Intravenous Administration Of Vitamin Research Articles

Consensus Guidelines for Periprocedural Management of Coagulation Status and Hemostasis Risk in Percutaneous Image-guided Interventions

From the Division of Vascular and Interventional Radiology, Jefferson Radiology, Hartford Hospital, 85 Seymour St, Ste 200, Hartford, CT 06106 (P.C.M.); Department of Radiology, Boston Healthcare System, VAMC Boston, Massachusetts (C.J.G.); Department of Medical Imaging, Scarborough General Hospital, Richmond Hill, Ontario, Canada (S.K.); Department of Radiology, GI/GU Division, Massachusetts General Hospital, Boston, Massachusetts (D.A.G.); Department of Radiology and Radiologic Sciences, Uniformed Services University of the Health Sciences and Department of Radiology, National Naval Medical Center, Bethesda, Maryland (D.L.M.); RADIA, Everett, Washington (R.B.O.); Department of Radiology, University of Florida, Gainesville, Florida (D.W.P.); Department of Medical Imaging, Division of Vascular and Interventional Radiology, University of Toronto, University Health Network, Toronto, Ontario, Canada (D.K.R.); Department of Interventional Radiology, The Reading Hospital and Medical Center, West Reading, Pennsylvania (D.S.); Radiology Associates of Central Florida, Mt Dora, Florida (M.S.S.); Mallinckrodt Institute of Radiology, St Louis, Missouri (D.A.Z.); and Geisinger System Radiology, Geisinger Health System, Danville, Pennsylvania (J.F.C.). Received November 18, 2008; accepted November 24, 2008. Address correspondence to P.C.M.; E-mail: pmalloy@ jeffersonradiology.com

Lipid peroxidation in hemodialysis patients: Effect of vitamin C supplementation

Objectives Renal failure is associated with several metabolic disturbances and increasing evidences support a role of oxidative stress and impaired antioxidant defence in the pathologic mechanisms that may contribute to accelerated atherogenesis in these patients. Aim of the study was to further investigate the relationship between oxidative stress and chronic renal failure. Design and methods We compared the paraoxonase (PON1) activity, the levels of lipid hydroperoxides and AGE adducts in plasma of hemodialysis patients before and after intravenous administration of vitamin C. Results An increase in lipid hydroperoxides, AGE adducts and a decrease in the activity of PON1 were observed in patients with respect to controls. The comparison before and after supplementation with vitamin C showed an increase of PON1 activity and a decrease of AGE and lipid hydroperoxides levels. Conclusions The results provide further evidence that lipid peroxidation and impairment of antioxidant system in plasma of patients may play a role in renal disease and suggest that evaluation of PON1 activity could represents an useful approach to monitor antioxidant treatment and new dialysis therapies.

Intravenous Vitamin K-induced Cardiovascular Collapse - A case report -

A cardiovascular collapse, due to preoperatively administered intravenous vitamin K (phytonadione), was experienced in a 59-year-old woman who was scheduled to undergo a left upper lung lobectomy. The patient developed sudden facial flushing, an upper torso rash, dyspnea, palpitation, and severe hypotension about 2 min after the intravenous administration of approximately 2 mg of vitamin K. Immediate hydration and an injection of 20 mg ephedrine restored her blood pressure to the preoperative level within 5 min. The patient recovered without any sequelae, but the operation was postponed. The patient's symptoms seemed to be due to an anaphylactoid reaction or anaphylaxis following the intravenous administration of vitamin K. This case report suggests that physicians should carefully review the indications of vitamin K prior to administration, even at low doses.

Treatment of Postherpetic Neuralgia with Intravenous Administration of Vitamin C

To the Editor:A 78-yr-old male suffered from intractable T3-6 postherpetic neuralgia. He reported 8 mo of constant, aching pain and intermittent, spontaneous, shooting pain over his right anterior chest and upper back. His pain did not respond to multiple trials of antidepressants and anticonvulsant

Vitamin C in disease prevention and therapy

Vitamin C is an essential nutrient involved in many biological and biochemical processes as an antioxidant. As oxidative damage is implicated in the development of various diseases, vitamin C could have a preventive or even therapeutic effect. Fruits and vegetables are the recommended sources of vitamin C. Five servings of fruits and vegetables are protective against cancer and cardiovascular disease, however not because of vitamin C alone. On the other hand, oral vitamin C supplements in amounts higher than Recomended Daily Allowance (RDA) are beneficial in wound healing, reducing theduration of common cold symptoms, but also in prevention of common cold in heavily physically stressed persons. Furthermore, vitamin C is effective in decreasing serum fibrinogen, which is related to increased cardiovascular risk. Positive effects may be also achieved by intraarterial or intravenous administration of vitamin C in patients with diabetes mellitus and cancer. However, positive effects frequently depend on many factors, such are dose, age, health habits, etc.

Serum calcium concentration and the safety of vitamin D therapy

Vitamin D and its analogues are administered to patients with secondary hyperparathyroidism (SHPT) in chronic renal failure (CRF). Hypercalcemia is one of the complications of this therapy, and is thought to be not rare, though its frequency is not clearly documented. There is a need to monitor serum corrected (ionized) calcium concentration and parathyroid hormone (PTH) in order to administer vitamin D and its analogues safely. Intravenous administration of vitamin D provides advantages over oral administration, though no definite evidence could show which is better. Calcitriol and maxacalcitol are administered intravenously, and the latter is more likely to increase serum calcium concentration than the former. It must be very careful to administer vitamin D to patients with predialysis CRF because hypercalcemia can accelerate progression of renal dysfunction.

P0268 CELIAC DISEASE PRESENTING AS A TRANSITORY LIVER FAILURE IN A 16 MONTHS OLD GIRL

Introduction: The big variety of clinical presentations of celiac disease makes of the diagnosis a challenge: mild hypertransaminasemia (1) is frequent but rare cases of liver failure related to untreated celiac disease were reported(2)(3). Methods: We report an unusual presentation of celiac disease in a 16 month old girl who was hospitalized twice for a transient liver failure. The context of a febrile gastroenteritis, during the first hospitalization, misled the diagnosis of celiac disease towards a viral infection or a metabolic disease. Low prothrombine activity (9%) and altered state of consciousness on the initial presentation became normal after one week of close observation, perfusion of fresh frozen plasma and the administration of intravenous vitamin K. One month later, the child was readmitted for frequent episodes of watery diarrhea, cachexia, abdominal distension and pitting edema. Blood tests showed elevated liver enzymes (SGPT/SGOT = 1540/1410 IU/l), hypoproteinemia (4.9g/dl), hypoalbuminemia (2.6 g/dl) and hypoprothrombinemia (27% activity), along with failure to thrive. Results: Paraclinical workup showed: negative serologies for viral hepatitis A, B, C, cytomegalovirus and epstein barr virus. Anti nuclear antibodies, anti DNA, anti liver-kidney microsomes, anti smooth muscles, anti liver cytosol 1, Anti thyroglobulines and anti thyroperoxidase antibodies were negative; abdominal ultrasound was normal; percutaneous liver biopsy identified macro and a micro cellular steatosis without any inflammatory infiltrates, and without any fibrosis. Anti transglutaminases IgA were positive (superior to 200 RU /ml ). Upper endoscopy with small bowel biopsy confirmed the diagnosis of celiac disease. After 6 months of a gluten free diet, the clinical condition, and the growth parameters improved considerably, with normalization of the liver function tests. Conclusion: This case shows the importance of considering celiac disease as a potential cause of acute liver failure. Hepatic steatosis can be one of the histological features encountered in celiac disease. Gluten free diet may reverse hepatic failure

Vitamin C pharmacokinetics: implications for oral and intravenous use.

Vitamin C at high concentrations is toxic to cancer cells in vitro. Early clinical studies of vitamin C in patients with terminal cancer suggested clinical benefit, but 2 double-blind, placebo-controlled trials showed none. However, these studies used different routes of administration. To determine whether plasma vitamin C concentrations vary substantially with the route of administration. Dose concentration studies and pharmacokinetic modeling. Academic medical center. 17 healthy hospitalized volunteers. Vitamin C plasma and urine concentrations were measured after administration of oral and intravenous doses at a dose range of 0.015 to 1.25 g, and plasma concentrations were calculated for a dose range of 1 to 100 g. Peak plasma vitamin C concentrations were higher after administration of intravenous doses than after administration of oral doses (P < 0.001), and the difference increased according to dose. Vitamin C at a dose of 1.25 g administered orally produced mean (+/-sd) peak plasma concentrations of 134.8 +/- 20.6 micromol/L compared with 885 +/- 201.2 micromol/L for intravenous administration. For the maximum tolerated oral dose of 3 g every 4 hours, pharmacokinetic modeling predicted peak plasma vitamin C concentrations of 220 micromol/L and 13 400 micromol/L for a 50-g intravenous dose. Peak predicted urine concentrations of vitamin C from intravenous administration were 140-fold higher than those from maximum oral doses. Patient data are not available to confirm pharmacokinetic modeling at high doses and in patients with cancer. Oral vitamin C produces plasma concentrations that are tightly controlled. Only intravenous administration of vitamin C produces high plasma and urine concentrations that might have antitumor activity. Because efficacy of vitamin C treatment cannot be judged from clinical trials that use only oral dosing, the role of vitamin C in cancer treatment should be reevaluated.

Vitamin K for Excessive Anticoagulation: Oral or IV?

Intravenous administration of vitamin K is effective for reversing excessive warfarin anticoagulation. What about oral administration? Researchers in

血液透析患者のエリスロポエチン抵抗性貧血に対するビタミンＣ静注効果

血液透析患者のエリスロポエチン抵抗性貧血に対するビタミンＣ静注効果

Vitamin K modulates cardiac action potential by blocking sodium and potassium ion channels.

Cardiovascular collapses, syncopes, and sudden deaths have been observed following the rapid administration of intravenous vitamin K. Our objectives were to characterize the effects of vitamin K on cardiac action potentials and to evaluate effects of vitamin K on sodium and potassium currents, namely I(Na), I(Kr), and I(Ks). Guinea pig hearts (n = 21) were paced at a cycle length of 250 msec and exposed to vitamin K at 1.15-4.6 micromol/L (2.5-10 mg/L). Monophasic action potential duration measured at 90% repolarization (MAPD(90)) was not significantly reduced (-1.6 +/- 0.3 msec; P >.05; N.S.) at 1.15 micromol/L, but increased by 6.5 +/- 0.4 msec (P <.05) at 2.3 micromol/L. MAPD(90) was not measurable at 4.6 micromol/L, as a result of inexcitability. Patch-clamp experiments in ventricular myocytes demonstrated a approximately 50% reduction in I(Na) by 10 micromol/L vitamin K and a concentration-dependent reduction of the K(+) current elicited by short depolarizations (250 msec; I(K250)). Estimated IC(50) for I(K250), mostly representing I(Kr), was 2.3 micromol/L. Vitamin K was less potent to block the K(+) current elicited by long depolarizations (5,000 msec; I(K5000)), mostly representing I(Ks), with an estimated IC(50) over 100 micromol/L. Therapeutic concentrations ( approximately 1.5 micromol/L) of intravenous vitamin K modulate cardiac action potential by blocking ionic currents involved in cardiac depolarization and repolarization.

Plasma Concentrations after Intravenous Administration of Phylloquinone (vitamin K 1) in Preterm and Sick Neonates

Vitamin K prophylaxis usually is administered orally or intramuscularly, but in neonatal intensive care oral administration might not be feasible and intramuscular administration is not general practice in very small infants. No data are available about plasma levels after intravenous administration of vitamin K to neonates. Therefore, we investigated plasma levels in 18 infants: 14 preterms with a birthweight of 1785±648 g and 4 sick newborns with a birth-weight of 3167±510 g after administration of a single dose of 0.3±0.1 mg/kg phylloquinone (vitamin K 1) (Konakion MM ®, Roche) intravenously after birth. Blood was collected 22.9±18.4 hours after intravenous administration of vitamin K 1. In 10 neonates a second sample was obtained 111.8±49.1 hours after the first vitamin K 1 administration. Gas chromatography-mass spectrometry (GC-MS) was used as the method for determination of vitamin K 1. The measured plasma concentration after intravenous administration of vitamin K 1 was 191.3±102.6 ng vitamin K in the first sample /mL in the first sample and 98.7±75.2 ng vitamin K 1/mL in the second samples . These results are similar to those described in newborns after oral administration of 3 mg vitamin K 1 and after intramuscular administration of 1.5 mg vitamin K 1. In conclusion, the recommendation of the producer to give 0.4 mg/kg of vitamin K intravenously to neonates, in whom oral or intramuscular administration is not feasible, seems to be rational.

Increased liver uptake of liposomes and improved targeting efficacy by labeling with asialofetuin in rodents

To improve liposome-directed therapy of liver disease and gene delivery, it would be beneficial to selectively target hepatocytes. For this purpose, conventional liposomes (CL) were labeled with asialofetuin (AF), an asialoglycoprotein. The biodistribution of AF-labeled liposomes (AF-L) in mice and their incorporation into rat hepatocytes, and their potential use in acute liver injury, were investigated. AF-L displayed a quicker plasma clearance than CL, and 25.4%, 2.7%, and 1.2% of the injected dose remained in the plasma versus 47.0%, 26.1%, and 9.5% of CL, respectively at 2, 4, and 20 hours after the injection. Total liver uptake of AF-L (73%+/-3.9%) was markedly higher (P < .005) than CL (16.5%+/-1.8%) 4 hours after the injection. Liposomal radioactivity (cpm/mg) was greatly enhanced in the liver (11-fold) during the first 4 hours after the administration of 14C-AF-L, and was much higher than in 14C-CL-injected mice (1.5-fold). In vitro incubation of isolated rat hepatocytes with 14C-AF-L or intravenous injection of 14C-AF-L in rats resulted in higher hepatocyte-bound radioactivity compared with 14C-CL (P < .01-.005). AF-L-associated 1,1'-dilinoleyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI) fluorescent signals were not only located in Kupffer cells, but also in hepatocytes, in which bile canaliculus networks were imaged. Intravenous administration of vitamin E (VE)-associated CL (VE-CL, 1 mg/mouse) significantly lowered alanine transaminase (ALT) levels in CCl4-treated mice (196+/-79 vs. 2,107+/-235 U/mL; P < .01). The ALT level in CCl4 + VE-AF-L group was decreased to 38+/-16 units/mL, which was significantly lower than the CC14 + VE-CL group (P < .05). In conclusion, labeling liposomes with AF led to a shortened liposome plasma half-life and greatly enhanced uptake of AF-L liposome by the liver. The enhanced uptake resulted from an increased incorporation of hepatocytes with AF-L liposomes. VE-associated AF liposomes further improved the protective effect of VE liposomes on CC14-induced acute liver injury in mice. Preferential hepatocyte incorporation of AF-L liposomes suggests a useful hepatocyte-targeting approach for drug delivery and gene transfection.

Disposition of vitamin E in the eye.

To study the effect of exogenous vitamin E on its plasma and eye tissue levels, we administered 100 mg/kg of dl-alpha-tocopherol either by intravenous, intramuscular, or oral routes in 3-day-old newborn kittens. Controls did not receive the drug. alpha-Tocopherol levels in the plasma, retina, choroid, and vitreous were analyzed by high-performance liquid chromatography at selected intervals following drug administration. Our results showed that after intravenous administration of vitamin E, the retinal alpha-tocopherol levels increased 300 and 500% the baseline value at 2 and 4 h, respectively. By contrast, comparable retinal levels were achieved at 24 h following intramuscular administration and 72 h following oral administration. In the intravenous group high retinal levels were maintained up to 168 h, while in the intramuscular and oral groups retinal levels continued to increase up to 192 h. Irrespective of route of administration, the retinal concentration of alpha-tocopherol remained high even when the plasma levels were declining; plasma levels did not reflect retinal levels at any time. Following exogenous vitamin E administration, alpha-tocopherol levels increased both in the choroid (4 to 6 times the control) and in the vitreous (1.5 to 4 times the control). Significant differences in tocopherol levels were also seen between the eyes in the same animal in all groups. Our studies suggest a single dose of vitamin E by intravenous, intramuscular, or oral routes increases retinal levels from 3 to 5 times the control levels. However, peak retinal levels are achieved earlier by parenteral than by the oral route.(ABSTRACT TRUNCATED AT 250 WORDS)

A study of factors which determine the pharmacological response to vitamin K in coumarin anticoagulated rabbits

The pharmacological response to vitamin K has been determined by measuring prothrombin complex activity (P.C.A.) in male New Zealand White rabbits anticoagulated (P.C.A. <20%) with the long acting 4-hydroxycoumarin brodifacoum, at a dose (10 mg/kg) which produces maximum antagonism of vitamin K 1. Thus, according concurrent concepts, this animal model may be used to assess vitamin K requirements in the absence of a functional vitamin K-epoxide reductase. After intravenous administration of vitamin K 1 (1 mg/kg) P.C.A. reached a maximum (64±19%) at 3 hr and then declined at a rate which corresponds to complete inhibition of clotting factor synthesis. Vitamin K 2 (1 mg/kg) stimulated clotting factor synthesis for 2 hr, while cis-vitamin K 1, vitamin K 3, vitamin K 1 2,3-epoxide and oral administration of vitamin K 1 were ineffective. Plasma concentrations of vitamin K 1 fell steeply during the 12 hr following administration of a pharmacological dose, and then declined with a terminal half-life of 18.9 ± 9.0 hr. Comparison of the phamacodynamic and pharmacokinetic data indicated that plasma concentrations in the range 0.4–1.0 μg/ml are required for clotting factor synthesis in the limiting situation of maximum antagonism of vitamin K by coumarin anticoagulants. These findings explain why frequent and repeated administration of vitamin K 1 may be necessary during coumarin poisoning.

Role of vitamin D glucosiduronate in calcium homeostasis.

Evidence has been presented suggesting the presence of vitamin D(3) 3beta-glucosiduronate and 1,25-dihydroxyvitamin D(3) glucosiduronate in rat bile. To evaluate the role of vitamin D glucosiduronates in calcium and phosphorus homeostasis, we synthesized vitamin D(3) 3beta-glucosiduronate and tested its biological activity in calcium- and vitamin D-deficient rats. After the intravenous administration of vitamin D(3) 3beta-glucosiduronate to rats maintained on a low calcium diet, there was an increase in duodenal calcium transport and an increase in serum calcium. Vitamin D(3) 3beta-glucosiduronate, however, was less active than equimolar amounts of vitamin D(3). At doses of less than 0.65-1 nmol per rat, the conjugate exhibited no activity. When vitamin D(3) 3beta-glucosiduronate was administered to vitamin D-deficient rats, 25-hydroxyvitamin D was detected in the serum; the increase in serum 25-hydroxyvitamin D levels was less than that observed after the administration of an equimolar amount of vitamin D(3). Vitamin D(3) 3beta-glucosiduronate showed no detectable activity in the induction of calcium binding protein in chick embryonic duodena, a system in which no endogenous steroid beta-glucuronidase activity is detectable. These data demonstrate that vitamin D(3) 3beta-glucosiduronate is biologically active in vivo and that the observed activity is due to hydrolysis of the conjugate to vitamin D(3). As vitamin D(3) 3beta-glucosiduronate is excreted in the bile of rats, it is possible that this conjugate is reutilized in vivo after hydrolysis to free vitamin D(3). These results suggest the existence of a mechanism for reutilization of the biliary products of vitamin D(3).

Anaphylactic shock following intravenous administration of vitamin B complex.

Vitamin preparations for parenteral administration have been employed extensively by all branches of medicine. In view of their wide parenteral use the ratio of serious reactions to the number of injections given must be exceedingly small; however, severe anaphylactic reactions do occur from parenteral administration of vitamins and for this reason the following case is reported as a reminder. Circulatory collapse from intravenous 1 and intramuscular 2 injections of thiamine hydrochloride has been reported. Anaphylaxis due to intravenous administration of nicotinic acid 3 and folic acid 4 has also been reported, but to our knowledge no instance of circulatory collapse following intravenous administration of vitamin B complex has been recorded. REPORT OF A CASE F. H., a 52-year-old white insurance agent, had received parenteral injections of vitamin B complex intermittently from several physicians for about a year because of nervousness, fatigue, and malaise. He was seen by one of us

Studies in the use of crystalline vitamin C (ascorbic acid) in the prophylaxis and treatment of infantile scurvy and some other disorders of infancy and childhood

Summary 1.Nineteen infants were given crystalline vitamin C* in the dosage of 1.83 mg. per kg. daily for a period of five months as a prophylactic against scurvy. No clinical or roentgenologic evidence of scurvy was apparent during the period of observation. 2.Crystalline vitamin C was used in the treatment of 21 cases of infantile scurvy. Satisfactory healing was obtained in all instances. A brief analysis of the amounts of the vitamin necessary to produce clinical healing is presented. 3.The presence and significance of fever in the scorbutic infant are analyzed, and the lack of temperature elevation following the administration of vitamin C is pointed out. 4.A study was made of the hematopoietic response following the administration of crystalline vitamin C. 5.There was no constant effect produced upon the capillary resistance (capillary fragility test) in our scorbutic infants following the administration of vitamin C. 6.A brief discussion of the effect of scurvy upon the heart is given. 7.Crystalline vitamin C seemed to stimulate wound healing in the incision of an infant operated upon for pyloric stenosis in whom there was no evidence of healing prior to its administration. 8.Intravenous administration of vitamin C seemed to have no effect on the hematuria in a case of subacute hemorrhagic nephritis. 9.Complete case histories of three scorbutic infants treated with crystalline vitamin C are given. Summary 1.Nineteen infants were given crystalline vitamin C* in the dosage of 1.83 mg. per kg. daily for a period of five months as a prophylactic against scurvy. No clinical or roentgenologic evidence of scurvy was apparent during the period of observation. 2.Crystalline vitamin C was used in the treatment of 21 cases of infantile scurvy. Satisfactory healing was obtained in all instances. A brief analysis of the amounts of the vitamin necessary to produce clinical healing is presented. 3.The presence and significance of fever in the scorbutic infant are analyzed, and the lack of temperature elevation following the administration of vitamin C is pointed out. 4.A study was made of the hematopoietic response following the administration of crystalline vitamin C. 5.There was no constant effect produced upon the capillary resistance (capillary fragility test) in our scorbutic infants following the administration of vitamin C. 6.A brief discussion of the effect of scurvy upon the heart is given. 7.Crystalline vitamin C seemed to stimulate wound healing in the incision of an infant operated upon for pyloric stenosis in whom there was no evidence of healing prior to its administration. 8.Intravenous administration of vitamin C seemed to have no effect on the hematuria in a case of subacute hemorrhagic nephritis. 9.Complete case histories of three scorbutic infants treated with crystalline vitamin C are given.

Acute pernicious form of beriberi and its treatment by intravenous administration of vitamin B 1: With especial reference to electrocardiographic changes

A patient with acute pernicious form of beriberi, showing an electrocardiographic evidence of myocardial damage, recovered very promptly from the cardiac failure under intravenous administration of vitamin B 1, with a resulting return to normal of the electrocardiogram.