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Managing Crush Injuries on Arrival
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Sarvdeep Singh Dhatt, Deepak Neradi
Mannitol (osmotic diuretic and free radical scavenger) may be used to treat and prevent ARF. It also helps to reduce compartment pressure by osmotic diuresis and decreasing vascular permeability. However, due to possible complications [nephrotoxicity/congestive heart failure (CHF)], its use is controversial and should be started/titrated according to urine output. Furosemide (loop diuretic) should be avoided, as it acidifies urine and promotes myoglobulin precipitation. Hyperkalaemia is an early sign of cardiac arrhythmia and needs early corrective measures. Early administration of 15 g/day of sodium polystyrene sulfonate (potassium binder) can be used to prevent fatal hyperkalaemia due to reperfusion injury. Correction of hypocalcaemia should be avoided, as administered calcium gets trapped in injured muscles and causes metastatic calcification and rebound hypercalcaemia. Calcium should be used only to prevent hyperkalaemic cardiac arrhythmia. Allopurinol (xanthine oxidase inhibitor) given early may be used to protect from reperfusion injury to ischaemic cells by reducing free radical formation. Dialysis is required in hyperkalaemia/metabolic acidosis resistant to medical therapy, volume overload and uraemia. Dialysis is usually required two to three times daily for 2 weeks to restore renal function. Crush victims are at increased risk of sepsis, systemic inflammatory response syndrome (SIRS) or multi-organ failure; therefore, they require intensive care monitoring, aggressive treatment of open injuries and nutritional supplementation.
The Rheology of Hair Products
Published in Laba Dennis, Rheological Proper ties of Cosmetics and Toiletries, 2017
The strength of binding of cationic surfactants to anionic polyelectrolytes varies according to the chemical constitution of the polyelectrolyte. Strength of binding decreases in the order polystyrene sulfonate > dextran sulfate > polyacrylate > DNA > alginate > pectate > sodium CMC.
Pathology of drug-induced respiratory disease
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
William D Travis, Douglas B Flieder
Aspiration may be an indirect complication of drug toxicity if patients are impaired and thus predisposed to aspiration. Exogenous lipoid pneumonia is one of the most common forms of aspiration, resulting in either nodular masses or diffuse infiltrates that histologically are characterized by varying sized vacuoles associated with a spectrum of inflammation, histiocytes, giant cells and fibrosis. BAL can be useful in the diagnosis of lipoid pneumonia by identification of lipid-laden macrophages or identification of specific oils such as squalene using gas chromatography with mass spectrometry.23,34,35 However, more rarely substances such as barium or kayexalate (sodium polystyrene sulfonate) may be aspirated. Kayexalate is an enterally administered cation-exchange resin used for treatment of hyperkalaemia. The latter appears as basophilic, irregular, sharply angulated, fragmented particles with little tissue reaction.19,36
Amphetamine extended-release oral suspension for attention-deficit/hyperactivity disorder
Published in Expert Review of Clinical Pharmacology, 2019
Ann C. Childress, Heather Chow
The technology responsible for the ER of AMPH EROS is the composition of sodium polystyrene sulfonate – AMPH particles. Sodium polystyrene sulfonate is a resin that ionically binds to AMPH and the drug-resin complex forms micron-sized particles. AMPH EROS contains both IR and ER AMPH components. The ER component has an aqueous, pH-independent polymer coating of varying thickness. After swallowing, drug particles enter the gastrointestinal (GI) tract [24]. As positively charged ions from GI fluids diffuse across the coating, they displace drug ions from the product. AMPH ions diffuse through the coating and into the GI fluids for absorption. As the coating is of variable thickness, some drug product takes longer to diffuse and absorb, providing for the delayed drug release characteristics of AMPH EROS. AMPH EROS was designed to release about 50% of AMPH in the first hour [25].
An evaluation of sodium zirconium cyclosilicate: a new treatment option for hyperkalaemia in China
Published in Expert Opinion on Pharmacotherapy, 2023
Yuan Lu, Bi-Cheng Liu, Hong Liu
Sodium polystyrene sulfonate (SPS) has long been the most frequently used oral potassium-lowering drug in China (patiromer is not yet available in China), however, the gastrointestinal events associated with SPS (constipation, intestinal obstruction, intestinal perforation) are of concern to clinicians. In fact, in hospitalized and emergency patients who develop acute hyperkalemia in China, insulin with glucose intravenously is used more often to lower serum potassium, but this only shifts intracellular potassium without resulting in a net loss of potassium from the body. Loop diuretics promote renal excretion of potassium ions, but also promote excretion of sodium and calcium ions resulting in water and electrolyte disturbances. In severe hyperkalemia, dialysis is the preferred treatment option, but the process of preparing for emergency dialysis is cumbersome and time-consuming for patients without vascular access. For chronic hyperkalemia, a low-potassium diet is the traditional approach to long-term management. However, potassium is present in a wide range of common Chinese foods. It is often difficult for patients to identify and comply with dietary restrictions [13]. Moreover, low potassium diets are believed not to be nutritionally optimal and are associated with many diseases including cardiovascular disease, kidney stones, and osteoporosis [14]. Pharmacological interventions are therefore essential in long-term management. There is no sufficient evidence, however, to support the use of SPS for long-term treatment. Patiromer is a non-absorbable synthetic polymer that exchanges K+ for Ca2+ in the gastrointestinal tract, mainly in the colon, thereby reducing serum potassium concentrations [15]. It has lower side effects than SPS, however, it is not yet available in China. In addition, the use of a sodium-glucose cotransporter-2 inhibitor (SGLT-2i) has been shown to increase K+ excretion and to decrease the risk of hyperkalemia in patients on a MRA [16]. However, there are some limitations in the applicable population due to its effect on hyperkalemia in non-diabetic patients is unclear. Given the cardioprotective and renoprotective effects of SGLT-2i, further study results are expected. Overall, compared with other countries, fewer oral potassium-lowering drugs are available in China. This unmet need for treatment has become even more critical based on the large number of people suffering from hyperkalemia in China. Crucially, in patients with CKD, HF and DM, RAASi is often reduced or discontinued due to hyperkalemia, which is not beneficial in maintaining renal and cardiac protection. All of these conditions create a great therapeutic need for new potassium-lowering drugs that have a higher efficacy and safety profile, both in combination with standard protocols for rapid potassium reduction in acute hyperkalemia and for long-term use in chronic hyperkalemia.