Adult acetonemic vomiting complicated with low body weight in a subject with Mycobacterium avium complex pulmonary disease: A case report

Abstract BackgroundPulmonary diseases often bring about a significant health issue and nutritional disorders. Weight loss and malnutrition are related to the severity of obstructive disorders. Therefore, such patients easily fall into lack of nutritional energy. Acetonemic vomiting is caused by acetonemic syndrome and recently it has been considered that acetonemic vomiting can occur at any age from infancy to adulthood. It is considered that acetonemic vomiting is likely brought about in subjects with low body weight, because stored carbohydrates in the body are reduced and fats are mainly utilized. As the results, large amounts of acetone are produced, which causes nausea and vomiting together with hypoglycemia.Case presentationA 79-year-old Japanese woman was brought to an emergency room with symptoms of nausea and vomiting. She was diagnosed as MAC pulmonary disease at the age of 52. Her height, body weight and body mass index (BMI) were 155.4 cm, 33.5 kg and 13.9 kg/m2, respectively. she had slight hypoglycemia and urinary ketone bodies. Surprisingly, she had been hospitalized four times within one year and her main complaint in every hospitalization were nausea and vomiting. Moreover, at every hospitalization, she had repeated slight hypoglycemia and urinary ketone bodies. Based on such findings, we finally diagnosed her as acetonemic vomiting complicated with low body weight. We started the education and diet therapy for her and after then she has not been hospitalized for one year.ConclusionsWe should bear in mind that the subjects with pulmonary diseases are often complicated with low body weight and thereby they could have acetonemic vomiting with slight hypoglycemia and ketosis. It is very important that such pulmonary diseases patients with low body weight and repeated nausea and/or vomiting get appropriate education and diet therapy, because their repeated symptoms can be mitigated by such therapy.