Hollander (Basal Gastric Secretion) Test
Norm of Hollander (Basal Gastric Secretion) Test
Complete vagotomy:
No acid secretion observed within 45 minutes of insulin-induced hypoglycemia.
Incomplete vagotomy:
Acid secretion is >20 mmol/L if total acid output is >2 mmol/hour.
Usage of Hollander (Basal Gastric Secretion) Test
Evaluate the effectiveness of a vagotomy.
Description of Hollander (Basal Gastric Secretion) Test
The Hollander test, usually performed 3–6 months after a surgical vagotomy, involves injection of insulin intravenously into a client with an otherwise normal blood glucose level. The vagus nerve responds to hypoglycemia by stimulating gastric acid secretion. Thus in the presence of hypoglycemia, increased acid production indicates an incomplete vagotomy, and absence of acid production indicates a complete vagotomy.
Professional Considerations of Hollander (Basal Gastric Secretion) Test
Consent form IS required.
Risks
Hypoglycemic seizures, strokes, myocardial infarction, and deaths have been reported during this test. Complications of nasogastric tube insertion include bleeding, dysrhythmias, esophageal perforation, laryngospasm, and decreased mean po2.
Contraindications
Hypoglycemia, coronary artery disease, or cerebrovascular disease.
Preparation
- The client should have patent intravenous access.
- Obtain regular insulin, a nasogastric tube and an irrigation syringe, a needle, a syringe, a fluoridated gray-topped tube, and an ampule of dextrose 50.
- See Client and Family Teaching.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
Procedure
- Insert the nasogastric tube, aspirate gastric contents, and place the contents in a container for measurement.
- Inject an intravenous bolus of 0.1–0.2 U/kg of body weight of regular insulin. After the blood glucose level falls to <50 mg/dL (usually within 30 minutes), the gastric contents should be aspirated.
- If post insulin gastric acid production exceeds the reinjection amount of gastric acid, the vagotomy is likely incomplete.
Postprocedure Care
- Monitor vital signs every 15 minutes × 4 and then every hour × 4. Monitor closely and treat for complications (listed in option 3 under Client and Family Teaching).
- Monitor blood glucose level every hour × 2. Provide food sources of glucose as needed if hypoglycemic symptoms appear.
Client and Family Teaching
- Fast from food for 12 hours and from liquids for 8 hours before the test.
- Do not smoke for 8 hours before the test.
- A nasogastric tube will be inserted through your nose into your stomach. Insertion may be uncomfortable and cause a pressurelike feeling or cause you to gag and cough. You will be asked to take sips of water and swallow to make tube insertion easier.
Factors That Affect Results
- Prednisolone is known to inhibit basal gastric secretion in rats.
- Epidermal growth factor (EGF) significantly reduces basal gastric secretion.
Other Data
- The ethanol extract of Amla (Emblica officinalis Gaertn) decreases basal acid secretion.
