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Management of Trace Elements in Short Bowel Syndrome
Published in John K. DiBaise, Carol Rees Parrish, Jon S. Thompson, Short Bowel Syndrome Practical Approach to Management, 2017
Compared with the macrominerals such as calcium, magnesium, or phosphorus, there is a greater potential for toxicity from excessive doses of trace elements. Parenteral administration of trace elements has a greater risk for toxicity than oral or enteral administration does because absorption control is bypassed. Organ dysfunction that impairs a primary route of excretion can also increase the likelihood of toxicity of some trace elements. Additionally, products that contain multiple trace elements for parenteral administration were formulated at a time when very limited information was available regarding requirements and parenteral dosing [4]. Subsequently, case reports of toxicity and other information have accrued over time, revealing that some trace elements have been dosed in excessive amounts in the multitrace element parenteral products [4]. Unfortunately, manufacturers have not been responsive to expert recommendations and reformulated trace element products have not been produced in the United States [4]. Table 13.2 [5] summarizes the multitrace element formulations currently available in the United States.
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
Paracetamol and ibuprofen are the mainstays of nonopioid analgesia. While they are primarily utilized worldwide for the management of mild pain and fever, paracetamol should not be overlooked in patients already receiving opioids for severe pain. Reduced doses and increased intervals are recommended for neonates and young infants, malnourished or debilitated patients. Intravenous paracetamol can be considered if enteral administration is impractical.
Endocrine emergencies
Published in Philip E. Harris, Pierre-Marc G. Bouloux, Endocrinology in Clinical Practice, 2014
Some studies recommend that thyroid hormone treatment should be given intravenously; others argue that enteral administration is as effective as intravenous administration. The justification for intravenous treatment is that the poor circulatory and hypometabolic state may make enteral absorption unpredictable.76 In the United Kingdom, intravenous liothyronine (T3) is available but intravenous T4 may be unavailable or difficult to obtain urgently.
Considering safety and patient tolerance in the use of ketogenic diet in the management of refractory and super-refractory status epilepticus: a systematic review
Published in Expert Review of Neurotherapeutics, 2021
Blandine Dozières-Puyravel, Sophie Höhn, Stéphane Auvin
The first studies reported here have provided enough preliminary data to validate the feasibility and safety of the use of KD for RSE and SRSE. In clinical practice, we recommend to use the most recent guidelines for the KD management [2]. In emergency situations, the use of fasting may lead to a quicker ketosis and seizure reduction. Fasting might be considered based on an individual basis since its use could be responsible for additional side effects including hypoglycemia or severe deterioration in some metabolism disorders usually considered as a contraindication of the KD [2]. In case of critical care, gastrointestinal problems are not infrequent making the enteral administration problematic. However, the KD is usually provided by enteral administration. More rarely, KD can be initiated and administered parenterally as recently mentioned in consensus guidelines or in a proof-of-principle case description [3,19].
Synthesis of high payload nanohydrogels for the ecapsulation of hydrophilic molecules via inverse miniemulsion polymerization: caffeine as a case study
Published in Drug Development and Industrial Pharmacy, 2019
Fiora Artusio, Ada Ferri, Valeria Gigante, Daniele Massella, Italo Mazzarino, Marco Sangermano, Antonello Barresi, Roberto Pisano
Caffeine was chosen as the model compound because of its widespread application and chemical nature. As a matter of fact, caffeine is largely employed in food, pharmaceuticals, cosmetics, and supplements. Its beneficial effects include increase of mental alertness, enhancement of sport performance, help in weight loss [20,21], treatment for apnea of prematurity [22], and antioxidant activity [23]. This active ingredient could also play a significant role in the inhibition of skin carcinogenesis [24–26]. Notwithstanding the wide range of therapeutic effects of caffeine, its marked hydrophilicity makes its effective administration quite challenging. The enteral administration route results in fast and uncontrolled release, the clearance in the stomach and concentration peaks in blood circulation are reached in about 1 min, whereas the drug is completely metabolized in about 2–3 h; therefore, regular administrations are required [27,28]. As regards the dermatological administration, a significant limitation consists in the scarce affinity of caffeine with the lipophilic outer layer of skin, namely the stratum corneum; such differences in chemical nature make it difficult to administer a therapeutically effective dosage of caffeine (and in general hydrophilic drugs) at transdermal level [29,30].
In vivo toxicity evaluation of nanoemulsions for drug delivery
Published in Drug and Chemical Toxicology, 2021
Mariana Appel Hort, Barbara da Silva Alves, Osmar Vieira Ramires Júnior, Mariana Correa Falkembach, Gabriela de Moraes Soares Araújo, Caroline Lopes Feijo Fernandes, Ronan Adler Tavella, Juliana Bidone, Cristiana Lima Dora, Flavio Manoel Rodrigues da Silva Júnior
In conclusion, the present findings suggest that NE are safe for enteral administration, but high doses given via a parenteral route can induce hematological changes and oxidative damage. It is worth noting that studies on the toxicity of unloaded NEs are very limited and are most often conducted in vitro. Finally, the results of this work contribute to the knowledge about in vivo NE toxicity and provide important data about their safe use in the pharmaceutical field. Further studies are also important to better elucidate some aspects of NEs safety.