Eating Disorders Self-Help and Recovery Tips

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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Anorexia-Bulimia Home Treatment Program

The best way to treat Anorexia Bulimia is at home with an individual program. This gives people a chance to control their behavior by themselves and not be dependent on a group or a therapist. The Positive Energy Treatment is the anorexia and bulimia selfhelp method discovered by Karen Phillips. This method is based on the belief that recovering from bulimia requires you to change your subconscious mind. You need to change negative feelings and thoughts into positive ones. You need to change a negative identity into a positive one.

AnorexiaBulimia Home Treatment Program Overview

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Anorexia Nervosa DRG Categr 428

Anorexia nervosa is an eating disorder of complex and life-threatening proportions. It is an illness of starvation that is brought on by a severe disturbance of body image and a morbid fear of obesity. One in 250 adolescents are affected, and tragically, about 5 of those affected die. Anorexia nervosa is characterized by a person's refusal to maintain a minimally normal body weight for her or his height and age. This is done through inadequate food intake with no medical reason to account for weight loss. A distorted body image, dominated by an intense fear of obesity, leads to a relentless pursuit of an unreasonable and unhealthy thinness. Anorexia has four primary characteristics fear of becoming obese despite weight loss a distorted body image body weight 15 less than normal because of a refusal to eat and in females past puberty, the absence of three consecutive menstrual periods. Weight is lost three ways in this condition by restricting food intake, by excessive exercise, or by...

Eating Disorders

Over the past decades, numerous studies among patients in treatment have indicated the co-occurrence of eating disorders and substance use disorders. However, these studies are often methodologically limited, and have provided a wide range of estimates of eating disorders in patients with substance use disorders, from 2 to 41 . More recently, improved methodological approaches have determined that (1) substance use disorders do not have a significantly greater co-occurrence with eating disorders compared to other psychiatric controls, and (2) although eating disorders are frequently diagnosed among inpatients with substance use disorders, they are also frequently diagnosed in other psychiatric inpatients. At this time, there is no strong relationship between eating disorders and substance use disorders, and studies that report strong associations typically involve patients who have additional psychiatric disorders that frequently co-occur with eating disorders and substance use...

Electrolyte Abnormalities Sodium

Hypercalcemia is found in hyperparathyroidism and malignancies with bony metastases and paraneoplastic syndromes. Signs include easy fatigue, weakness, anorexia, nausea, vomiting, weight loss, stupor, coma, body aches, headaches, thirst, polydipsia and polyuria. Treatment is with normal saline fluid resuscitation, furo-semide, sodium phosphate, corticosteroids, plicamycin, calcitonin. Surgical excision is employed for patients with hyperparathyroidism in hypercalcemic crisis.

Gender Ethnicracial And Life Span Considerations

Anorexia nervosa generally occurs in adolescent females between the ages of 12 and 18, usually before the onset of puberty. Onset that occurs prior to age 11 is associated with a poor prognosis. It is a condition that is found in industrialized countries, but at lower rates internationally than in the United States. It rarely occurs in black African American females and in males. Approximately 1 of women and adolescent girls in the United States may have an eating disorder such as anorexia and bulimia.

Obsessive Compulsive Disorder

OCD is a chronic and often disabling disorder that affects 2-3 of the US population. OCD has been labeled a 'hidden epidemic' and is ranked 20th in the Global Burden of Disease studies among all diseases as a cause of disability-adjusted life years lost in developed countries. OCD is often associated with substantial quality of life impairment especially in individuals with more severe symptoms. The disease usually begins in adolescence or early adulthood with 31 of first episodes occurring at 10-15 years of age and 75 by the age of 30. The essential features of OCD are recurrent obsessions or compulsions that are severe enough to be time consuming (i.e., take more than 1 h per day) and or cause significant levels of distress or interference with normal daily activities. OCD can have comorbidity with major depression and social phobia, as well as other mental disorders such as eating disorders and schizophrenia.9

Discharge And Home Healthcare Guidelines

Explain that the patient should notify the primary healthcare provider if she or he develops any discomfort in the first few months after transfusion. Attributing these signs to specific diseases may make the patient unnecessarily anxious, but the patient should know to notify the healthcare provider for anorexia, malaise, nausea, vomiting, concentrated urine, and jaundice within 4 to 6 weeks after transfusion (hepatitis B) jaundice, lethargy, and irritability with a milder intensity than that of hepatitis B (hepatitis C) or flulike symptoms (HIV infection).

When You Need to Gain Weight

Some men are underweight because of an eating disorder or because of treatment for a chronic disease such as cancer. They need to maintain their weight and add more pounds. For these men, taking in more calories than they burn is the answer. As simple as this may sound, underweight men often have to struggle with this concept. Some of these men experience appetite loss from chemotherapy or radiation therapy taken for cancer. Others struggle with an overwhelming fear of being fat that compels them to restrict their intake of food while burning calories by obsessively exercising. If you are underweight, there are a number of steps you can take to gain additional pounds.

Primary Nursing Diagnosis

Eating disorders management Nutrition management Nutritional counseling Nutritional monitoring Weight management Patients with bulimia generally do not need hospitalization unless they experience severe electrolyte imbalance, dehydration, or rectal bleeding. The bulimia is usually managed with individual behavioral and group therapy, family education and therapy, medication, and nutritional counseling. Work with the interdisciplinary team to coordinate efforts and refer the patient to the physician to evaluate the need for antidepressants and anti-anxiety medication.

NOC Respiratory Status Gas Exchange

Observe for early stages of hypoxemia and effects on nervous system (mood changes, anxiety, confusion), circulatory system (tachycardia, hypertension), respiratory system (altered depth and pattern, dyspnea, retractions, grunting, prolonged expiration), gastrointestinal system (anorexia).

Description Of Empirical Research

Additional adaptations of DBT have recently been developed and evaluated for a range of populations and diagnostic groups, including eating disorders (Palmer et al., 2003 Safer, Telch, & Agras, 2001 Telch, Agras, & Linehan, 2000 Telch, Agras, & Linehan, 2001 Wisniewski & Kelly, 2003) incarcerated men (McCann, Ball, Ghanizadeh, Gallietta, & Froelich, 2002), suicidal adolescents (Miller, 1999 Miller, Wyman, Huppert, Glassman, & Rathus, 2000 Rathus & Miller, 2002), female juvenile offenders (Trupin, Stewart, Beach, & Boesky, 2002), and older adults with depression (Lynch, Morse, Mendelson, & Robins, 2003) preliminary data are encouraging. Although apparently disparate groups, each can be conceptualized according to the combined capability deficit and motivational model that underlies DBT. For example, Telch and colleagues view binge eating behavior as dysfunctional emotion regulation behavior that develops from inadequate emotion regulation skills and is...

Reliability and Validity of Clinical Diagnosis

Because of space limitations, only a few other studies can be mentioned. The introduction of many new diagnoses obviously created many new potential problems, among them, estimating the incidence of specific disorders. For example, In the years since 1980, bulimia has gone from being virtually unknown to being described by some medical investigators as a 'major public health problem' (Pope, Hudson, & Yurgelun-Todd, 1984) and being designated by one prominent nonmedi-cal leader of contemporary female opinion as a disorder of 'epidemic proportions''' (Ben-Tovin, 1988, p. 1000). This author also states that The use of DSM-III-R seems likely to lead to a dramatic decline in the diagnosis and prevalence of bulimia (Ben-Tovin, 1988, p. 1002).

Trauma History and Response to Trauma History

A history of trauma is significant in evaluating for trauma sequelae including dissociative phenomena, hyperarousal, depression, eating disorders, substance use disorders, psychiatric disorders (especially posttrau-matic stress disorder), domestic violence, and commercial sex work. Specific questions about posttrau-matic stress disorder include those about dissociation, intrusive thoughts, flashbacks, nightmares, easy startle, hypervigilance, insomnia, and a sense of a foreshortened future.

Identifying key symptoms

Sometimes more than one symptom may be important. For instance, patients may present with a complex mixture of symptoms which the treatment should palliate. In this situation a combination score or an algorithm maybe considered. In a trial assessing the value of mitoxantrone and prednisone in twenty-seven patients with hormonally resistant prostate cancer, Moore etal. 40 pre-defined a palliative response as a decrease in analgesic score by > 50 per cent or a decrease in 'present pain intensity' by > 2 points without an increase in analgesic score. In this phase II study nine patients were considered 'palliated' using this trial-specific definition, compared with only one who showed a traditional partial response. In an MRC Lung Cancer Working Party trial 41 comparing oral chemotherapy versus standard intravenous chemotherapy in patients with small cell lung cancer, QL was considered to be a primary outcome. In order to be considered 'equivalent' the oral treatment was required 'to...

Pregnancy Category B vaginal

Special Concerns Use with caution in infants up to 1 month of age, in clients with GI disease, liver or renal disease, or a history of allergy or asthma. Safety and efficacy of topical products have not been established in children less than 12 years of age. Side Effects Oral Candidiasis. GI N& V, diarrhea, bloody diarrhea, abdominal pain, GI disturbances, te-nesmus, flatulence, bloating, anorexia, weight loss, esophagitis. Nonspecific colitis, pseudomembranous colitis (may be severe). Allergic Morbilliform rash (most common). Also, maculopapular rash, urticaria, pruritus, fever, hypotension. Rarely, polyarteritis, anaphylaxis, erythema multiforme. Hematologic Leukope-nia, neutropenia, eosinophilia, thrombocytopenia, agranulocytosis. Miscellaneous Superinfection. Also sore throat, fatigue, urinary frequency, headache.

Imbalanced Nutrition Less Than Body Requirements

Defining Characteristics (Specify loss of weight with adequate intake, lack of interest in food, anorexia, nausea, vomiting, diarrhea, congenital defect of gastrointestinal system, regurgitation, abdominal pain, dysphagia, inability in infant to suck and swallow, failure to thrive, malabsorption syndromes, growth and developmental changes food jags, fads, ritualisms, rejection of solid foods , vitamin deficiency, increased metabolic demand, chronic illness, poor nutrient quality of food.)

Effects On The Fetus And Neonate

Although maternal poliomyelitis in the first two trimesters can be associated with spontaneous abortion or stillbirth and can predispose to intrauterine growth retardation and premature delivery, poliovirus infection of the fetus was an infrequent occurrence in the prevaccine era (2-7). Maternal poliovirus infection was not linked to an increased incidence of congenital anomalies (8). Neonatal poliomyelitis was a complication of maternal infection, however. Cases presented from birth to 28 days of age, with most cases occurring between days 5 and 21. The incubation period of neonatal poliomyelitis was often shorter (< 11 days) than that observed with poliomyelitis acquired at a later age. Symptoms included anorexia and lethargy, and paralytic disease was frequent. Fever was variable, and diarrhea occasionally was present. Reports of neonatal Neonatal infections by the nonpoliovirus EVs can be asymptomatic, cause benign illness, or produce life-threatening, severe disease (33,34)....

Multivariate Behavior Genetic Studies of Mood and Anxiety Disorder Symptoms

Phobia), however, the common nonshared environmental factor contributed a greater share of the liability variance than the common genetic factor. Using the same Virginia-based twin sample, Kendler et al. (1995) examined the causes of comorbid-ity among panic disorder, phobias, GAD, major depression, alcoholism, and bulimia nervosa in women. They reported that the genetic influences responsible for the overlap between major depression and GAD in female twins appeared to be distinct from the genetic influences responsible for the overlap between panic disorder and phobias. Based on the finding of more than one shared genetic factor, the authors speculated that the anxiety disorders may be etiologically heterogeneous. Although provocative, this hypothesis seems hard to reconcile with the earlier findings by this group on common genetic influences on depression and phobias (Kendler et al., 1993c).

Genetic Considerations

Determine a history of risk factors, with a particular focus on medications. Establish a history of anorexia, nausea, vomiting, constipation, polyuria, or polydipsia. Ask about muscular weakness or digital and perioral paresthesia (tingling) and muscle cramps. Ask family members if the patient has manifested personality changes.

Initial Evaluation Of The Patient With Substance Use Disorders

Ally begins crossing the blood-brain barrier within 15-20 seconds. Physical signs of acute opiate intoxication include euphoria and tranquility, sedation, slurred speech, problems with memory and attention, and miosis. Signs and symptoms of opioid withdrawal can be both objective (rhinorrhea and lacrimation, nausea and vomiting, diarrhea, piloerection, mydria-sis, yawning, and muscle spasms) and subjective (body aches, insomnia, craving, dysphoria, anxiety, hot and cold flashes, and anorexia). Heroin withdrawal usually begins within 4 to 8 hours after last use, whereas with methadone, with its longer elimination half-life, withdrawal may not begin until 24 to 48 hours after last use.

Immunotoxicity Studies In Nonhuman Primates Safety Assessment

A variety of human-derived cytokines have been studied in pregnant rhesus and cynomolgus monkeys according to specific protocols, which involve drug administration from GD 20 to 80 (Henck et al. 1996 Hendrickx et al. 2000). An example of a prototype teratology study is provided by Trown and colleagues (1986) in which intramuscular administration of interferon alpha-2a (Roferon R-A) intramuscularly to pregnant rhesus monkeys from GD 20 to 70 resulted in a dose-dependent increase in abortions (control 12.5 , low dose 25 , mid dose 37 , and high dose 66 ). Abortions were clustered between GD 37 to 68, that is, about 17 to 48 days after onset of drug administration. Maternal toxicity, expressed as anorexia and weight loss, was most prominent between weeks 3 to 5 after drug administration, and occurred coincident with the abortions. indicate a pharmacological effect of the cytokine alternatively, they may be associated with an immune response to the human-derived protein. Hormone analysis...

Client And Clinician Selection

In selecting clients, in general, the goal is to be as inclusive as possible, with a plan to monitor clients over time and evaluate whether the model appears helpful to them. As noted earlier, although most of the empirical studies on Seeking Safety were conducted on clients formally and currently diagnosed with both disorders, in clinical practice the range has been much broader. It has included clients with a history of trauma and or SUD, clients with serious and persistent mental illness, clients with just one or the other disorder, and clients with other disorders (e.g., eating disorders). An important consideration is clients' own preference. Given the powerlessness inherent in both PTSD and SUD, empowerment is key. It appears best to describe the

Major Depressive Disorder And Mood Disorders With Depressive Features Due To Hiv And Aids

Depressive illness is a major cause of distress in patients with HIV and AIDS, and has a severe impact on the quality of life and on medication adherence. Depression is a debilitating condition its symptoms include sadness, pessimism, anhedonia, guilt, and sui-cidality in addition to neurovegetative changes such as impaired sleep and appetite. These latter signs can often be confused with the primary illness, as HIV and AIDS often produce fatigue, anorexia, and wasting syndromes, making the diagnosis of depression challenging in this patient group. Additionally, somatic symptoms of depression may be confused with opportunistic infections, further complicating the differential diagnosis and increasing utilization of physicians' time and services.

Side effectscontraindications

Metformin is generally well tolerated and safe. Gastrointestinal side effects (diarrhea, flatulence, abdominal discomfort, anorexia, nausea, and metallic taste) predominate and are commonly dose-related. Dose reduction, administration with food, or an extended-release formulation can improve drug tolerance. Over 50 of individuals tolerate the maximum daily dose of metformin, but 5-10 of people need to discontinue the drug altogether.65

Physiological Effects

The plateau stage of drug effects lasts 3-4 hours. The principal desired effect, according to most users, is a profound feeling of relatedness to the rest of the world. Most users experience this feeling as a powerful connection to those around them, as well as to the universe (Leister, Grob, Bravo, & Walsh, 1992). Although the desire for sex can increase, the ability to achieve arousal and orgasm is greatly diminished in both men and women (Buffum & Moser, 1986). MDMA has thus been termed a sensual, not a sexual, drug. The prescription drug sildenafil (Viagra) may be taken in order to counteract this effect, and may be sold along with MDMA (Weir, 2000) the successor medications involving sexual enhancement can be expected to be used in this manner. The array of physical effects and behaviors produced by MDMA is remarkably similar across mammalian species (Green et al., 1995) and includes mild psychomotor restlessness, bruxism, trismus, anorexia, diaphoresis, hot flashes,...

Clinical manifestations

Most ovarian cancers are diagnosed between the ages of 40 and 65. Symptoms of early stage disease are often vague. Acute symptoms due to ovarian rupture or torsion are unusual. As a result, 75 to 85 percent of cases of ovarian cancer are advanced at the time of diagnosis. More advanced disease is typically associated with abdominal distention, nausea, anorexia, or early satiety due to the presence of ascites and omental or bowel metastases.

Mechanism of Action

MDMA is a dirty drug, affecting many neurotransmitter systems. It is primarily serotonergic, and its principal mechanism of action is as an indirect seroto-nergic agonist (Ames & Wirshing, 1993 Rattray, 1991 Sprague et al., 1998). The drug's effects, and side effects (an arbitrary distinction), including anorexia, psychomotor agitation, difficulty in achieving orgasm, and profound feelings of empathy, can be explained as a result of the flooding of the serotonin system (Beck & Rosenbaum, 1994). After ingestion, MDMA is taken up by the serotonin cells through active channels, effecting the release of serotonin stores. MDMA also blocks reuptake of serotonin, and this contributes to its length of action. Although it inhibits the synthesis of new serotonin, this does not contribute to the intoxication phase, but it may contribute to sustained feelings of depression reported by some users and to a diminished magnitude of subjective effects when the next dose is taken within a few...

Clinical Manifestations Of Dengue Infection

Dengue fever is characterized by sudden onset of fever, frontal headache, retro-orbital pain, general malaise, generalized myalgias and arthralgias, nausea, vomiting, and rash. One characteristic feature of dengue fever is the severity of body pain, which can be incapacitating and explains why the disease is sometimes called breakbone fever. Other nonspecific symptoms may be present, such as anorexia, mild conjunctival injection, diarrhea, pruritus, and changes in taste sensation. Leukopenia and thrombocytopenia are frequent, and liver enzymes may be mildly elevated. The febrile period lasts 5-7 days, but the patient may remain symptomatic for several more days. The disappearance of fever correlates with the disappearance of viremia. Convalescence may be marked by a period of lassitude. There have been reports of severe depression after the acute period of illness (4,5).

Amylin Analogs Pramlintide

Pramlintide is the first amylin analog commercially available and received FDA approval in March 2005 for therapy in both T1DM and T2DM. Pramlintide, studied as an adjunctive therapy to insulin, has been shown to improve postprandial and overall glycemic control in individuals with both T1DM and T2DM (improvements in HbA1C of 0.67 82 and HbA1C of 0.62 ,83 respectively) without increasing the incidence of hypoglycemia or weight gain. The glycemic improvements with pramlintide had no significant effects on lipid concentrations or blood pressure and showed no evidence of cardiac, hepatic, or renal toxicity. The most frequent adverse side effects associated with pramlintide therapy include transient mild to moderate nausea and anorexia. In its current formulation, pramlintide is administered via subcutaneous injection separately from insulin.

Demonstration of a Structure Toxicity Relationship A Strategy for Lead Progression

The drug-sparing 30-day toxicology protocol designed by Piper required that my laboratory need only prepare 8-12 g of each test compound. The use of such limited drug quantities was feasible, as the protocol would involve the dosing of only three rats per sex. As the rationale of the study was to enable the expeditious identification of oxazolidinones having at least a 10-fold therapeutic index in the rat, the test compounds were dosed orally, twice daily (b.i.d.), at a dosage level 10-fold the ED50 (the effective dose (mgkg_ 1) that protected 50 of the mice from death after an injection of a lethal dose of S. aureus). As the comparative study progressed, the toxicologists reported several distinct toxicological findings that were readily apparent by clinical observation in the group of rats dosed orally with ( + )-DuP-721 at 100mgkg_ 1 day_ 1. Those findings included alopecia, severe anorexia, ataxia, and the death of one of the six animals another two animals observed in a moribund...

Sudden Death on a Physiological Basis

Up to this point in the discussion of sudden cardiac death, lesions of the heart that are visible either grossly or microscopically have been described. Sudden cardiac death on a physiological basis without a visible etiology can also occur. Thus, sudden death can be, though rarely, one of the sequelae of Wolff -Parkinson-White syndrome.140 Sudden cardiac death is also seen in conjunction with the Q-T interval syndrome.1 There are two forms of this syndrome the congenital hereditary form and the acquired form. The Jervell and Lange-Nielsen syndrome and the Romano-Ward syndrome are the two hereditary forms. The acquired form is secondary to drugs, electrolyte abnormalities, toxic substances, hypothermia, anorexia nervosa, and diet programs involving liquid protein diets. In the acquired form of the Q-T interval syndrome, removing the inciting factor abolishes the syndrome. The mechanism of death in both anorexia nervosa and dieting with liquid protein diets is the same development of a...

Amitriptyline hydrochloride

Action Kinetics Amitriptyline is metabolized to an active metabolite, nortriptyline. Has significant anti-cholinergic and sedative effects with moderate orthostatic hypotension. Very high ability to block serotonin uptake and moderate activity with respect to norepinephrine uptake. Effective plasma levels of ami-triptyline and nortriptyline Approximately 110-250 ng mL. Time to reach steady state 4-10 days. tV2 31-46 hr. Up to 1 month may be required for beneficial effects to be manifested. Amitriptyline is also found in Limbritrol and Triavil. Uses Relief of symptoms of depression, including depression accompanied by anxiety and insomnia. Chronic pain due to cancer or other pain syndromes. Prophylaxis of cluster and migraine headaches. Non-FDA Approved Uses Pathologic laughing and crying secondary to forebrain disease, bulimia nervosa, antiulcer agent, enuresis. Contraindications Use in children less than 12 years of age. How Supplied Injection 10 mg mL Tablet 10 mg, 25 mg, 50 mg, 75...

Treat chronic pancreatitis with alcohol abstinence oral pancreatic enzyme replacement and fatsoluble vitamin supplements

Mallory-Weiss tears are superficial esophageal erosions that may cause a GI bleed. They usually are seen with vomiting and retching (alcoholics and bulimies). Diagnosis and treatment are done endoscopically (sclerose any bleeding vessels). Boerhavc's tears are full-thickness esophageal ruptures if not iatrogenic (from endoscopy), they are usually due to vomiting or retching (alcoholics and bulimics). Diagnose with endoscopy or barium enema, and treat with immediate surgical repair and drainage.

Urinary Tract Infection Introduction

Diagnosis of UTI can be made by a urine culture from a clean-catch or a catheterized specimen. However, there is a high risk for contamination with clean-catch specimens. Lab result criteria for a UTI diagnosis colony counts of 100,000 colonies in a clean-catch urine and any urine culture greater than 5,000 colonies from urine obtained on a suprapubic puncture or catheterized specimen. Signs and symptoms of UTI in pediatric patients are age-related. For example, unique symptoms of UTI displayed by the infant failure to thrive and fever by the preschooler anorexia and somnolence by the school-ager enuresis and personality changes and those by the adolescent fatigue and flank pain.

Syndrome of Inappropriate Secretion of Antidiuretic Hormone and Diabetes Insipidus

- Absence of clinical evidence of volume depletion or diuretic use and normal thyroid, renal, and adrenal function. Symptoms of hyponatremia include confusion, muscle weakness, seizures, anorexia, nausea and vomiting, and stupor, when the serum sodium falls below 110 mEq L - Serum sodium greater than 150 mEq L, unaccompanied by a corresponding fluid deficiency. Sodium levels reaching 170 mEq L are accompanied by muscle cramping, tenderness and weakness, fever, anorexia, paranoia, and lethargy

Vomitoxin Deoxynivalenol

Group B trichothecenes, such as vomitoxin (VT or deoxynivalenol) and similar metabolites 3-acetyl deoxynivalenol and nivalenol, are less toxic than the group A trichothecene T-2 toxin (Bergsj0 et al. 1993). Vomitoxin is produced by Fusarium graminearum and F. culmorum and is a common contaminate of grain used to make human and animal feed. Because it is not destroyed by milling and processing, vomitoxin could be present in human food products at ppm levels (Islam et al. 2003). Swine and other monogastrics are the most sensitive to VT while chickens and turkeys have the highest tolerance to VT (Rotter et al.1996). Ingestion of moderate to low levels can cause anorexia, decreased nutritional efficiency, and immunotox-icity manifest by reduction in natural immunity and poor production performance in food animals. Exposure to high concentrations of VT causes nausea, emesis, leukocyte apoptosis, and circulatory shock (Rotter et al. 1996).

Metformin hydrochloride

Special Concerns Cardiovascular collapse, acute CHF, acute MI, and other conditions characterized by hypoxia have been associated with lactic acidosis, which may also be caused by metformin. Use of oral hypoglycemic agents may increase the risk of cardiovascular mortality. Although hypoglycemia does not usually occur with metformin, it may result with deficient caloric intake, with strenuous exercise not supplemented by increased intake of calories, or when metformin is taken with sulfonylureas or alcohol. Because of age-related decreases in renal function, use with caution as age increases. Safety and efficacy have not been determined in children. Side Effects Metabolic Lactic acidosis (fatal in approximately 50 of cases). Oral Unpleasant or metallic taste. GI Diarrhea, N& V, abdominal bloating, flatulence, anorexia. He-matologic Asymptomatic subnormal serum vitamin B12 levels. Drug Interactions None reported that would interact with dental therapy or oral health. How Supplied...

Clinical and Medical Uses of Chronometry

Cognitive effects of normal aging, mild cognitive impairment, senile dementia, traumatic brain and closed head injuries, mortality, under-nutrition and malnutrition in children, eating disorders, parasitic infections, neurological effects of HIV and AIDS, drug effects and addictions, multiple sclerosis, sleep disorders, diabetes, attention deficit and hyperactivity disorder (ADHD), stroke, vascular dementia, degenerative brain diseases associated with aging (Huntington, Alzheimer, Parkinson), epilepsy, chronic fatigue syndrome, hypoxia, post-traumatic stress disorder (PTSD), psychiatric disorders (anxiety, schizophrenia, depression, bipolar), yoga and meditation, chemical, pharmaceutical, and nutriceutical (e.g., Gingko biloba) agents.

Symptoms caused in humans 1731 Giardiasis

Cryptosporidium is a common cause of acute self-limiting gastroenteritis, symptoms commencing on average 3-14 days post-infection. Symptoms include a 'flulike illness, diarrhoea, malaise, abdominal pain, anorexia, nausea, flatulence, malabsorption, vomiting, mild fever and weight loss (Fayer and Ungar, 1986). From 2 to more than 20 bowel motions a day have been noted, with stools being described as watery, light-coloured, malodorous and containing mucus (Case-more, 1987). Severe, cramping (colicky) abdominal pain is experienced by about two-thirds of patients and vomiting, anorexia, abdominal distension, flatulence and significant weight loss occur in fewer than 50 of patients. Gastrointestinal symptoms usually last about 7-14 days, unusually 5-6 weeks, while persistent weakness, lethargy, mild abdominal pain and bowel looseness may persist for a month (Casemore, 1987). In young malnourished children, symptoms may be severe enough to cause dehydration, malabsorption and even death....

Background Information

Swine influenza naturally occurs in outbreaks from late autumn to early spring. After a 1 to 3 day incubation period, there is a sudden onset of coughing, dyspnea, fever, anorexia, inactivity, prostration, and piling (huddling together). There is weight loss, but a generally low mortality rate (< 1 ) and the pigs begin to recover after 5 to 7 days (Easterday and Hinshaw, 1992). The pathology of the viral pneumonia is essentially identical to human cases (Urman et al., 1958). It is also a disease of major economic importance to the pig industry. Pigs can be readily infected by human isolates. The disadvantages of using pigs as an influenza model include their cost ( 1 pound purchase price, 5 to 10 day board) and a limited number of Biosafety Level 2 facilities that can handle these animals. Equine influenza is another naturally occurring disease of large animals. Unlike strains that infect humans, there is relatively little antigenic shift in equine influenza isolates only two...

Parasitic Diseases Diagnoses

Once the Salmonella bacterium is ingested, it multiplies rapidly in the mucosal layers of the stomach and small intestine. The greater the number of organisms ingested, the shorter the incubation period typically, incubation is 8 to 48 hours after ingestion of contaminated food or liquid, and symptoms usually last for 3 to 5 days. An inflammatory response in the tissues produces gastroenteritis. The infection may stop there, or the salmonella organisms may travel via the lymph and vascular system throughout the body. The dissemination of organisms produces lesions in other organs or, possibly, sepsis. Systemic lesions may result in appendicitis, peritonitis, otitis media, pneumonia, osteomyelitis, or endocarditis. Symptoms of intermittent fever, chills, anorexia, and weight loss indicate sepsis. HISTORY. Establish a history of fever (often 102 F and higher), nausea, abdominal pain, vomiting, anorexia, and diarrhea that has persisted for at least 4 days. Ask about headache or...

Common Nursing Diagnoses See Ineffective Tissue Perfusion

Defining Characteristics (Specify in iron deficiency anemia irritability, anxiety, blood loss in the stool, hypochronic RBCs, normal or near normal RBC count, decreased serum ferritin and iron in sickle cell anemia pallor, weakness, anorexia, easy fatigability, jaundice and developmental delays in aplastic anemia pallor, fatigue, weakness, loss of appetite, normochromic, normocytic RBCs in reduced numbers, leukopenia, thrombocytopenia risk of spontaneous bleeding or bleeding after mild to severe trauma .)

Classification Antitubercular drug

Uses Prevention of disseminated Mycobacterium avium complex (MAC) disease in clients with advanced HIV infection. Contraindications Hypersensitiv-ity to rifabutin or other rifamycins (e.g., rifampin). Use in clients with active tuberculosis. Lactation. Special Concerns Safety and efficacy have not been determined in children, although the drug has been used in HIV-positive children. Side Effects Oral Taste perversion, discolored saliva (brownish-orange). GI Anorexia, abdominal pain, diarrhea, dyspepsia, eructation, flatulence, N& V. Respiratory Chest pain, chest pressure or pain with dyspnea. CNS Insomnia, seizures, paresthesia, aphasia, confusion. Musculoskeletal Asthenia, myalgia, arthralgia, myo-sitis. Body as a whole Fever, headache, generalized pain, flu-like syndrome. Dermatologic Rash, skin discoloration. Hematologic Neutro-penia, leukopenia, anemia, eosino-philia, thrombocytopenia. Miscella

Leukemia And Lymphoma Introduction

Pathologic effects of leukemia include the replacement of normal bone marrow elements by leukemic cells which results in clinical manifestations of anemia, neutropenia, and thrombocytopenia. Symptoms related to anemia may result in fatigue, weakness, pallor, and lethargy. Neutropenia predisposes the child to febrile episodes and infection. Symptoms related to thrombocytopenia may result in cutaneous bruises or purpura, petechiae, epistaxis, melena, and gingival bleeding. Other common symptoms related to leukemic infiltration include hepatosplenomegaly and lymphadenopathy bone and joint pain anorexia abdominal pain weight loss. Other symptoms, that are very rare, may include hematuria, gastrointestinal bleeding, or central nervous system (CNS) bleeding. Prognosis is based on age and initial WBC at diagnosis, sex, histologic type of the disease, number of chromosomes, the DNA-index, morphology and cell-surface immunologic markers. Clinical manifestations of Hodgkin's disease exhibit 60...

Pharmacological studies

The clinical use of stimulants in narcolepsy has been the object of an American Sleep Disorders Association (ASDA) Standards of Practice publication. Typically, the patient is started at a low dose, which is then increased progressively to obtain satisfactory results. This final dose varies widely from patient to patient. In adults, methylphenidate and amphetamines at dosages of more than 60 mg day do not significantly improve EDS without the appearance of long-term side effects, including frequent worsening of the nocturnal sleep disruption. The drug is usually administered in three divided doses with a maximum of 20 mg in the morning, 20 mg at lunchtime, and 20 mg at 3 pm - never later. Therefore, short naps are necessary. The combination of pharmacological agents and two short naps provides the best daily response to EDS, with no stimulant drug taken after 3 pm. The slow-release form may provide gradual and delayed response during the daytime. Side effects such as headaches,...

Prevention Strategies

Physical symptoms compound psychological distress and can precipitate death by suicide. Providing symptomatic relief and palliation of nociceptive and neuropathic pain, pruritus, diarrhea, nausea, emesis, and anorexia can avert a suicidal crisis in persons with HIV infection.

Assessing Psychopathology Across Cultures

In an attempt to address this last issue, DSM-IV (American Psychiatric Association, 1994) includes an appendix that lists ''culture-bound syndromes,'' or disorders that occur in specific cultural settings only. For example, ''koro'' is a disorder primarily found in parts of Southern Asia (Taiwan, Indonesia, Mal-ayasia, Borneo, and Southern China) in which males harbor an ''obsessive fear that their penises will withdraw into their abdomens.'' More recently, specific disorders found primarily in Western cultures have also been considered culturally bound.'' They include ''anorexia nervosa,'' in which individuals (typically females) have an obsessive concern with their weight, and ''multiple personality disorder,'' in which one person is thought to have multiple personalities that assume control over that person's behavior (Takahashi, 1990).

Clinical Disease Manifestations Of Hivassociated Cognitive Impairments

May present with a mild influenza-like illness and rarely a mononucleosis-like syndrome (Martin et al., 1992 Beckett and Forstein, 1993 Huang et al., 2005). A portion of these individuals will develop headaches, fever, myalgia, anorexia, rash, and or diarrhea within the first 2 weeks (Schacker et al., 1996 Lindback et al., 2000 Tyrer et al., 2003 Pilcher et al., 2004). Prior to seroconversion, the acute phase of viral infection is characterized by a rapid HIV-mediated loss of memory CD4+CCR5+ T cells within the mucosal tissues that results in potentially irreversible immune suppression (Veazey et al., 1998 Brenchley et al., 2004 Mehandru et al., 2004 Derdeyn and Silvestri, 2005). During this acute HIV infection, high levels of vire-mia and viral shedding at mucosal sites occur. Genital and oral ulcers, cancers, and coinfections with a number of sexually transmitted microbial pathogens, including herpes simplex and hepatitis viruses, syphilis, and gonorrhea, can also manifest during...

UL for Women 51 years3000 yigday of preformed vitamin A

A LOAFX of 6,460 yig day of vitamin A (which was rounded to 6,000 yig day) was identified by averaging the lowest doses of four case reports (Pcrsson ct al., 1965). Four cases of hypcrvitaminosis A occurred after doses of 5,500 to 6,750 yig day of vitamin A for 1 to 3 months (Table 4-10). The age of onset of symptoms ranged from 2.5 to 5.5 months and included anorexia, hypcrirritability, occipital edema, pronounced craniotabcs, bulging fontanels, increased intracranial pressure, and skin lesions and desquamation. The lowest dose associated with a bulging fontanel involved a 4-month-old girl given a daily dose of 24 drops of AD-vimin (about 5,500 jig of vitamin A) for 3 months. Her fontanels bulged 0.5 centimeters above the plane of the skull. The other three cases involved a dose of 6,750 ng day of vitamin A for 1 to 2.5 months. Increased intracranial pressure and bulging fontanels were observed in these cases as well. Other effects observed at the higher...

Medical Complications Of Alcoholism Gastrointestinal Tract and Pancreas

Alcohol decreases gastric emptying and increases gastric secretion. As a result, the mucosal barrier of the gastrium is disrupted, allowing hydrogen ions to seep into the mucosa, which release histamine and may cause bleeding. Acute gastritis is characterized by vomiting (with or without hematemesis), anorexia, and epigastric pain. It remains unclear whether chronic alcohol abuse increases the risk of ulcer disease.

Clinical Presentation and Natural History

Note fatigue, malaise, anorexia, or other constitutional symptoms. The specific constipation symptoms vary according to the type of constipation. Slow-transit constipation, for example, is often associated with infrequent defecation, bloating, fatigue, and malaise. By contrast, disordered defecation commonly presents with hard stools, straining, rectal pressure, and feelings of incomplete evacuation.

See Imbalanced Nutrition Less Than Body Requirements

Related to (Specify loss of appetite and or pain in mouth induced malabsorption or enteropathy caused by abdominal radiation, chemotherapy, abdominal surgery, or frequent antibiotic use and anorexia-inducing substances secreted by tumor cells xerostomia (irreversible dryness of mouth , destruction of microvilli of taste buds and or lining of salivary glands all can be caused by radiation therapy .) Defining Characteristics (Specify anorexia, nausea, vomiting, stomatitis, mucositis, decreased salivation, cachexia, fatigue, diarrhea, alterations in taste, gustatory changes, weight loss, abdominal pain, psychologic and sociocultural factors.)

Basic Tenets Of Cognitive Models Of Emotional Disorder

Cognitive models are also based on the general idea that there is a continuity of normal and abnormal cognitive processes. For instance, Beck (1991) stated that the cognitive model of psychopathology proposes that the excessive dysfunctional behavior and distressing emotions or inappropriate affect found in various psychiatric disorders are exaggerations of normal adaptive processes (p. 370). Thus, it is quite simple to apply the presuppositions of cognitive models to emotional disorders such as depression and panic disorder, or related ones such as eating disorders. For example, triggering events such as a social rejection or a small increase in body weight are construed by some individuals as a small setback others perceive them as no less than decisive evidence of utter failure and personal defect. In addition, some people exhibit relatively characteristic or stable patterns in the ways in which they appraise emotion-provoking stimuli (e.g., Abramson et al., 1978 Riskind, Williams,...

Univariate Studies of Mood and Anxiety Disorder Symptoms

Kendler et al. (1996) were interested in determining whether various alternative manifestations of depression would show different etiologies. They performed a latent class analysis of the DSM-III-R symptoms of major depression in a population-based sample of female twins. The analysis yielded three classes of clinically significant depressive symptoms, which were termed severe typical depression (distinguished by frequent weight loss and decreased appetite rather than weight gain and increased appetite, insomnia rather than hypersomnia, and frequent co-occurrence of anxiety and panic), ''mild typical depression'' (characterized by similar but less severe symptoms than severe typical depression), and atypical depression (characterized by frequent hypersomnia, increased appetite, and weight gain, associated with co-occurring bulimia). They found that among twins concordant for major depression, concordance for the specific subtype was more common than would be predicted by chance. The...

Pharmacological treatments of OSA risk factors and morbidities

That particular psychotropic drugs such as the SSRI antidepressants fluoxetine (see also above), sertraline and fluvoxamine may be useful as weight-loss agents was initially suggested by the unexpected observation of weight loss in trials of these agents in patients treated for neuropsychiatry conditions 92 . Subsequently, randomized controlled trials were specifically designed to assess their efficacy as weight-loss agents in obesepatients without neuropsychiatry co-morbidities. Of these agents, fluoxetine has been the most studied, in obese subjects without attendant co-morbidities 93 , in obese subjects with diabetes 94, 95 and in obese subjects with eating disorders 96 . Short-term (8 weeks) studies in the first group showed an approximate weight loss of about 4 kg compared with placebo, though doubts have surfaced about sustained benefit in longer-term studies. Trials of fluoxetine as a weight-loss agent in obese type 2 diabetics have shown mixed results. Fluoxetine has shown to...

Diagnosing Psychiatric Disorders In Patients With Substance Use Disorders

Given these considerations, one could ideally establish diagnostic rules to assist in determining whether a psychiatric syndrome is due to substance use or represents a separate and independent disorder. For example, some clinicians may establish a rule that a patient must be abstinent from alcohol and drugs for at least 4 weeks before they can make a diagnosis. Unfortunately, one does not always have the luxury of observing such lengthy abstinent periods (either by historical report or in the present) to assess this. In such circumstances, guidelines, as opposed to strict rules, can be helpful. For example, several studies have indicated that for alcoholics with major depression, treating the depression can have a positive impact on drinking (Cornelius et al., 1997 Greenfield et al., 1998). Thus, while DSM-IV-TR (American Psychiatric Association, 2000) criteria for substance-induced mood disorder suggest at least 4 weeks of observation during abstinence before a clinician can...

Assessment

Determine if the patient has a history of recent infection, steroid use, or adrenal or pituitary surgery. Establish a history of poor tolerance for stress, weakness, fatigue, and activity intolerance. Ask if the patient has experienced anorexia, nausea, vomiting, or diarrhea as a result of altered metabolism. Elicit a history of craving for salt or intolerance to cold. Determine presence of altered menses in females and impotence in males.

Lifestyle Diet

Numerous medications (anticholinergics, anti-depressants, narcotics) may lead to iatrogenic constipation by impeding neural signaling, resulting in impaired colonic muscular coordination (Table 3.1). Initial treatment of constipation with an identified pharmacologic cause consists of discontinuing the offending drug or replacing the drug with a nonconstipating alternative, if available. Psychiatric disorders such as depression, psychosis, and anorexia nervosa, as well as their pharmacologic treatments, may contribute to or worsen constipation. This has become a real clinical problem with the increasing and almost ubiquitous prescription of Pace of life Medications Weight loss anorexia laxative abuse Weight Loss, Eating Disorders, and Laxative Abuse Lack of oral intake, or bulimia, can be associated with reduced fecal volume. By their mechanism of action, overuse of laxatives may result in constipation due to dehydration, hypokalemia, or hypermagnesemia, altering neural transmission...

Acute APAP Poisoning

Phase 1 (up to 24 hours) Asymptomatic or nonspecific symptoms, anorexia, malaise, nausea, vomiting, pallor, diaphoresis. Phase 2 (24-72 hours) Onset of hepatic injury, right upper quadrant (RUQ) pain, high aspar-tate aminotransferase (AST), then increased prothrombin time (PT) and alanine amino-transferase (ALT).

Barlows disease

Perifollicular hyperkeratotic papules, surrounded by a hemorrhagic halo hairs twisted like corkscrews and possibly fragmented submucosal gingival bleeding, subperiosteal hemorrhage, arthralgia anorexia listlessness exophthalmos and conjunctival hemorrhage poor wound healing

Melanocortins

The melanocortin (MC) receptor family comprises five known subtypes. MC3 and MC4 receptors and their natural peptide ligands, a-MSH and AgRP, are expressed within the CNS and are involved in feeding behavior and energy regulation.146,147 The localization of these receptors to amygdala148 suggests they may be involved in anxiety-related behaviors. a-MSH, the endogenous nonselective MC3 4 receptor agonist, given i.c.v. produces anxiogenic effects in various behavioral models including increased separation distress vocalizations in the chick149,150 decreased exploratory behavior in the hole-board test in the rat151 reduced time spent in the open arms of the rat EPM151 and decreased licking in the Vogel conflict model in rat.152 Similarly, the synthetic nonselective MC3 4 agonist MTII is active in the Vogel conflict model in the rat152 and decreases the amount of time rats engage in social interaction.153 The MC4 receptor antagonist, HS014, and the more selective antagonist, MCL-0020,...

Case Study

This final case study deals with the complexity of an animal model for irritable bowel syndrome (IBS) in combination with the fact that changes in gene expression are believed only to occur in a small subset of cells. The aim of this study was to investigate long-term changes in gene expression in viscera-specific neurons of both nodose ganglia (NG) and dorsal root ganglia (DRG) in a postinfectious mouse model of IBS.23 The pathogenesis of IBS is heterogeneous, but at least in a subpopulation of patients emotional stress and enteric infection have been implicated.24 Therefore, the mouse model of IBS that was chosen for this study consisted of a transient inflammation induced by the nematode Nippostrongylus brasiliensis (Nb) combined with exposure to stress. Gene expression profiles were measured both in NG and DRG visceral sensory neurons because the gastrointestinal tract receives dual extrinsic sensory innervation. Vagal afferents have their cell bodies in the NG and project...

Hypoparathyroidism

History may reveal damage to the parathyroid glands during some form of neck surgery. The patient may report many GI symptoms, including abdominal pain, nausea and vomiting, diarrhea, and anorexia. Signs of hypocalcemia such as paresthesia (numbness and tingling in the extremities), increased anxiety, headaches, irritability, and sometimes depression may be reported. Some patients complain of difficulty swallowing or throat tightness. Others report difficulty with balancing and a history of falls or injuries.

Flutamide

CNS Confusion, depression, drowsiness, anxiety, nervousness. Hematologic Anemia, leuko-penia, thrombocytopenia, hemolytic anemia, macrocytic anemia, me-themoglobinemia. Hepatic Hepatitis, cholestatic jaundice, hepatic en-cephalopathy, hepatic necrosis. Der-matologic Rash, injection site irritation, erythema, ulceration, bullous

Busulfan

Anemia, leukopenia, thrombocy-topenia. Pulmonary Bronchopul-monary dysplasia with interstitial pulmonary fibrosis. Ophthalmologic Cataracts after prolonged use. Der-matologic Hyperpigmentation, especially in clients with a dark complexion also, urticaria, erythema multiforme, erythema nodosum, alopecia, porphyria cutanea tarda, excessive dryness and fragility of the skin with anhidrosis, dryness of the oral mucous membranes, cheilosis. Metabolic Syndrome resembling adrenal insufficiency, including symptoms of weakness, severe fatigue, weight loss, anorexia, N& V, and melanoderma (especially after prolonged use). Also, hyperuricemia and hyperuricosuria in clients with chronic myelogenous leukemia. Oral Dry mouth, stomatitis, cheilosis. Miscellaneous Cellular dysplasia in various organs, including lymph nodes, pancreas, thyroid, adrenal glands, bone marrow, and liver. Also, gynecomastia, seizures after high doses, cataracts after prolonged use, hepatotoxicity, cholestatic jaundice,...

Azathioprine

Azathioprine can be hepatotoxic, and associated symptoms may include anorexia, nausea, fatigue, weight loss, jaundice, pruritis, dark urine, and elevated LFTs. Ideally, LFTs should be monitored every 2 weeks for the first 4 weeks and every 1-3 months thereafter (Gaffney and Scott 1998).

Child Psychiatry

Attention-deficit hyperactivity disorder (ADHD) as the name implies, affected children are hyperactive and have short attention spans. Males are affected more often than females. Look for a fidgety child who is impulsive and cannot pay attention but is not cruel. Treat with stimulants (paradoxical calming effect) such as methylphenidate (Ritalin) and dextroamphetamine, both of which may cause insomnia, abdominal pain, anorexia, and weight loss or growth suppression. Anorexia look for a female adolescent who is a good athlete and or student with a perfec-liomstie personality. Patients have body weight at least 15 below normal, intense fear of gaining weight ( or feel fat even though emaciated), and amenorrhea (all three are required for diagnosis). Death occurs in roughly 10-15 of patients as a result of complications of starvation and or bulimia (electrolyte imbalances, cardiac arrhythmias, infections). Some patients are hospitalized against their will for IV nutrition. Roughly...

NOC Fluid Balance

Assess for presence of associated symptoms diarrhea, fever, ear pain, UGI symptoms, vision changes, headache, seizures, high pitched cry, polydipsia, polyuria, polyphagia, anorexia, and so forth record intake and output, including all body fluid losses, IVs and oral fluids (specify frequency).

Dynamic body image

The study examines the validity of a body image questionnaire (FKB-20) assessing body image disturbances in a clinical sample (n 405 outpatients of a psychosomatic clinic) and two non-clinical samples (n 141 medical students and n 208 sports students). The criterion group was constituted by 98 patients of the clinical sample with diagnosed body image disturbances (anorexia, transsexualism, hypochondriac symptoms). The validity coefficients were 0.56-0.65. The sensitivity of the questionnaire was 82-90 , the specificity 90-97 , and the total mistake rate was 8-10 . The FKB-20 proves to have good validity and can be used for the diagnosis of body image disturbances.

Pirbuterol acetate

Contraindications Cardiac arrhythmias due to tachycardia tachycardia caused by digitalis toxicity. Special Concerns Safety and efficacy have not been determined in children less than 12 years of age. Additional Side Effects CV PVCs, hypotension. CNS Hyperactivity, hy-perkinesia, anxiety, confusion, depression, fatigue, syncope. Oral Bad taste or taste change, stomatitis, glossitis, dry mouth. GI Diarrhea, anorexia, loss of appetite, abdominal pain, abdominal cramps. Der-matologic Rash, edema, pruritus, alopecia. Miscellaneous Flushing,

Interferonalpha

The side effects from IFN-a during initial exposure to the drug are fever, chills, myalgias, and malaise which could be easily controlled with antipyretics. Dose related side effects are gastrointestinal complaints, metallic taste, anorexia, leucopoe-nia, decrease in platelet count, elevation of liver function tests as well as stupor, psychosis and peripheral neuropathy.

Sexspecific Behavior

Another behavioral sign of a sexually distinct nervous system comes from the prevalence of certain neurological and psychiatric diseases in males versus females. For example, both dyslexia and schizophrenia are more prominent in males (about 75 of cases), while anorexia nervosa is exhibited primarily by females (over 90 of cases). Many studies have also focused on the cognitive abilities of normal adult humans (Kimura, 1996). When presented with two figures drawn at different orientations, males are better able to mentally rotate the objects to determine whether the two figures are the same. In contrast, when presented with a picture containing many objects, females are better able to say which objects have been moved in a second picture. While these results tend to fascinate us, the challenge will be to understand what exactly is being measured and what its relevance is to behavior.

Nephrotic Syndrome

Patients may report no illness before the onset of symptoms others have a history of systemic multisystem disease, such as lupus erythematosus, diabetes mellitus, amyloidosis, or multiple myeloma or have a history of an insect sting or venomous animal bite. Symptoms usually appear insidiously and may include lethargy, depression, and weight gain. The patient may describe gastrointestinal (GI) symptoms of nausea, anorexia, and diarrhea. Initially, patients report periorbital edema in the morning and abdominal or extremity edema in the evening.