Through the years, various studies (1-5) have been done regarding the prevalent practice of adding one or more drugs to parenteral fluids. The greater variety of drugs being used intravenously, plus the formulation of newer and more complex parenteral fluids, has led to an increased awareness of potential incompatibilities existing between drug and solution. Recognition of the hazards of such extemporaneous combinations has necessitated the study of drug stability in solution. The objective of this report is to determine compatibility characteristics of admixtures prepared from a series of balance intravenous electrolyte solutions and a group of commonly used therapeutic agents. Visual, spectrophotometric and microbiological assay techniques are to be used to establish the compatibility profiles of these admixtures.

The use of the alimentary route to supply essential nutrients, either by mouth or nasogastric tube, is by far the best. This route, however, requires an intact and functioning gastrointestinal tract which may be found in certain chronic intestinal diseases, malignant tumors, and cases of gastrointestinal obstruction. In there and certain other clinical situations, parenteral feeding is necessary to provide essential nutrients normally provided in the diet. The intravenous route of administration is generally recognized as the most effective means of systemic administration. Yet, considering the other routes used clinically, it is of relatively recent development. Parenteral therapy began in 1616 with the discovery of the circulatory system by the English physician William Harvey. In 1656, Sir Christopher Wren successfully gave intravenous injection to dogs. Later years saw experimentation with attempts at parenteral therapy, especially blood transfusions, with little or no succes. It was not until the early nineteenth century that Thomas Latta, in Scotland, used saline with great success to treat the intractable diarrhea of cholera. He is considered to be the first man to use intravenous injection in terms of relational therapy. On the basis of the data presented here, it appears that the major compatibility problem in protein hydrolysatedextrose solutions will be that of high concentrations of calcium and phosphate ion. The compatible concentration ranges for these electrolytes have been mapped in Table VI. If a precipitation of calcium phosphate is to occur, it will be manifested almost immediately after admixture of the components. It has been demonstrated that greater concentrations of these ions will be tolerated by Polynute if the calcium component is added last (see Table VIIL). The reason for this phenomenon remains unclear. The maximum compatible concentrations does not seem to be affected by the addition of the other drugs included in this work. Common additives such as vitamins, insulin, heparin, and magnesium have not been shown to produce physical incompatibilities, in usual therapeutic concentrations.

Aim: To compare the effects of i.v. iron sucrose and Fe chloride on the iron indices of haemodialysis patients with anaemia. Methods: One hundred and eight haemodialysis patients receiving recombinant human erythropoiesis- stimulating agent (ESA) (mean age 59.37 years) were enrolled and randomly assigned to an iron sucrose or an Fe chloride group. Iron supplements were administered at 100 mg/week during the first 4 weeks (loading dose). Ferritin and transferrin saturation (TSAT) were then measured and dose adjusted. Ninety-eight subjects completed treatment; 51 in the iron sucrose group and 47 in the Fe chloride group. Ferritin, TSAT, haematocrit (Hct), reticulocyte count, serum albumin, fractional clearance of urea (Kt/V) and intact parathyroid hormone (iPTH) were measured. Results: There was no significant difference in baseline characteristics between the groups. Significant differences between the groups were observed in both iron indices and ESA dosage. Hct at week 24 (31.1% vs 29.7%, P = 0.006) and ferritin at week 20 (731.3 vs 631.7 ng/mL, P = 0.006) in the iron sucrose group were significantly higher than in the Fe chloride group. ESA dosage used in the iron sucrose group at week 8 was significantly lower than in the Fe chloride group (244.9 vs 322.6 U/kg per month, P = 0.003), and iron sucrose group received significantly lower iron dose than the Fe chloride group at week 8 (P = 0.005). Conclusion: Although the differences in ESA dosage, ferritin and iron dosage between two groups were found during the study period while similar results were shown at the end of 24 week study. Thus, iron sucrose and Fe chloride are safe and work equally well for haemodialysis patients.

What is known and objective: Amphotericin is the preferred treatment for pulmonary histoplasmosis during pregnancy. The long half-life of amphotericin supports less than daily administration. Case summary: A 28-year-old pregnant woman diagnosed with recurrent pulmonary histoplasmosis was initiated on liposomal amphotericin 250 mg (4 mg/kg) intravenously daily. After 2 weeks, the patient was discharged and successfully received 250 mg thrice weekly at a hospital-associated outpatient infusion centre. After 6 weeks of outpatient treatment, a chest X-ray demonstrated no remaining disease and therapy was discontinued. What is new and conclusion: Administration of thrice-weekly liposomal amphotericin in a hospital-associated, outpatient infusion centre may be a promising option for stepdown treatment in patients unable to take itraconazole.

No description available.

Bakgrund: Parenteral nutrition kan ges vid i stort sett alla tillstånd när magtarmkanalen ej fungerar eller kan utnyttjas tillfredställande. Benigna tarmsjukdomar, t ex Morbus Crohn eller short bowel syndrome av annan anledning är den vanligaste orsaken till HPN (home parenteral nutrition). En europeisk studie från 1997 visar att incidensen för HPN i Danmark är 2,8 patienter/miljoner invånare/år. Vanligen är patienten uppkopplad till HPN-utrustningen 12-14 timmar/dygn. WHO (World Health Organisation) har utarbetat en definition av livskvalitet; ”Quality of life is defined as individuals’ perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.” Syfte: Syftet med denna litteraturstudie är att undersöka och beskriva hur patienter med parenteral nutrition i hemmet upplever sin livssituation och behandlingens inverkan på livskvaliteten. Metod: Studien är en litteraturstudie där tio kvantitativa/kvalitativa artiklar valts ut från PubMed och granskats enligt Carlssons & Eimans bedömningsmallar. Resultat: Tre teman framkom; fysiska faktorer, psykiska faktorer och sociala faktorer. Resultatet visar en negativ påverkan på livskvaliteteten i olika aspekter. Dock visar en av studierna att livskvaliteten förbättras efter HPN. Slutsats: I jämförelse med normalbefolkningen och patienter med korttarmssyndrom utan behov av HPN tyder denna litteraturstudie på låg livskvalitet hos patienter med HPN.

Background: It has been hypothesized that dysbiosis plays a significant role in the pathogenesis of intestinal failure–associated liver disease (IFALD). Therefore, we aimed to investigate the effect of probiotics on IFALD in patients receiving parenteral support, namely home parenteral nutrition (HPN) and home intravenous fluids (HIVFs). Methods: We retrospectively reviewed charts of patients with intestinal failure who received HPN or HIVF for >2 weeks at our tertiary center between January 2005 and August 2016. We excluded patients <18 years of age, patients with other causes of liver disease, patients who used probiotics for <30 days, patients with <6 months' follow-up, and those who had long-term antibiotic use (>30 days). Bivariable and multivariable logistic regression analyses were used in this study. Results: A total of 282 patients who received parenteral support were included. Eighty-five percent of our sample received PN. A total of 78 (27.7%) patients used probiotics. The prevalence of IFALD in patients who used probiotics was 35.9% vs 54.4% in patients who did not use probiotics, P =.005. In multivariable analysis, only small-bowel length of 10-90 cm and HPN use showed a significant impact on IFALD, odds ratio (OR) = 4.394 (95% confidence interval [CI], 1.635-11.814; P =.003) and OR = 4.502 (95% CI 1.412-14.351; P =.011), respectively. Conclusion: Our study revealed that the prevalence of IFALD was comparable among the probiotic users and nonusers. Only small bowel length of 1090 cm and HPN use showed a significant impact on IFALD.

Treatment of enterococcal endocarditis requires up to 6 weeks of intravenous (IV) antimicrobial therapy. When susceptible, an ampicillin-based regimen is preferred. Studies evaluating ampicillin stability utilizing high-pressure liquid chromatography have indicated enhanced stability (greater than 24 hours at room temperature), supporting outpatient administration. Thus, we report the successful treatment of a 30-year-old male with tricuspid valve enterococcal endocarditis in an outpatient setting using continuous infusion ampicillin via an ambulatory infusion pump. The patient received daily gentamicin at an outpatient infusion center with the ampicillin dose to be infused over the next 24 hours. Outpatient ambulatory infusion pumps allow for delivery of ampicillin via continuous infusion or pump-programmed pulse dosing. Preparation and administration in an outpatient infusion center may be a viable option to circumvent stability and delivery issues. Furthermore, 81% (34/42) of treatment days were completed outpatient, supporting that this approach may increase access to treatment and help reduce the economic burden to health care.

<p>The objective for this work is to identify and develop an intramuscularly delivered cyanide scavenger. This dissertation outlines in vitro methods which are used to evaluate platinum-based complexes for the potential to scavenge cyanide. Examples of the in vitro techniques used are HPLC, UV-Vis and an ion-selective electrode as orthogonal strategies to monitor cyanide scavenging. Intramuscular formulations for the active platinum-based scavengers are prepared and evaluated for stability. Subsequently, the formulations are tested by collaborating labs for in vivo efficacy. In addition, Sprague Dawley rat studies are employed to investigate the potential toxicity for several platinum complexes. Taken together, this dissertation outlines a short list of novel platinum-based cyanide scavengers as potential alternatives to legacy cobalt-based scavengers. </p>

No description available.