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Colloid versus Crystalloids
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
For the patient with hypotension due to hypovolemia, one of the first therapeutic interventions is fluid replacement. The options for replacement include crystalloids or colloids. The three main crystalloids are hypertonic saline, normal (0.9%) saline (NS), and balanced (buffered) salt solutions. The most commonly used balanced salt solution in the United States is lactated Ringer's (LR). The colloids include albumin, starch, and gelatin solutions.
Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Beware of hypovolaemia. This can cause or exacerbate hypertension [10]. Also, it is sometimes difficult to decide whether fits in the presence of hypertension are the cause or an effect. In a post-ictal patient, the magnitude of BP increase has been found to be a useful clinical parameter to exclude a hypertensive crisis [11].
Recognition and management of cardiopulmonary arrest
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Hypovolaemia: this may be a primary cause of PEA, often due to severe bleeding: Bleeding may be obvious, as in severe trauma, or hidden, as in the case of a gastrointestinal bleed.Hypovolaemia may also be caused by severe dehydration, for example, as a result of prolonged or excessive diarrhoea and vomiting.Circulating volume should be restored rapidly with delivery of blood and/or fluids and, if necessary, surgery to stop the haemorrhage.
Link between body weight changes and metabolic parameters in drugs naïve subjects with type 2 diabetes treated with canagliflozin monotherapy
Published in Hospital Practice, 2020
Eiji Kutoh, Asuka Wada, Alexandra N. Kuto, Jyunka Hayashi, Rumi Kurihara
There are a number of explanations for this unexpected result in group C. Firstly, the subjects in group C are somewhat lean (mean baseline BMI is 26.39 ± 6.70). Patients who have poor glycemic control are often hypovolemic and underweight. With canagliflozin, the glycemic control improves and the anabolic effects of insulin (increased lipogenesis) may occur. Secondly, another possible mechanism of weight gain may be control of food intake. It has been reported that SGLT-2 induces appetite due to the compensatory loss of energy (glucose) excretion into the urine [1–3]. Patients with improved glycemic control probably have a tendency to eat more. Alternatively improved glycemic control makes patients have more appetite. These backgrounds may have led to body weight gain in the subjects in group C. This weight gain could have unfavorable effects on lipids (or other parameters such as blood pressure). However, in this study, no effects on atherogenic lipid levels were noted with canagliflozin (Table 6).
ENHANZE® drug delivery technology: a novel approach to subcutaneous administration using recombinant human hyaluronidase PH20
Published in Drug Delivery, 2019
Kenneth W. Locke, Daniel C. Maneval, Michael J. LaBarre
According to the US prescribing information, HYLENEX recombinant (150 U) can be injected prior to the start of subcutaneous fluid administration to facilitate absorption of 1000 mL or more of solution (U.S. Food and Drug Administration, 2005). The dose, rate of injection, and type of solution need to be adjusted on an individual basis. Hypovolemia can be avoided by using solutions containing adequate amounts of inorganic electrolytes and/or controlling the volume and speed of administration. HYLENEX recombinant may also be added to small volumes of fluid replacement solutions or solutions of drugs for SC injection, with specific fluid dosage dependent upon age, weight, clinical condition and laboratory parameters. The dispersion and absorption of other injected or SC infused drugs can also be enhanced by pre-administration of HYLENEX recombinant or by adding 50–300 U (typically 150 U) hyaluronidase to the injection solution prior to infiltration, interstitial, intramuscular, intraocular, retrobulbar, soft tissue or SC use. Finally, HYLENEX recombinant may also be used to facilitate SC administration of urographic contrast media when IV administration is difficult to achieve, particularly in infants and small children. (U.S. Food and Drug Administration, 2005).
A Radical Approach to Ebola: Saving Humans and Other Animals
Published in The American Journal of Bioethics, 2018
Sarah J. L. Edwards, Charles H. Norell, Phyllis Illari, Brendan Clarke, Carolyn P. Neuhaus
Ebola is extremely difficult to model in other animals, and this presents another practical barrier to vaccine development. Mice, hamsters, and guinea pigs have all been developed as animal models of infection for a number of species and strains of Ebola virus and Marburg virus. Yet (as with most research on animal models) these rodent studies alone are insufficient to reliably guide human vaccine development, as they do not exhibit the symptoms of disease present in the typical human case of Ebola—that is, abrupt onset with flu-like symptoms, including fever, malaise, and myalgia, followed by anorexia, lethargy, nausea, vomiting, and diarrhea. Hemorrhaging can develop, particularly in severe cases at the peak of illness, and include petechiae, uncontrolled bleeding from venipuncture sites, epistaxis, and other mucosal hemorrhages. Fatal cases are accompanied by hypovolemic shock and multiple organ failure.