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Prednisolone
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
In the period 1990-2008, in the same clinic in Leuven, Belgium, 315 patients were diagnosed with contact allergy to/allergic contact dermatitis from corticosteroids. Eighteen subjects (5.7%) presented with allergic manifestations (conjunctivitis, eczema of the face, periocular skin or eyelids) caused by the use of CS-containing ocular preparations. Three patients had used ophthalmic preparations containing prednisolone and one prednisolone pivalate (4, overlap with ref. 3). The former is probably incorrect, as prednisolone in eye drops is used as an ester (acetate, pivalate, disodium phosphate).
Phenytoin
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
The main advantages of PHT in the treatment of status epilepticus are its effectiveness in controlling convulsions, relatively long half-life, and lack of significant central nervous system depression. Disadvantages are its cardiovascular toxicity if given too rapidly, the time required for giving the full loading dose, and its relative ineffectiveness in suppressing focal epileptic activity. Phenytoin is effective in suppressing experimental seizures as soon as adequate brain concentrations are attained, which, in rats, is only a few minutes. The parenteral form of PHT was developed in the 1950s originally for intramuscular (i.m.) use. Ironically, it is poorly absorbed by this route because it crystallizes in muscle and should not be given i.m. The currently available preparation contains propylene glycol and ethanol. Propylene glycol itself is cardiotoxic (44). The PHT preparation currently available in the United States may be diluted to 5 mg/ml or less in normal saline solution (45). This permits steady administration by infusion equipment. Injection of a bolus of undiluted PHT by hand can be dangerous. Blood pressure and EKG should be monitored during PHT infusion. To overcome these problems with the current preparation, a disodium phosphate ester of phenytoin has been developed. It is water soluble and has an excellent safety profile given i.v. or i.m. (46). If a person’s seizures do not respond to PHT infusion, there is a very high probability that a significant acute CNS insult has occurred. PHT infusion may thus aid in diagnosis.
High-Performance Liquid Chromatography
Published in Adorjan Aszalos, Modern Analysis of Antibiotics, 2020
Joel J. Kirschbaum, Adorjan Aszalos
A 5-μm octadecylsilane column (150 × 4.6 mm) was used to resolve penicillin from penicilloic, penilloic, and penicillic acids using 0.008 M tetrabutylammonium chloride in 0.006 M phosphate buffer-acetonitrile (70:30), pH 6–7.5, flowing at 1.5 ml/min into a 254 nm detector. Penilloic acid was partly resolved into two peaks, which may represent the R and S diastereomers [287]. Degradation in acid media was investigated using an anion-exchange column with a mobile phase of 15.4 ml of 0.1 M citric acid and 7.0 ml of 0.2 M disodium phosphate diluted to 650 ml water (pH 3.8) flowing at 0.7 ml/min into both refractive index and 254 nm UV detectors. Benzylpenicillenic acid, benzylpenilloic acid, penicillamine, benzylpenillic acid, and benzylpenamaldic acid were resolved [288]. The first compound was detected after 4 hr. and the last four were still present after 48 hr.
Toxicity of phosphate enemas – an updated review
Published in Clinical Toxicology, 2022
Rosa Hamilton Smith, Michael Eddleston, D. Nicholas Bateman
In the UK and US, sodium phosphate enemas contain osmotically active phosphate. Commonly used preparations include Sodium Acid Phosphate with Sodium Phosphate (Fleet Enema®; dihydrogen phosphate dihydrate 12.8 g with disodium phosphate dodecahydrate 10.24 g, in water to 128 mL; ∼1400 mM with an osmolality of >2200) [1] and Sodium Phosphates Enema (monobasic sodium phosphate 19 g with dibasic sodium phosphate 7 g in water to 118 mL), the amount prescribed varying slightly from product to product. The dose is usually prescribed as a volume and depends on patient age, 2–4 years 25% adult dose (∼30–35 mL); 5–11 years 50% adult dose (∼60–70mL); over 12 years full dose (118–128 mL). The phosphate solution has osmotic action and works by pulling water into the lower bowel, softening and expanding the stool, resulting in a build-up of pressure that triggers peristalsis and allows defaecation to take place, usually within only a few minutes. This rapid expulsion of an enema with the stool results in low exposure of the gut to the high phosphate dose. However, occasionally, the sodium phosphate solution is retained in the gut lumen and then absorbed, which can lead to water and electrolyte imbalances, and resultant clinical consequences [2]. Adverse effects resulting from rapid increases in serum phosphate with resultant changes in calcium and magnesium, or effects from the excess movement of fluid into the bowel lumen from the blood.
The Role of 18F-FDG PET/CT in Suspected Intraocular Sarcoidosis and Tuberculosis
Published in Ocular Immunology and Inflammation, 2021
C. Burger, J. L. Holness, D. P. Smit, S. Griffith-Richards, C. F. N. Koegelenberg, A. Ellmann
Some patients may have had false negative PET/CTs as they received either corticosteroids (peribulbar injections or oral) or methotrexate (1 patient) prior to the PET/CT. Steroids reduce the sensitivity of PET/CT performed for other inflammatory diseases e.g. large vessel vasculitis.23 The impact peribulbar corticosteroid injections could have on FDG uptake may have been underestimated. According to Weijtens et al,24 the serum concentration of a peribulbar injection of 5 mg dexamethasone disodium phosphate is similar to the serum concentration after the oral administration of 7.5 mg, which is of similar potency to 50 mg oral prednisone. Also, the curves of the serum concentration after peribulbar administration and intravenous administration appeared similar. We recommend that if a PET/CT is considered, it should be performed before administering systemic or local corticosteroids other than topical drops.
An expert update on novel therapeutic targets for hyperphosphatemia in chronic kidney disease: preclinical and clinical innovations
Published in Expert Opinion on Therapeutic Targets, 2020
Mario Cozzolino, Markus Ketteler, Carsten Alexander Wagner
In general, phosphate bioavailability is considerably lower for plant-derived phosphate (e.g. vegetables), compared to meat sources [75]. This is likely attributed to a lower phosphate: protein ratio and the fact that phosphate derived from vegetables (phytate) is absorbed to a lower extent (<50%). Almost all processed foods contain phosphate additives, such as disodium phosphate, monosodium phosphate, and potassium triphosphate, to preserve their color and shelf lives. What is of particular concern is the fact that this ‘bad’ phosphate (e.g. processed foods) is almost completely absorbed (from 80-100%) in the intestine [76,77], compared to only 30-70% by naturally occurring phosphates (phosphoproteins, phospholipids, phosphate esters) [78]. In Western diets, achieving adequate phosphate restriction is challenging due to the high phosphate content (1–1.6 g/day) [79].