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Trauma and Poisoning
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Once a poison has been absorbed, the only alternatives are to remove it from the body or render it less harmful. Removal from the body can involve accelerating the normal elimination by pathways (e.g., alkalinization of the urine), either hemodialysis or peritoneal lavage to remove the poison from the blood, or chelation of the substance to increase its excretion and decrease its toxicity.
Tumescent Anesthesia
Published in Marwali Harahap, Adel R. Abadir, Anesthesia and Analgesia in Dermatologic Surgery, 2019
William B. Henghold, Brent R. Moody
There are a variety of different commercially available preparations, all of which come without preservatives added and intended for single-dose injection (46). For ease of administration, the preferred concentration is the 8.4% solution, which is equivalent to 1 mEq/mL. A standard tumescent anesthetic formulation contains 10 mEq/mL or 10 mL of an 8.4% solution. Alkalinization causes spontaneous degradation of epinephrine, reducing the shelf life of the solution; therefore, the mixture should be prepared on the day of the procedure and not stored for later use. Also, too much alkalinization can lead to precipitation of the anesthetic, rendering it unsafe for use (may lead to tissue necrosis). If the solution appears cloudy after the addition of all the ingredients, it should be discarded.
Clinical Toxicology of Sea Snakebites
Published in Jürg Meier, Julian White, Handbook of: Clinical Toxicology of Animal Venoms and Poisons, 2017
Other measures should also be adopted to manage myolysis. Good hydration should be ensured with adequate IV therapy. Urine output should be maintained and monitored. The level of myolysis should be monitored with CK levels and qualitative measurement of urine myoglobin (quantitative measurement of urine myoglobin is, in most labs, very expensive). Potassium level should be monitored, and hyperkalaemia looked for, using regular or continuous ECG. Some authors believe alkalinisation of the urine is useful if there is significant myoglobinuria. While physiotherapy may not be either helpful, or tolerated, in the early stages of myolysis, in the recovery period, an exercise program is worthwhile to assist full muscle recovery. Where myolysis is so severe that there is either respiratory distress or glossopharyngeal dysfunction, then intubation and ventilation should be considered, as discussed above for neurotoxicity.
Incidence of rebound salicylate toxicity following cessation of urine alkalinization
Published in Clinical Toxicology, 2023
Mary O’Keefe, Matthew Stanton, Ryan Feldman, Jillian Theobald
This is a single-center, retrospective review and was reliant on only the documentation within one poison center. Data are obtained through non-mandatory reporting to this poison center, and this relies entirely on accuracy of caller information, whether by healthcare professionals or laypeople, introducing the potential of transcription errors in data. Another limitation includes the inability to track a patient’s urine pH throughout treatment, therefore it is unknown whether the patient achieved urine alkalinization. The reported cases were clinically diverse and confounding variables such as co-ingestion or comorbid condition could not be controlled for. Additionally, the clinical relevance of rebound is not clear as data on patient outcomes in those with rebound serum concentrations greater than 300 mg/L (2.17 mmol/L) who were not restarted on urine alkalinized is not available for comparison given all five patients were restarted on urinary alkalinization.
A rare case of spontaneous tumor lysis syndrome in multiple myeloma
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Louay Aldabain, Lyn Camire, David S. Weisman
For the treatment of established TLS, the expert consensus panel recommended hydration with IV fluids at approximately 3 L/m2 every 24 h to maintain a urine output of 80 to 100 mL/m2/h [12]. Diuretics may be considered in euvolemic patients to augment urine output, but they are contraindicated in patients with hypovolemia or obstructive uropathy. Alkalinization with sodium bicarbonate must be individualized. The panel recommended treatment with rasburicase over allopurinol for patients with preexisting hyperuricemia (≥ 450 μmol/L or 7.5 mg/dL), with a dose of 0.15 to 0.2 mg/kg once daily in 50 mL of normal saline as an IV infusion over 30 minutes for 5 days [12]. Patients should be on a cardiac monitor with close follow-up of electrolyte levels. Hyperkalemia should be managed based on standard treatment. Asymptomatic patients with hypocalcemia require no treatment. Symptomatic patients may be treated with calcium gluconate 50 to 100 mg/kg IV, administered slowly. Hyperphosphatemia can be managed with adequate hydration and phosphate binders. For severe hyperphosphatemia, hemodialysis is preferred to peritoneal dialysis or continuous venovenous hemofiltration [12]. Hemodialysis is also indicated for persistent hypokalemia, hypocalcemia, hyperuricemia, or volume overload [12,13].
Established and recent developments in the pharmacological management of urolithiasis: an overview of the current treatment armamentarium
Published in Expert Opinion on Pharmacotherapy, 2020
Mohamed Abou Chakra, Athanasios E. Dellis, Athanasios G. Papatsoris, Mohamad Moussa
Urinary pH has a crucial role in the prevention of stone formation. Therefore, cystine stone formation can be reduced by increasing the urinary pH level. The solubility of cystine does not increase significantly until a level of urine pH above 7–7.5 is reached. Urine alkalinization up to pH 7.5 by means of sodium bicarbonate and/or potassium citrate is used [119]. A urinary pH of greater than 7.5, however, should be avoided, as this may promote calcium phosphate stone formation. Because of the relationship found between the excretion of urinary sodium and cystine, potassium citrate has emerged as the preferred sodium-free alkalizing agent where the use of potassium citrate for urine alkalization in cystinuria is effective and can be recommended in the absence of severe renal impairment [120].