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Acholia (from Greek (Greek) a - a negative particle and chole - bile), cessation of the flow of bile into the duodenum; a symptom of certain diseases, more often of the biliary tract (blockage of the common bile duct). delayedin the liver, bile enters the bloodstream. With A., jaundice, discolored, clayey stools, bile-colored urine, skin itching, and occasionally severe brain phenomena (delusions, coma), hemorrhages in the skin and mucous membranes, and sometimes high fever are noted. Treatment: elimination of the cause A.

This article actually consists of several unrelated fragments. It is required to correct it so that it is homogeneous! You can do this with the Edit or Edit link. Acetonemic syndrome is expressed by symptoms that are provoked by a failure in metabolism. An unpleasant condition appears when ketone bodies accumulate in the blood. Acetonemic crises can often occur: dehydration, repeated vomiting, smell of acetone from the mouth, subfebrile condition, abdominal syndrome.

The disease is diagnosed on the basis of some symptoms, as well as tests - they determine ketonuria, elevated urea levels, electrolyte imbalance. In the case of an acetone crisis, it is important for the child to carry out infusion therapy as early as possible, put a cleansing enema, and put him on a diet that contains easily digestible carbohydrates.

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Acetonemic syndrome is a condition that occurs when metabolic processes in the child's body are disturbed, a kind of ramipril pills in metabolic processes. At the same time, no malformations of organs, violations in their very structure are not detected, just the functioning, for example, of the pancreas and liver is not regulated.

Acetonemic syndrome occurs more often in children, but it also occurs in adults.

This syndrome itself is one of the manifestations of the so-called neuro-arthritic anomaly of the constitution (nervous-arthritic diathesis is the old name for the same condition). This is a certain set of character traits in combination with a certain work of the child's internal organs and nervous system.

In infants, this condition may be due to late preeclampsia of the pregnant woman or nephropathy.

In adults, the accumulation of ketone bodies is most often caused by diabetes mellitus. The lack of tritace blocks the entry into the cells of organic systems of glucose, which accumulates in the body. Acetonemic syndrome is often found in children with constitutional anomalies (nervous-arthritic diathesis). Such children are distinguished by increased excitability and rapid exhaustion of the nervous system; they have a thin physique, are often overly shy, suffer from neurosis and restless sleep.

At the same time, a child with a neuro-arthritic anomaly of the constitution develops speech, memory and other cognitive processes faster than their peers.

Children with neuro-arthritic diathesis are prone to impaired metabolism of purines and uric acid, therefore, in adulthood, they are prone to the development of urolithiasis, gout, arthritis, glomerulonephritis, obesity, and type 2 diabetes mellitus.

Symptoms of altace syndrome

The child smells of acetone from the mouth. The same smell comes from the skin of the child and from his urine. Dehydration and intoxication, pallor of the skin, the appearance of an unhealthy blush. The presence of vomiting, which can occur more than 3-4 times, especially when trying to drink or eat something. Vomiting may appear in the first 1-5 days.

Deterioration of cardiac tones, arrhythmia and tachycardia.

As soon as the crisis has begun, the child shows restlessness and agitation, after which he becomes lethargic, drowsy and weak. Extremely rare, but seizures may occur. In the abdomen, there are cramping pains, stool retention, nausea (spastic abdominal syndrome).
therapy

Therapy

Often, the symptoms of acetonemic syndrome occur when there is a malnutrition - a small amount of ramipril in the diet and the predominance of ketogenic and fatty amino acids in it. Children have an accelerated metabolism, and the digestive system is still not sufficiently adapted, as a result of which there is a decrease in ketolysis - the process of utilization of ketone bodies slows down.

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Parents themselves can carry out express diagnostics for the determination of acetone in the urine - special diagnostic strips that are sold in pharmacies can help with this. They need to be lowered into a portion of urine and, using a special scale, determine the level of acetone.

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At the international pediatric consensus in 1994, doctors defined specific criteria for making such a diagnosis, theydivided into basic and additional.

vomiting is repeated sporadically, with attacks of varying intensity, between attacks there are intervals of the normal state of the baby, the duration of crises ranges from several hours to 2-5 days, negative laboratory, radiological and endoscopic examination results confirming the cause of vomiting, as a manifestation of the pathology of the digestive tract.

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Additional criteria include

episodes of vomiting are characteristic and stereotypical, subsequent episodes are similar to previous episodes in time, intensity and duration, and the attacks themselves may end spontaneously. attacks of vomiting are accompanied by nausea, abdominal pain, headaches and weakness, photophobia and lethargy of the child.

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How to treat acetonemic syndrome.

The diagnosis is also made with the exclusion of diabetic ketoacidosis (complications of diabetes), acute surgical pathology of the gastrointestinal tract - peritonitis, appendicitis. Neurosurgical pathology (meningitis, encephalitis, cerebral edema), infectious pathology and poisoning are also excluded.

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With the development of an acetone crisis, the child must be hospitalized.

Carry out a dietary correction: it is recommended to consume easily digestible carbohydrates, strictly limit fatty foods, provide fractional drinking in large quantities. A good effect from a cleansing enema with sodium bicarbonate, the solution of which is able to neutralize some of the ketone bodies that have entered the intestines. Oral rehydration is shown with the help of combined solutions (orsol, rehydron, etc.), as well as alkaline mineral water.

after care

The main directions of treatment of non-diabetic ketoacidosis in children

Diet (enriched with liquid and readily available carbohydrates with fat restriction) is prescribed for all patients.

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Indications for the appointment of tritace therapy:

  • Etiotropic therapy (antibiotics and antiviral drugs) is prescribed according to indications.
  • In cases of moderate ketosis (acetonuria up to ++), not accompanied by significant dehydration, water-electrolyte disturbances and indomitable vomiting, diet therapy and oral rehydration are indicated in combination with the appointment of altace in age doses and etiotropic therapy of the underlying disease.
  • The appointment of prokinetics (motilium, metoclopramide), enzymes and cofactors of carbohydrate metabolism (thiamine, cocarboxylase, pyridoxine) contributes to an earlier restoration of food tolerance and normalization of fat and carbohydrate metabolism.
  • Supportive care is very important to help reduce exacerbations.
  • In the treatment of acetonemic syndrome, the main methods are those that are aimed at combating crises.

Persistent repeated vomiting that does not stop after the use of prokinetics

The presence of disorders of hemodynamics and microcirculation; Signs of impaired consciousness (stupor, coma); The presence of moderate (up to 10% of body weight) and severe (up to 15% of body weight) dehydration; The presence of decompensated metabolic ketoacidosis with an increased anion gap; The presence of anatomical and functional difficulties for oral rehydration (anomalies in the development of the facial skeleton and oral cavity), neurological disorders (bulbar and pseudobulbar).

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Before starting infusion therapy, it is necessary to ensure reliable venous access (preferably peripheral), determine hemodynamic parameters, acid-base and water-electrolyte balance.


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