Randomised trial of intravenous high dose metoclopramide and intramuscular chlorpromazine in controlling nausea and vomiting induced by cytotoxic drugs.

topical steroids. Examination showed a brownish-red, sharply marginated scaly plaque overlying the knuckles and proximal phalanges, candidal cheilitis, a vulval rash, and a non-healing sore on the right foot. Her lifelong epilepsy had necessitated treatment with phenobarbitone, carbamazepine, and phenytoin. Substitution of high dose sodium valproate for phenytoin in 1981 had induced dose related vomiting with a weight loss of 25-4 kg (original weight 90 kg), diffuse alopecia, and dry skin. After seven months sodium valproate had been changed to phenytoin, but the weight loss continued with dysgeusia, refusal of food, vomiting, and alternating diarrhoea and constipation. No organic cause had been found, and behavioural problems had necessitated psychiatric referral. Zinc deficiency was diagnosed clinically. Serum zinc concentration was 8-2 ymol/l (54 /Lgfl100 ml) (laboratory normal 12-7-20 Hmol/l (83-131 jug/l00 ml)). Serum albumin concentration was not measured at the time of diagnosis but had been normal throughout 1982-3 until two months previously. All signs and symptoms responded to oral zinc sulphate within two weeks. Relapse did not occur despite continuing treatment with phenytoin and carbamazepine.