Management of hyponatremia in patients with heart failure: A retrospective study
Elida Zairina, Junaidi Khotib, Chrismawan Ardianto, Syed Azhar Syed Sulaiman, Charles D. Sands, Timothy E. Welty in Unity in Diversity and the Standardisation of Clinical Pharmacy Services, 2017
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).
Drowning Deaths
Sudhir K. Gupta in Forensic Pathology of Asphyxial Deaths, 2022
Fresh water is hypotonic to human plasma and intracellular fluid of alveolar epithelial cells. Meanwhile, sea water is usually hypertonic in this regard. Based on this concept and on experiments conducted on submerged animals, two separate tissue-level mechanisms were postulated for fresh water and sea water drowning. Hypotonic medium reaches alveoli, penetrates the capillaries through the alveolar epithelial cells by osmosis, which results in hypervolemia in circulatory system along with a drop in tonicity of plasma. Hypotonic atmosphere at alveoli and adjacent capillaries results in bursting of cells, which release the intracellular K+ ions. This ion leak results in an altered Na+/K+ ratio, a potential stimulant for cardiac arrhythmia that can cause ventricular fibrillations. Evidence-based supportive results in human studies are not available for this postulation and are even contradictory in many instances. Nowadays, asphyxia due to the inability to exchange gas is considered as the main mechanism of death by many forensic surgeons.
Body Water
Flavia Meyer, Zbigniew Szygula, Boguslaw Wilk in Fluid Balance, Hydration, and Athletic Performance, 2016
Dehydration can occur in several ways, and the specific processes discussed here are the ones having relevance to the athlete. The most common type is referred to as hypovolemic hypertonic dehydration, which has also been described as hypernatremia dehydration. High sweat rates during training or competition typically promote hypovolemic hypertonic dehydration. Because the sweat gland draws on the plasma water to produce sweat, plasma volume decreases (hypovolemic). The sweat gland reabsorbs electrolytes, and thus, water is lost disproportionately to the ions in the vascular space. Consequently, the remaining sodium, chloride, and other ions are concentrated resulting in greater tonicity of the blood (hypertonic). Because sodium is the most prominent ion in the blood, sodium concentrations will rise above normal producing hypernatremia, which is an increase in plasma sodium concentration. Although ECF is the frontline source of water being lost, the higher tonicity or osmolality of the blood will draw fluid from the ICF. Consequently, both compartments may experience a decrease in water volume. Hypertonicity, or hyperosmolality, plays a critical role in water regulation, which is discussed in Section 1.4 of this chapter.
Fecal microbiota transplantation: a review on current formulations in Clostridioides difficile infection and future outlooks
Published in Expert Opinion on Biological Therapy, 2022
Adèle Rakotonirina, Tatiana Galperine, Eric Allémann
One method of formulating bacteria with alginate is the extrusion method, a well-described method in the literature. This method mainly consists of the bacterial suspension with the alginate solution being placed inside a syringe and extruded dropwise through a small needle into a calcium chloride solution so the drops gelify and produce particles. Everything is then washed and either lyophilized or kept in an isotonic solution [95]. The process can be automatized with an extrusion apparatus. The parameters influencing the process are the nozzle diameter, the flow rate, the distance between the nozzle and the crosslinking solution and the concentration of the alginate and crosslinking solutions. The diameter of the particles obtained by this method range from 0.5 to 3 mm [119]. The content of the particles can be released in phosphate buffer as the cross-linked cation is replaced by other cations present in the buffer [120] and therefore enables this formulation to release the bacteria in the intestines. The principle behind alginate encapsulation is presented in Figure 4.
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.
Nasal saline irrigation: prescribing habits and attitudes of physicians and pharmacists
Published in Scandinavian Journal of Primary Health Care, 2021
Jesse Tapiala, Antti Hyvärinen, Sanna Toppila-Salmi, Eero Suihko, Elina Penttilä
In summary, the most popular method for NSI was a Neti pot (n = 477; 80.7%) filled with an isotonic solution (n = 440; 73.9%) that was 30–40 degrees Celsius (n = 417; 70.1%). Hypertonic (n = 18; 3.0%) or hypotonic (n = 11; 1.8%) solutions were rarely administered and the rest did not instruct the tonicity (n = 126; 21.2%). Volumes of 51–100 ml (n = 72; 12.2%) and 101–200 ml (n = 83; 14.0%) were recommended the most, while the majority gave no recommendation at all (n = 316; 53.4%). Many of the respondents recommended homemade solutions (n = 483; 81.2%) as opposed to purchasing ready-to-use nasal solutions from pharmacies (n = 325; 54.6%). Irrigations were most instructed as a daily (n = 222; 37.8%) or twice-a-day (n = 277; 47.2%) therapy. Regular irrigations were recommended by 77 (12.9%) of the respondents, while the rest (n = 518; 87.1%) opted for a short-term usage (mean: 6.52 days, SD = 3.9, min = 1 day and max = 30 days). There was no significant difference in the length of the recommended use between pharmacists and physicians.
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