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Measurement of the Size and Number of Adipose Cells
Published in Fernand P. Bonnet, Adipose Tissue in Childhood, 2019
Hirsch et al.12 were the first to propose a technique of needle transcutaneous biopsy of human s.c. adipose tissue; this technique has been widely accepted. They use standard equipment: No. 15 fine-walled needle and 50-mℓ syringe. Local anesthesia is performed with procain solution injected first intradermally, then deeply into the layer of s.c. fat. When samples of adipose tissue are intended for in vitro metabolic studies, only the intradermal injection is done and the fat tissue is aspirated from a much deeper layer. The syringe is previously siliconized in order to avoid cell rupture from contact with the glass; it is then rinsed with a moderately warm solution of either isotonic NaCl or, in the case of metabolic studies, with a pH 7.4 Krebs-Ringer buffer solution containing 1 mg of glucose per milliliter.5 The needle is then inserted, the stylet removed, and the syringe put in place; 1 mC of isotonic solution is injected. The piston of the syringe is held in such a way as to obtain a maximum depression; rotating the needle while moving it in and out permits collecting part of the injected solution containing fragments of adipose tissue. Holding the layer of fat tissue between the thumb and index finger is recommended so as to move the needle more easily. Certain improvements have since been proposed, mainly concerning needles or syringes better adapted to this type of biopsy.13,14 The procedure lasts approximately 1 min.
Management of hyponatremia in patients with heart failure: A retrospective study
Published in Elida Zairina, Junaidi Khotib, Chrismawan Ardianto, Syed Azhar Syed Sulaiman, Charles D. Sands, Timothy E. Welty, Unity in Diversity and the Standardisation of Clinical Pharmacy Services, 2017
S. Saepudin, P.A. Ball, H. Morrissey
The remaining hyponatremic patients received sodium chloride both as capsules and intravenous solution. However, sodium chloride capsules were administered mostly in combination with sodium chloride solution to patients with severe hyponatremia. Isotonic solution of sodium chloride is very good for patients with hypovolemic hyponatremia, whereas the hypertonic solution has an efficacious effect for hyponatremic patients with hypervolemic or euvolemic conditions (Bhaskar 2010, Spasovski 2014). The most important aspect of administering the sodium chloride solution is the rate of correction, particularly for patients with acute hyponatremia. Overly rapid administration of hypertonic solution of sodium chloride can induce neuron obstruction leading to severe neurologic disorder (Verbalis 2007, Spasovski 2014).
Fluid Compartments
Published in Lara Wijayasiri, Kate McCombe, Paul Hatton, David Bogod, The Primary FRCA Structured Oral Examination Study Guide 1, 2017
Lara Wijayasiri, Kate McCombe, Paul Hatton, David Bogod
This is an isotonic solution and results in ECF expansion, diuresis and natriuresis as explained below: Sodium will diffuse from areas of high concentration to those of lower concentrations and will be followed by waterThe cell membrane is impermeable to sodium and thus the distribution of the saline (water) administered will be confined to the ECF with 75% (750 mL) in the ISF and 25% (250 mL) in the plasmaThe plasma expansion from 3.5 to 3.75 L is enough (7% increase) to be detected by the baroreceptors and ADH secretion is reducedThe increased sodium load and ECF expansion will cause an increase in ANP secretion and natriuresis, and inhibition of the renin–angiotensin–aldosterone system.
Isotonic versus hypotonic saline as maintenance intravenous fluid therapy in children under 5 years of age admitted to general paediatric wards: a randomised controlled trial
Published in Paediatrics and International Child Health, 2020
Manish Kumar, Kaustav Mitra, Rahul Jain
Addressing the treatment of hospital-acquired hyponatraemia with hypotonic maintenance fluid, Moritz and Ayus recommended 0.9% saline in dextrose as maintenance intravenous fluid (IVF) in children [1]. However, concerns were raised about the increased risk of hypernatraemia with isotonic saline, and a physiologically based fluid protocol was suggested to avoid hyponatraemia [2]. As a compromise between traditional 0.18% saline and complete switching to isotonic solution, The National Patient Safety Agency, UK recommended 0.45% saline as standard maintenance fluid to avoid the risk of severe hyponatraemia [3]. Since then, many trials and reviews have demonstrated a significantly increased risk of hyponatraemia in children receiving hypotonic maintenance fluid [4–13]. A recent clinical practice guideline on maintenance fluid in children by the American Academy of Pediatrics recommended isotonic saline as maintenance IVF in children aged from 1 month to 18 years as it significantly reduces the risk of hyponatraemia [14].
Excipients in parenteral formulations: selection considerations and effective utilization with small molecules and biologics
Published in Drug Development and Industrial Pharmacy, 2018
Bindhu Madhavi Rayaprolu, Jonathan J. Strawser, Gopal Anyarambhatla
Tonicity agents should be considered in effort to support tissue compatibility at the site of administration. Often, injectable products will be admixed with 0.9% sodium chloride or 5% Dextrose to support Isotonicity at the time of infusion. Major factors to be considered when selecting tonicity agents are the route of administration, potential incompatibility with the active ingredient or other excipients, and osmolality of drug product, typically between 275 and 295 mOsm/kg [16]. Should the injection be administered prior to dilution in a suitable isotonic solution, a tonicity agent should be considered. Commonly used tonicity agents and Iso-osmotic percentage of commonly used tonicity agents includes dextrose (5%), mannitol (5%), potassium chloride (1%), and sodium chloride (0.9%). Solvents such as propylene glycol can also function as a tonicity adjusting agent.
Preliminary Evaluation of the Viability of Peritoneal Drainage Catheters Implanted in Rats for Extended Durations
Published in Journal of Investigative Surgery, 2019
Nathan Legband, Arielle Black, Craig Kreikemeier-Bower, Benjamin S. Terry
A limitation of the pilot study was that the performance of the catheters may not have been accurately assessed due to issues with the catheters after implanted. One round fluted drain and two custom catheters were removed from the study early due to the incision on the back reopening (Figure 5). In these cases, the catheter became loose from the suture securing it to the back and a length of the catheter would extend out and retract in as the rat would move. The open wound and movement of the catheter caused noticeable discomfort to the animal. The movement of the catheter could have dislodged a portion of it from the peritoneal cavity and contributed to the leaking of saline from the back incision when infused into the catheter. A dislodged catheter could have decreased the weighted score and efficiency of the catheter. In future implants of the catheters, the back incision should be closed more securely and the elbow of the catheter access port should be fixed to the subcutaneous tissue below the incision. During implantation, the catheter should not be stretched from the peritoneal to the back incision tightly which will allow for the rat to have less restricted movement and decreased tension on the suture, skin, and fascia from the catheter moving. Another limitation of this study is that only one infusate, saline, was used to test the peritoneal catheters. Saline is a benign isotonic solution that the body can readily metabolize. Other infusates used for peritoneal dialysis, drug treatment, or oxygenation may not be as benign as saline and may influence tissue ingrowth and thus the patency and efficiency of the peritoneal catheter.