eye movement (nystagmus)

Heart problems may occur in rare cases.

CHRONIC TOXICITY

You will likely not have any gastrointestinal symptoms. Symptoms that may occur include:

• Increased reflexes
• Slurred speech
• Tremors

In severe cases, you may also have nervous system and kidney problems such as:

• Kidney failure
• Memory problems
• Movement disorders
• Problems keeping salts in your body
• Psychosis

ACUTE ON CHRONIC TOXICITY

You will likely get some gastrointestinal symptoms and many of the severe nervous system symptoms listed above.

Determine the following:

• Patient's age, weight, and condition
• Name of the product (ingredients and strengths, if known)
• Time it was swallowed
• Amount swallowed
• Whether the medication was prescribed for the patient

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

See: Poison control center - emergency number

The health care provider will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. You may receive:

• Activated charcoal, especially if other substances were also taken
• Blood tests to measure lithium levels
• Fluids through a vein (by IV)
• Kidney dialysis
• Medicines to control nausea
• Tube through the mouth into the stomach to remove some of the pills before they are absorbed by the stomach (gastric lavage) -- only if you recently swallowed a large amount of lithium

If you have acute lithium toxicity, how well you do depends on how much lithium you took and how quickly you get help. Those who do not develop nervous system symptoms usually have no long-term complications.

If serious nervous system symptoms occur, you may have permanent neurologic problems.

Chronic toxicity is sometimes difficult to diagnose until late in the course. This delay can lead to long-term problems. If dialysis is performed quickly, you may feel much better, but symptoms such as memory and mood problems may be permanent.

Acute on chronic overdose often has the worst outlook. Nervous system symptoms may not go away even after many rounds of dialysis.

Thundiyil JG, Olson KR. Lithium. In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 30.

Gastric Acid, e.g. GERD or stomach ulcer would need a proton pump inhibitor.

Prilosec and Nexium are 2 of the top US prescriptions for this.