Administration Of Large Volumes Research Articles

Infusion of High Doses of Undiluted Etoposide Through Central Venous Catheters During Preparation for Bone Marrow Transplantation

We employed a new method to administer etoposide in high doses to 51 patients undergoing autologous bone marrow transplantation. Undiluted etoposide (20 mg/ml) was sterilely drawn into Luer-Lok plastic syringes, connected to IV extension tubing, and infused intravenously by a syringe pump over 3-4 hours. Patients received etoposide at doses ranging from 400 to 1600 mg/m2 per day (median dose: 800 mg). Total actual etoposide doses infused during the transplant period ranged from 2200 to 9000 mg. The infusion rate range was 4.1-13.4 mg/min. No episodes of hypotension, bronchospasm, or hemorrhagic cystitis were noted during or within 3 days of the etoposide infusion. In addition, no cracking of the infusion apparatus was observed in any of the 148 separate infusions. Serum bicarbonate concentrations fell significantly in 6 patients who received the higher etoposide doses. This procedure is superior to the standard method of etoposide drug delivery, since large doses of etoposide may be given without the concomitant administration of large volumes of fluid over short periods of time.

Continuous Arteriovenous Hemofiltration: An Alternative to Hemodialysis

An introduction to the procedure of continuous arteriovenous hemofiltration (CAVH) for management of acute renal failure, as well as a review of hemodialysis, is presented. Initially developed for the management of hemodynamically unstable patients with acute renal failure, CAVH now is also used for management of fluid overload and acid-base disturbances resulting from conditions such as acute pulmonary edema, congestive heart failure, septic shock, and oliguric states in which pharmacologic or parenteral nutrition therapy necessitates administration of large volumes of fluids. CAVH, in contrast to hemodialysis, does not typically involve use of blood pumps but uses the patient's own mean arterial pressure to generate a driving force across the hemofilter membrane. CAVH, like hemodialysis, can remove excess fluid and uremic toxins; however, fluid removal by CAVH is characterized by the slow, continuous process of ultrafiltration and thus avoids the risk of hypotension, muscle cramps, or disequilibrium syndrome. Furthermore, CAVH does not require fluid restriction, allowing for increased administration of parenteral nutrition and intravenous medications; neither does it require expensive equipment or highly trained personnel. Although CAVH membrane materials may differ, they all permit the removal of plasma water and non-protein-bound solutes with molecular weights less than 10,000. To prevent blood from clotting in the hemofilter, most patients will require administration of heparin, which in some patients may increase the possibility of hemorrhaging. CAVH also can remove pharmacologic agents from the blood; however, only the non-protein-bound fraction of the drug has the potential to be cleared from the bloodstream by CAVH.(ABSTRACT TRUNCATED AT 250 WORDS)

Bioassayable growth hormone activity in blood from healthy individuals and acromegalic patients.

Biological growth activity (bioassayable GH) was determined in blood from healthy individuals and from patients with acromegaly using the rate of longitudinal bone growth in hypophysectomized rats with tetracycline as intravital marker. Also radioimmunoassayable GH and somatomedin A activity were determined. In pooled plasma or serum from normal subjects no bioassayable growth activity was demonstrated. In the clinically active acromegalic patients as a group as well as in one individual patient there was a significant (P less than 0.05) bioassayable growth activity in serum as compared to serum from normal subjects. The bioassay determination of GH in plasma/serum from normal subjects and acromegalic patients was hampered by the toxicity and the problems connected with the administration of large volumes.

Clinical evaluation of the administration of large volumes of plasma in the treatment of severely burned children

Clinical evaluation of the administration of large volumes of plasma in the treatment of severely burned children

Clinical evaluation of the administration of large volumes of plasma in the treatment of severely burned children

Clinical evaluation of the administration of large volumes of plasma in the treatment of severely burned children

Altered reactivity to Escherichia coli endotoxin of mice subjected to sub-lethal tourniquet treatment.

SummarySignificantly less E. coli endotoxin (administered as single intravenous injection) was required to elicit a lethal end point in tourniquet treated mice than normal mice. Early intraperitoneal administration of large volumes of physiological saline significantly negated the effects of tourniquet treatment as regards lethal outcome with a given E. coli endotoxin dose. Such saline therapy failed to prevent death in normal animals given endotoxin. These observations plus the estimation of 25-35% original plasma volume loss to the traumatized area suggests that reduction of plasma volume is the major factor in initiating enhanced mortality of tourniquet treated mice receiving E. coli endotoxin.

Die renale Elektrolytausscheidung normaler und adrenalektomierter Ratten nach intraven�sen Salzinjektionen und ihre Beeinflussung durch Corticosteroide

Groups of normal rats of both sexes in moderate water diuresis received i.v. injections of 5 ml./kg, of hypertonic (5 times isoosmotic) solutions of sodium chloride, mannitol er sodium sulfate. The renal excretion of water, sodium, chloride and potassium in a 30 minute-period following this injection was measured. It was compared to control values obtained 40 minutes earlier in the same animals after an i.v. injection of isotonic glucose solution. All hypertonic solutions increased diuresis, natriuresis, chloruresis and kaliuresis. While the effects of mannitol and sodium chloride were comparable, sodium sulfate was more natriuretic and less chloruretic. The excretion of potassium after injection of sodium sulfate was twice as high than after injection of sodium chloride or mannitol. The kaliuretic effeet of sodium chtoride in rats, therefore, is assumed to be due to an increase in the excretion of sodium rather than of chloride. Under the same conditions the renal exeretion of water, Nu+, K+ and Cl' after i.v. injections of either isotonic glucose solution or 4.5 per cent NaCl solution (5 ml/kg.) was studied in large groups of adrenalectomized or sham-operated rats, untreated or treated with Cortisone, Cortexone, Aldosterone or Corticotropin. The influences of adrenalectomy and of the various hormones are described in detail. They were quite similar to the effects observed in isotonic saline diuresis after oral administration of large volumes of 0.9 per cent NaCl solution. I t was concluded that the changes observed in isotonic saline diuresis after adrenalectomy or in corticosteroid-treated rats are not due to changes in intestinal absorption, but rather to primary changes in renal excretion. Furthermore, the “kaliuretic” effect of an increase in urinary sodium excretion was found not to be abolished by adrenalectomy, as opposed to hypophyseetomy.