PATHOLOGH

In most severe cases only, pathological changes in organs are observed. Liver becomes yellow in color. Microscopically, necrosis of central part of lobule, fatty change in the lever, are well demonstrated.

Kidneys commonly show nothing abnormal. Heart tends to be small due to myocardial atrophy with subendocardial haemorrhage. In brain, lesions resembling Wernick’s encephalopathy may develop in severe cases. The lesions are petechial haemorrhages, and areas of congestion in the hypothalamic region. The lesions may be due to the metabolic toxaemia, which is possible due to the deficiency of Vitamin B1 and C. Polyneuritis also develops in severe cases.

Biochemical and circulatory changes: Loss of water by excessive vomiting leads to dehydration, haemoconcentration and even oligaemic shock in a severe case. Loss of salt in vomitus causes fall of plasma sodium chloride in a severe case. Likewise as potassium is lost in large amounts in vomitus in a severe case, state of hypokalaemia can develop. Haemoglobin, blood haematocrit values can rise; likewise blood urea, uric acid levels will rise. Thus, hypotension develops. In case of persistent hypotension below 80 mmHg., systolic pressure, oliguria and anuria can develop. Hepatic dysfunction due to starvation leads to ketosis and acidosis. Cerebral symptoms are partly due to petechial haemorrhages and also perhaps due to the water and electrolyte depletion.

Thus in this condition, in a severe case, there are excessive vomiting, starvation, dehydration, hepatic and cerebral dysfunctions. Severe form of this condition is now seldom encountered because of early treatment.