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Tube Feedings Formulas and Methods
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Such liquefied pharmaceuticals often contain a significant amount of sorbitol. Examples of these include liquid acetaminophen, furosemide and metoclopramide. The sorbitol contained within these products can be sufficient to be a possible cause of diarrhea. Electrolyte replacement therapy such as potassium chloride solutions can be hypertonic and may be irritating to the gastrointestinal (GI) system.
Other Complications of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
In intestinal enteropathy, treatment of diarrhea is primarily empiric, to relieve symptoms, correct fluid and electrolyte imbalances, improve blood glucose control and nutrition, and manage underlying causes. Antidiarrheals must be used carefully since they can cause toxic megacolon. Constipation may alternate with diarrhea. Treatment includes adequate hydration, regular physical activity, and increased intake of fiber. Sorbitol or lactulose may be helpful for constipation, and saline or osmotic laxatives may be required for more severe cases.
Macronutrients
Published in Chuong Pham-Huy, Bruno Pham Huy, Food and Lifestyle in Health and Disease, 2022
Chuong Pham-Huy, Bruno Pham Huy
The polyols, such as sorbitol, are alcohols of glucose and other sugars. They are found naturally in some fruits and are made commercially by using aldose reductase to convert the aldehyde group of the glucose molecule into the alcohol. Sorbitol is used to replace sucrose in the diet of people with diabetes (8).
Sodium zirconium cyclosilicate for the management of chronic hyperkalemia in kidney disease, a novel agent
Published in Expert Review of Clinical Pharmacology, 2021
Anjay Rastogi, Ramy M. Hanna, Anita Mkrttchyan, Maham Khalid, Sinan Yaqoob, Kelly Shaffer, Puneet Dhawan, Niloofar Nobakht, Mohammad Kamgar, Ray Goshtaseb, Kristine Sarmosyan, Mariarosaria Gnarini, Olivia Wassef, Edgar Lerma
Generally, SPS was packaged with sorbitol which induces diarrhea and helps eliminate colonic potassium [27]. Rectal administration of SPS has been problematic and has been associated on several occasions with colonic necrosis, especially in formulations with added sorbitol [27]. This has resulted in a change in recommendations, moving away from SPS with sorbitol. Most commonly SPS/sorbitol use induces diarrhea, while part of its mechanism of action is not desirable from a patient point of view. SPS has not been studied or approved for the treatment of chronic hyperkalemia, and the longest follow-up study was in 14 patients followed over 14.5 months without colonic necrosis [28]. Without larger scale studies and longer follow-up, SPS does not have sufficient evidence to recommend its use in chronic hyperkalemia [20,21].
Patiromer for the treatment of hyperkalemia
Published in Expert Review of Clinical Pharmacology, 2020
Gates B. Colbert, Dhwanil Patel, Edgar V. Lerma
Patiromer (Veltassa; Relypsa, Inc., A Vifor Pharma Group Company) is approved for the treatment of hyperkalemia in the United States, Europe, and Australia. The chemical name for cross-linked polymer of calcium 2-fluoroprop-2-enoate with diethenylbenzene and octa-1,7-diene, combination with D-glucitol. The active ingredient is patiromer sorbitex calcium. This is a nonmetal active moiety, a non-absorbed potassium-binding polymer, and a calcium-sorbitol counterion. Each gram of patiromer is equivalent to a nominal amount of 2 grams of patiromer sorbitex calcium. The sorbitol content is 2 g per 4.2 g dose, compared to 20 g of sorbitol in a standard 15 g dose of SPS [22]. It is a uniform spherically shaped, non-systemically absorbed polymer suspension in water, that exchanges calcium in the colon lumen for available potassium cations. Calcium was chosen instead of sodium as the counterion, sodium being the counterion of SPS and SZC, to prevent the addition of sodium exposure to patients who most often are on sodium-restricted diets. The polymer is amorphous and free-flowing which is composed of individual spherical beads that have a low swelling ratio [23,24]. Patiromer is insoluble in solvents such as water, 0.1 M HCl, n-heptane, and methanol.
Novel 2-phenoxypyrido[3,2-b]pyrazin-3(4H)-one derivatives as potent and selective aldose reductase inhibitors with antioxidant activity
Published in Journal of Enzyme Inhibition and Medicinal Chemistry, 2019
Xin Hao, Gang Qi, Hongxing Ma, Changjin Zhu, Zhongfei Han
Numerous variously ARIs (Figure 2) have been developed and some of them are endowed with excellent inhibitory activity11–15. However, most of the ARIs have failed clinically due to inadequate efficacies or pharmacokinetic drawbacks. Although the underlying mechanism of the low efficacy is unclear at present, it is speculated that only inhibiting the accumulation of sorbitol is not enough to prevent and treat pathological changes in all the tissues. As the reduction of glucose consumes NADPH, which is required for regenerating reduced glutathione (GSH), this could induce intracellular oxidative stress (Figure 1). In addition, the abnormal decrease of NAD+ gives rise to changes in cellular redox potentials and the activity of enzymes such as nitric oxide synthase (NOS) and GSH reductase would further exacerbate intracellular oxidative stress16–18. The pathogenesis of diabetic complications and hyperglycaemia-induced oxidative stress always promote to each other. Thus, it will be particularly important to develop ARIs having antioxidant activity, which keeps the enzyme in its reduced form and decreases the damage due to oxidative stress, and this could enhance the overall efficacy of ARIs targeted at diabetic complications.