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Preparing the Malnourished Patient for Parenteral Nutrition (PN)
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
But as a hypertonic solution, central parenteral nutrition also has the ability to pull fluid into the vascular space (Metheny 1990). If the patient has a low ejection fraction, or is already fluid overloaded, they may develop CHF and pulmonary edema. This has been a rare occurrence, in my experience. But having been burned at least once by this phenomenon, my practice is starting a new parenteral nutrition patient at roughly half of the full calculated volume requirements. This is another application of the “first do no harm” principle. Although it may take you a few more days to get to full PN volume, you will sleep better at night than if you had to worry about volume overload with an initiating formula.
Ageing
Published in Henry J. Woodford, Essential Geriatrics, 2022
Non-oral enteral feeding is sometimes appropriate. Small-bore and soft nasogastric tubes are usually better tolerated. Reducing the flow rate or changing feed formulation can diminish the incidence of diarrhoea. There is a risk of re-feeding syndrome (see page 225). Percutaneous endoscopic gastrostomy (PEG) tubes are discussed on pages 129 and 224. Total parenteral nutrition is a possible alternative, but there is little evidence of a benefit when used in older people; it has potential harms and high costs. The hypertonic solution used needs to be given via a large calibre vein (usually via central venous access). In general terms, enteral nutrition is preferable to the parenteral route whenever possible.37
Long-Term Glucose Infusions in the Treatment of Fetal Growth Retardation
Published in Asim Kurjak, John M. Beazley, Fetal Growth Retardation: Diagnosis and Treatment, 2020
In pregnant women the blood glucose increased in the course of infusions to 150 to 200 mg% (8 to 11 mmol/1). This elevation lasted for approximately 8 h. In sporadic cases a mild, insignificant glycosuria was observed, not influencing the amount of glucose administered. The daily supply of 2 1 of liquid did not manifest itself by excessive weight gain or increased blood pressure. Only occasionally was edema seen. The hypertonic solution did not damage the veins. However, usually we used a different vein each day.
Why mRNA-ionizable LNPs formulations are so short-lived: causes and way-out
Published in Expert Opinion on Drug Delivery, 2023
As per the claim of the ionizable LNPs manufacturer [47,48], the internal core aqueous phase of these advanced ionizable LNPs is very minimal, which prevents the mRNA from being hydrolyzed. But current research shows significantly different data. Several studies have already proven that [14,42,49–51] ionizable LNPs contain about 20–24% water, which is sufficient for the degradation of the mRNA during storage without lyophilization or freezing. Kulkarni et al. [40], formulated RNA-ionizable LNPs with DSPC: Cholesterol: PEG-DSPE (55:44:1 mol%). They observed the lamellar structure change after incubating the formulated solution in PBS and the hypertonic solution in PBS (Figure 4A). The study indicates that entrapped water might destabilize the lipid over prolonged exposure.
Vitamin K2 protects PC12 cells against Aβ (1-42) and H2O2-induced apoptosis via p38 MAP kinase pathway*
Published in Nutritional Neuroscience, 2020
Elham Hadipour, Zahra Tayarani-Najaran, Masoud Fereidoni
Apoptosis was measured by staining propidium iodide (PI) and Sub-G1 peak in a flow cytometric device. DNA fragmentation is one of the events that occur during apoptosis while mono and oligo parts of the nucleosomal DNA form. When the cell permeability increases with a hypertonic solution, then the DNA fragment with a low molecular weight can be removed from the cell. As a result, apoptotic cells have lower DNA content. Before the cell cycles G1 Peak, there is another peak that belongs to them and represents the percentage of apoptosis.22 For this assessment, 105 PC12 seeded in each well of a 12-well plate, and after a day, PC12 cells were treated with NGF (50 ng/ml) and allowed to differentiate for 48 h. Vitamin K2 (20 and 50 μM) was added into the cultures 24 h in prior to Aβ (1-42) (25 µM for 48 h) and H2O2 (150 µM for 24 h) exposure. After treatment with Aβ (1-42) and H2O2, cells were harvested and 400 μl hypotonic buffer which contains 50 μg/ml PI in 0.1% sodium citrate plus 0.1% Triton X-100 was added to each sample before flow cytometric analysis using a FAC Scan flow cytometer (BD Biosciences, CA, USA).
A dose-response relationship study of hypertonic saline on brain relaxation during supratentorial brain tumour craniotomy
Published in British Journal of Neurosurgery, 2018
Joaquín Hernández-Palazón, Diego Fuentes-García, Paloma Doménech-Asensi, Sebastián Burguillos-López, Joaquín García-Ferreira, Luis Falcón-Araña, Claudio Piqueras-Pérez
Before the trial, randomized treatment allocations were generated by an independent person using a computer random number generator with a 1:1 allocation. To ensure masking, the material needed for infusions was provided before the surgical procedure by personnel not related to the research staff, so the main researcher and operating room (OR) staff were blinded to the amount of HS given. Baseline characteristics and intraoperative variables were recorded in all patients. After randomization, patients were assigned to receive, at the time of scalp incision, 3 mL/kg or 5 mL/kg of 3% HS (osmolarity = 1024 mOsm/L) for the low-dose (L) and high-dose (H) groups, respectively. The hypertonic solution was administered through a central line for 20 min using an infusion pump.