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Introduction to Drugs and Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Profound physiological changes occur throughout pregnancy (Table 1.2). Maternal enzymes, particularly cholinesterases (Pritchard, 1955), have lowered activity in pregnancy. Maternal blood volume increases by approximately 40–50 percent during pregnancy to support the developing fetus’s requirements (Cunningham et al., 2017). Increased blood volume may lower serum concentrations through increased volume of distribution. Absorption of drugs occurs with kinetics similar to the non-pregnant adult. Renal clearance is increased in pregnancy and enzyme activity is often downregulated. Increased blood volume exacerbates pregnancy-associated decreased enzyme activity levels, decreasing the overall effective serum concentration of a given dose. Increased renal output causes an increased clearance index for most drugs. Drugs tightly bound to serum proteins have little opportunity to cross the placenta or enter breast milk. Pregnancy changes place increased demands on cardiovascular, hepatic, and renal systems. The gravid uterus is vulnerable to a variety of effects not present in the non-pregnant state, such as hemorrhage, rupture, or preterm contraction.
Body fluids and electrolytes
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
If oral replacement is not enough or if the situation is severe, intravenous therapy solutions are used to replace and restore the circulating blood volume. As the body needs more than water for maintenance, electrolytes are also required. The fluids should be administered at a rate rapid enough and in sufficient quantity to maintain adequate tissue perfusion, taking the patient’s cardiac and renal functions into consideration. The patient might require a fluid challenge, when specific volumes are administered at a specific rate and intervals, while monitoring the patient’s haemodynamic status and response to ensure that there is an adequate renal result.
Functions of the Cardiovascular System
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
The normal total blood volume is 5–6 L in males and 4–5 L in females. When a subject is supine, 75% of the blood volume is in the systemic circulation, 16% in the pulmonary circulation and 8% in the heart. Some 6% of the total blood volume is in the systemic capillary exchange vessels, 60% in the veins and 15% in the arteries and arterioles. In the pulmonary circulation, 3% of the total blood volume is in the pulmonary capillaries, with 8% in the arteries and 5% in the veins. When standing, the volumes in the heart and pulmonary circulations fall to 6% and 9% of total blood volume, respectively, and the amount in the veins increases.
Pinealectomy and melatonin administration in rats: their effects on pulmonary edema induced by α-naphthylthiourea
Published in Drug and Chemical Toxicology, 2023
Mohammed Raed Abdullah Al Gburi, Eyup Altinoz, Hulya Elbe, Melike Ozgul Onal, Umit Yilmaz, Nesibe Yilmaz, Melike Karayakali, Mehmet Demir
Pulmonary edema is a clinical disorder leading to respiratory failure (Barile 2020). The disorder is observed due to the hydrostatic effect of elevated pulmonary vascular pressure and blood volume. The Alveolar-capillary membrane is an extremely thin structure that allows optimal gas exchange and serves as a barrier to fluid accumulation in the alveolar space, limiting the diffusion of solute volumes physiologically (Comellas and Briva 2009). There is a significant balance between alveolar fluid uptake and secretion in the maintenance of optimal gas exchange in the alveolar space. The alveolar-capillary membrane’s increased permeability allows the passage of fluid and protein into the interstitial fluid space and alveoli (Casey et al. 2019). Excessive accumulation of pleural fluid was described as pleural effusion (PE), which leads to a common problem induced by several mechanisms and disorders (Allibone 2006). Several lung diseases could be associated with PE. PE plays a key role in the respiratory system, especially the normal changes associated with age that compromise the respiratory system (Wing 2004). In particular, it reduces pulmonary gas exchange while leading to restriction of lung functions based on the fluid volume and the reduction in lung compliance (Ruiz et al. 2006).
Minimally invasive capillary blood sampling methods
Published in Expert Review of Medical Devices, 2023
Michael S. F. Hoffman, James W. McKeage, Jiali Xu, Bryan P. Ruddy, Poul M. F. Nielsen, Andrew J. Taberner
Volumetric absorptive microsampling (VAMS) is a more advanced DBS sampling method for the remote collection of capillary blood. VAMS overcomes the spot area bias and homogeneity issues associated with the conventional DBS method [93]. The hydrophilic polymeric tips of VAMS samplers use capillary action to wick up a fixed volume blood sample (less than 50 µl) into a porous substrate, regardless of the haematocrit, in less than 4 seconds [93]. The blood volume absorbed is determined by the properties and amount of substrate. The VAMS sample is dried for 2 hours at room temperature and then sent via mail to a central laboratory for analysis. The VAMS sampler can be integrated into automated bioanalytical procedures in the laboratory. This simple, user-friendly dried blood collection approach reduces analysis costs, the number of clinical visits, and may be used to monitor study drug adherence.
Relationship between the prognostic nutritional index and resistant hypertension in patients with essential hypertension
Published in Clinical and Experimental Hypertension, 2022
Fatih Yılmaz, Meryem Keleş, Feyza Bora
PNI is a screening tool that displays both nutritional and inflammatory status. A low PNI level means a decrease in albumin and or TLC. PNI may be more valuable as a prognostic marker than serum albumin or (TLC) alone. Serum albumin has anti-inflammatory, antioxidant, anticoagulant, and antiplatelet aggregation activity as well as physiological properties as the main determinant of blood colloid osmotic pressure (38). Increased colloid osmotic pressure due to high serum albumin levels is associated with increased blood volume. High blood volume leads to high preload and increased myocardial load (24). In addition, albumin draws sodium and potassium into the intravascular space and further increases the expansion of the intravascular volume. It was observed that albumin levels above 40–50 g/L levels in both men and women were associated with an increase in SBP and DBP (39). High serum albumin levels can stabilize the circulating inflammatory cytokines and oxidative stress markers. In our study, there was no difference in serum albumin levels between the (CHTN) and healthy groups, but the albumin level was significantly lower in patients with RHTN (p < .05). Serum albumin is considered a negative acute-phase reactant that decreases in response to systemic inflammation. Hypoalbuminemia resulting from an increased inflammatory response is associated with inflammatory cytokines, including IL-1, IL-6, and TNF-α, which direct metabolism toward a catabolic state (40,41). Therefore, a lower albumin level may suggest impaired immunonutritional status.