Abstract
Diabetic patients often have a complicating depression or neurosis which is sometimes indistinguishable from autonomic neuropathy or diabetic central neuropathy. We report a 33-year-old female office worker who responded to antidepressants against recurrent nausea and vomiting. She was admitted this hospital for the fourth time because of nausea and vomiting since the onset insulin-dependent diabets in 1971. Physical examination revealed proliferative diabetic retinopathy, diminished ankle jerk reflexes and a vibratory sensation. Laboratory findings on admission are summarize as follows: fasting plasma gluccose 430 mg/dl, urinary ketone bodies (2+), HbA1c 9.3%, base excess of arterial blood -6.6mEq/l. It took three months until the vomiting was cured with improvement of diabetic control. She was repeatedly admitted to this hospital in spite of good diabetic control and no evidence of diabetic ketoacidosis. No abnormality was found by EEG, brain scan, or spinal fluid examination.
The coexistence of autonomic neuropathy was demonstrated by a decreased coefficient of variation of the R-R interval on EEG (0.07%) and orthostatic hypotension. An upper GI series did not reveal any sign of gastric dilatation, diminished peristalsis or prolonged retention of barium. The patient was started on antidepressants, which alleviated her symptoms for the next 12 months. The present case suggests that depression might contribute to hyperemesis of unknown origin in some cases of diabetes.
