Type 1 diabetes complicated with uncontrollable adult cyclic vomiting syndrome: a case report

Abstract

We herein describe the case of a 29-year-old woman with type 1 diabetes from 10 years of age who developed adult cyclic vomiting syndrome. Beginning at 25 years of age, she was frequently hospitalized for stress-induced vomiting. Her vomiting episodes developed acutely and remitted after severe vomiting of more than 30 times a day for a few days. The vomiting periods were accompanied by leukocytosis with a predominance of neutrophils, high blood pressure and fever. In addition, it was noted that her levels of both adrenocorticotropic hormone and antidiuretic hormone during the vomiting attacks increased and subsequently dramatically decreased immediately after symptom improvement; therefore, she was diagnosed with adult-type cyclic vomiting syndrome in accordance with the diagnostic criteria of Rome III, a system developed to classify functional gastrointestinal disorders. Though glycemic control had improved with continuous subcutaneous insulin infusion therapy, the vomiting frequency increased due to the failure of drug treatments and general psychotherapy to terminate the vomiting attacks, making discharge difficult and greatly interfering with everyday life. Eventually, hypnotherapy and miniature garden therapy were prescribed, which significantly reduced the vomiting frequency, making it possible to discharge her from inpatient medical care.In the treatment of this patient with type 1 diabetes and adult-type cyclic vomiting syndrome, continuous subcutaneous insulin infusion therapy and comprehensive psychotherapy were effective.

Diabetic Gastroparesis Presenting with a Cyclic Vomiting Pattern

“…[18][19][20][21] In terms of the HPA axis, corticotropin releasing factor (CRF) is considered as an importance trigger for the vomiting phase starts, and it stimulates of the hypersecretion of ACTH and cortisol. [21][22][23] The current patient did not show features of migraine and abnormal ACTH and cortisol level. Another study also reported that absence of migraine was more common in male cyclic vomiting patients associated with diabetic gastroparesis than in their female counterparts.…”

Cyclic Vomiting Syndrome: An underdiagnosed entity. Report of a case

“…The presence of diabetes can make management difficult during the period of hyperemesis, due to the possibility of ketosis linked to its pathology. 2,11 Treatment of CVS involves fluid and electrolyte replacement measures during acute episodes, control of vomiting with antiemetics, and prevention of recurrence. 12 Ondansetron is the first-line drug to control nausea and vomiting, with a maximum dose of 32 mg/ day.…”

Type 1 diabetes complicated with cyclic vomiting syndrome and exogenous insulin antibody syndrome: A case report

“…However, T1D complicated with cyclic vomiting syndrome (CVS) is very rare. To date, there was only one case reported from Japan ( 5 ). CVS is an idiopathic functional vomiting disorder characterized by recurrent, stereotypical episodes of severe nausea, vomiting and abdominal pain interspersed with periods of little or no symptoms ( 6 ).…”