August 4, 2006
Other
Question from Tennessee, USA:
My five year old son has been having bouts of vomiting for the last year or longer. These bouts come on quickly, about every three weeks, and are a serious problem because his glucose levels drop dramatically during these episodes. We have seen a gastrointestinal doctor and have done an MRI (looking for intra-cranial neuroplasm), as well as an endoscopy and a celiac panel. All are negative except for inflammation and irritation in his stomach and esophagus, which I think are from the throwing up, not causing it. The vomiting is always accompanied by a headache, again, which comes on very quickly. Have you seen anything like this before? Can you offer some advice as to this problem? He is starting school in two weeks and I do not want him to be missing a lot of school, but short of finding a solution, it will be inevitable.
Answer:
I have not seen many cases of “cyclical vomiting,” but it is an entity discussed in the medical literature. I do not believe that it is a singular issue, but is, perhaps, caused by several possible concerns.
Recurrent vomiting with low blood glucose brings to mind adrenal insufficiency. Has the child ever had associated imbalances with his blood sodium and potassium? Adrenal issues certainly can co-exist with type 1 diabetes and your pediatric endocrinologist has probably looked for this.
There is an entity called “abdominal migraine” that could, I suppose, present in this manner.
Have you checked for ketones during this time to be certain it does not reflect an issue with his diabetes and the insulin pump?
DS
