mL Of Dextrose Research Articles

Neural Prolotherapy in Persistent Post-Surgery Pain: A Case Report

Introduction: Persistent postoperative pain is a clinical condition of discomfort (pain) and lasts more than 2 months after surgery without other causes, such as chronic infection or pain due to chronic conditions that occurred before surgery. This study aims to describe PPSP management and its outcomes.
 Case presentation: A woman, 54 years old, a housewife, came to the hospital with complaints of persistent pain from a surgical scar in the abdominal area. The pain has gotten worse in the last 3 months and sometimes feels like it's spreading to the area around the surgical wound. The pain is felt sharp and hot, spreads to the area around it, and is felt when resting, aggravated by activity experienced 5 months ago since the operation to remove the uterus. The patient was diagnosed with persistent post-surgical pain. Neural prolotherapy is performed on patients with PPSP indications. The drugs used are 5% dextrose solution and 2% lidocaine. Injection of 0.5-1 ml of dextrose was carried out in the area along the surgical scar and its surroundings. After the injection, the patient felt that the pain was reduced (numeric rating scale 1/10).
 Conclusion: Neural prolotherapy can be used in the management of patients with PPSP complaints. Treatment with neural prolotherapy injection using a mixture of D5% solution and lidocaine has a good prognosis for symptom improvement and relatively minimal complications.

Efficacy of High-Dose Vitamin C Infusion on Outcomes in Sepsis Requiring Mechanical Ventilation: A Double-Blind Randomized Controlled Trial.

Background Critically ill patients have an increased requirement for vitamin C in sepsis and these patients have low levels of vitamin C. The researchers validated the efficacy of high-dose vitamin C intravenous infusion (IVI) in patients with sepsis requiring mechanical ventilation. Methods Forty patients were randomly assigned to 2 groups (20 each) in a 1 : 1 ratio in accordance with the vitamin C treatment regimen: Group I (GI): patients received 1.5 g/6 h vitamin C in 50 ml of dextrose 5% in water (D5W) IVI over 30 minutes for 4 consecutive days; Group II (GII): patients received 100 mg vitamin C/day as a first single dose in 50 ml of D5W IVI over 30 minutes and the other three subsequent doses were 50 ml of plain D5W IVI over 30 minutes for 4 consecutive days. Primary outcomes were the change in sequential organ failure assessment (SOFA) score at day 7, the incidence of ventilator-associated pneumonia (VAP), and the plasma vitamin C level. The glutathione peroxidase (GPX) activity, C-reactive protein (CRP) level, duration of vasopressor therapy, and 28-day mortality were secondary outcomes. Results The change in SOFA score at day 7 showed a significant difference between GI and GII (p < 0.001). The incidence of early VAP was significantly lower in GI (p=0.044). Vitamin C levels showed a significant rise in GI at day 1 and day 4 (p < 0.001 and p < 0.001, respectively). GPX activity of day 4 and day 7 was significantly higher in GI (p=0.005 and p=0.014, respectively). CRP levels of day 4 and day 7 were significantly higher in GII (p < 0.001 and p < 0.001, respectively). There was a significant difference in 28-day mortality (p=0.038) and duration of vasopressor therapy (p=0.033) in GI compared to GII. Conclusion The early use of high-dose vitamin C intravenous infusion in patients with sepsis requiring mechanical ventilation in combination with the standard treatment for sepsis lowered the incidence of VAP, increased the antioxidant status, and improved the illness severity. Trial Registration. This trial is registered with ClinicalTrials.gov Identifier (NCT04029675).

Ultrasound-guided trigger point injection with dextrose prolotherapy vs. lidocaine in cervical myofascial pain syndrome

Background Neck pain is a common complaint. One of the most common causes of neck pain is myofascial pain syndrome (MFPS). Ultrasound (US) is used as a diagnostic and therapeutic method. Aim The paper aims to compare the effects of US-guided trigger point (TrP) injection with dextrose prolotherapy vs. lidocaine in treating cervical MFPS. Patients and methods The study included 40 MFPS patients with chronic primary cervicitis divided randomly into two equal groups according to the line of treatment. Group 1 included 20 patients treated by one injection with 1 ml of dextrose 5% per TrP. Group 2 included 20 patients treated by one injection with 1 ml of 2% lidocaine per TrP. Both groups were US-guided. After treatment, both groups did stretching and strengthening exercises for 1 month. Follow-up was done 1 week and 1 month post injection. Results There was a significant improvement of visual analog scale and the degree of tenderness in both groups, more significant improvement in group 1 than group 2 as regards the degree of tenderness, significant improvement of the neck range of motion (ROM) in lateral flexion in both groups, significant improvement of the neck disability index (NDI) in both groups, and significant improvement in both groups as regards the absence of TrPs 1 month post injection. Conclusion TrP injection with prolotherapy or lidocaine showed faster improvement in pain, neck ROM, and functional NDI, but the improvement was short term. Dextrose prolotherapy showed slower but prolonged improvement.

CLINICAL EVALUATION OF DEXTROSE PROLOTHERAPY FOR MANAGEMENT OF TEMPOROMANDIBULAR JOINT DISORDER

INTRODUCTION: Temporomandibular disorders (TMDs) are clinically significant conditions which can be a source of acute or chronic orofacial pain and dysfunction including limitation of mandibular movement. Simple lysis and lavage in the upper joint space which washes out inflammatory mediators were found to be highly effective in reestablishing normal maximum interincisal opening (MIO), jaw function and relieving the symptoms despite the disc position not have been corrected. OBJECTIVES: To evaluate the efficiency of arthrocentesis, used normal saline, followed by injection of dextrose 50%, in a single injection protocol, for management of patients with TMDs. MATERIALS AND METHODS: This study was conducted on fourteen TMD patients have been diagnosed on the bases of the clinical data and MRI findings. The selected patients were divided equally into two groups, each group comprising of seven patients. The group-A: has been treated by arthrocentesis followed by 2 ml of dextrose 50% injected into the superior compartment of TMJ. The group-B: has been treated with arthrocentesis alone. All patients have been evaluated at the end of the 24 hours, 1st, 2nd, 3rd, 4th, 5th and 6th weeks postoperatively. RESULTS: unassisted mouth opening showed an increase at all time intervals. There was a significant improvement in pain, the range of motion, joint effusion and joint sounds. CONCLUSIONS: Arthrocentesis followed by 50% dextrose injection is superior to arthrocentesis alone in reducing impairment in patients with TMDs on its clinical outcome.

Effect of in ovo feeding of amino acids and dextrose solutions on hatchability, body weight, intestinal development and liver glycogen reserves in newborn chicks.

Early development of the digestive tract is crucial for achieving maximal growth and development of chickens. This study examined the effects of in ovo (IO) feeding of 0.70 mL of dextrose (10.00% and 20.00%) or amino acids solutions into the yolk sac at day 14 of incubation on small intestine histomorphometry and histomorphology, intestinal development, hatchability, body weight, and liver glycogen reserves in newborn chicks. Results showed body weight in amino acid fed hatchlings was higher than control and dextrose groups non-significantly, but hatchability was lower in amino acid group than others. Also, diameter of glycogen vacuoles in all IO treatment groups was more than control. Administration of exogenous dextrose and amino acids solutions into the yolk sac enhanced intestinal development by increasing the size and surface area of the villi and changed villi shape as well. It seems that dextrose or amino acids solutions could improve the intestinal villi development, while they did not affect finger-like villi in jejunum.

Long-Term Stability Comparison between an Original and a Generic Version of Piperacillin/Tazobactam in Dextrose 5 % Infusion Polyolefin Bags at 5 ± 3 °C after Microwave Freeze-Thaw Treatment

Abstract Background Piperacillin-Tazobactam is frequently infused in hospitals. The use of a generic version was considered after the out of stock of the brand name Tazocin®. The stability of 4 g of Tazocin® in 120 mL of dextrose 5 % (D5) was demonstrated during 35 days at 5 °C ± 3 °C after freezing (−20 °C) and microwave thawing (FMT). The aim of the study was to investigate and compare the long-term stability of Tazocin® and a generic product in the same conditions. Methods Five polyolefin bags of 4 g of Piperacillin/Tazobactam® Sandoz and 5 bags of 4 g of Tazocin® were prepared under aseptic conditions in 120 mL of D5 and stored 3 months at 20 °C then thawed and stored 58 days at 5 ± 3 °C. Spectrophotometric absorbance at different wavelengths, pH measurement, visual and microscopic observations were also performed. The concentrations were measured by HPLC, at 211 nm for tazobactam and 230 nm for piperacilline. Results No significant change in pH values or optic densities, no crystals were detected. The lower confidence limit at 95 % of the concentration for the solutions remains superior to 90 % of the initial concentration until 58 days of storage at 5 ± 3 °C. Conclusion Under these conditions, 4 g/120 mL of Piperacillin/Tazobactam® Sandoz or Tazocin® in D5 infusion in polyolefin bags remains stable at least for 58 days at 5 ± 3 °C after FMT

Profound Hypoglycemia and Corresponding Insulin Levels with Massive Glargine Overdose

Introduction: Despite widespread use of insulin in diabetes, reports of intentional overdose are rare. Insulin kinetics are different in acute poisoning from that in therapeutic doses in part due to delayed absorption from the injection site and reduced clearance. We present a case of insulin glargine overdose where the peak serum insulin levels were observed more than 24 hours after presentation with persistent hypoglycemia for over 100 hours from initial presentation. Case: An unidentified middle-aged female was found comatose in an abandoned house by emergency medical services. She was hemodynamically stable except hypothermic at 34°C. Initial point of care glucose was undetectable and 25mg/dL after 1mg IM glucagon administration. She was given 75ml of Dextrose 50% intravenously and intubated in the field for airway protection. Serum glucose on hospital arrival was &amp;lt;20mg/dL, necessitating the initiation of dextrose 5%, then 10% and eventually continuous infusion of dextrose 40% (D40) via central venous catheter for persistent hypoglycemia. Evaluation revealed serum insulin level of 362 mCU/mL (4-30) with C-peptide 0.3ng/ml (1.4-4.4) when serum glucose was 51, suspicious for exogenous insulin use. Renal and liver function tests were normal, AM cortisol was appropriate and oral hypoglycemic agent panel was negative. Peak total serum insulin levels were 1395mCU/ml with free insulin levels 1022mCU/ml 36 hours after initial presentation. With exaggerated insulin levels, testing for insulin antibodies was done which was negative. D40 drip was weaned off slowly over the next few days and discontinued at 102 hours after arrival. Patient was extubated soon afterwards and admitted to intentional overdosing with over 5000units (5-6 vials) of Lantus. She was admitted to a psychiatry facility for management of depression and suicidality. Conclusion: Profound and persistent hypoglycemia can be observed for days due to altered pharmacokinetics after massive doses of long-acting insulins. Disclosure Z.I. Saeed: None. Z. Zia: None. C.N. Mariash: None.

Prophylactic amiodarone in patients with severe aortic stenosis and left ventricular hypertrophy undergoing aortic valve replacement: Silencing the rebels

BackgroundVentricular fibrillation occurs commonly after aortic cross clamp in patients undergoing aortic valve replacement for severe aortic stenosis. Amiodarone is a class III antiarrhythmic drug that can be used as a prophylactic measure to prevent reperfusion ventricular fibrillation as ventricular fibrillation increases myocardial oxygen demand and hence myocardial damage. MethodsA prospective, randomized, triple blinded study conducted in a single institution, Cardio-thoracic Academy, Ain –Shams University, Cairo, Egypt.120 patients with severe AS enrolled for elective aortic valve replacement. 60 patients received 10 ml of normal saline 9% (control group), while the other 60 patients received a single dose of Amiodarone 150 mg in 10 ml of Dextrose 5% through the pump circuit (Case Group). The incidence of post clamp arrhythmia, need of defibrillation, cardiac support was recorded. Results36 patients (60%) of the case group had spontaneous sinus rhythm upon declamping which is significantly lower than control group. The incidence of VF was lower in the case group (P value < 0.001) (highly significant). The number of DC shock required for ventricular defibrillation, total bypass and declamping times were significantly lower in the case group. ConclusionsProphylactic use of a single dose amiodarone through the pump circuit before cross clamp release reduces the incidence of reperfusion induced ventricular fibrillation and subsequent defibrillation therapy needed.

Comparison of honey and dextrose solution on post-operative peritoneal adhesion in rat model

BackgroundPeritoneal adhesion between abdominal organs is a complication of surgery. It causes major complications like pain, bowel obstruction, infertility and increases risk of death. Honey is known to have anti-inflammatory and antioxidant properties potentially relevant for adhesive protection. MethodsThirty rats were divided into five groups: negative control without any surgical procedure (normal group), control group treated with normal saline, experimental group I treated with 1ml of 10% honey, experimental group II treated with honey at half concentration of group I (honey0.5), and positive control group receiving 1ml of dextrose 5%. Inflammatory, growth and angiogenesis factors (TNF-α, Il-6, IL-1β, TGF-β1 and VEGF) of the adhesion tissue were assessed using ELISA. Antioxidant factors (NO, GSH and MDA) were also assessed using biochemical procedures. ResultsThe difference between peritoneal adhesion scores, TNF-α, IL-1β, IL-6, TGF-β1, VEGF, NO, GSH and MDA value of all groups was strongly significant (p<0.001). We showed that honey can decrease peritoneal adhesion (p<0.001), TNF-α (p<0.001), IL-1β (p<0.001), IL-6 (p<0.001), TGF-β1 (p<0.001), VEGF (p<0.001), NO (p<0.001), MDA (p<0.001) and increase GSH (p<0.001) compared with control group. Honey 0.5 also significantly decreased peritoneal adhesion (p<0.001), TNF-α (p<0.001), IL-1β (p<0.01), IL-6 (p<0.001), VEGF (p<0.001), NO (p<0.001), MDA (p<0.01) and increase GSH (p<0.001) compared with control group. ConclusionsWe find that honey can decrease inflammatory, growth and angiogenesis factors which can advance peritoneal adhesion and increase antioxidant factors. Honey could serve as a protective agent for peritoneal adhesion.

Computed tomographic-guided percutaneous radiofrequency ablation with hydrodissection of hepatic malignancies in the subcapsular location: Evaluation of safety and technical efficacy

BackgroundImage-guided percutaneous radiofrequency ablation (RFA) has been the most commonly used modality in the treatment of nonresectable hepatic malignancies. However, tumors in the subcapsular location are still technically challenging. This study was undertaken to evaluate the feasibility, safety, and efficacy of computed tomographic-guided percutaneous RFA with hydrodissection for hepatic malignancies in the subcapsular location. MethodsA total of 103 patients with 253 hepatic lesions were treated with computed tomographic-guided percutaneous RFA. Computed tomographic-guided percutaneous RFA with hydrodissection was performed in 15 patients with 15 hepatic nodules. All tumors located in the hepatic subcapsular location were considered difficult to treat on planning sonography. Hydrodissection was performed with 5% dextrose in water or saline solution in displacing adjacent structures ≥ 10 mm away from the liver capsule. Two RFA systems with multitined expandable electrodes or straight internally cooled single electrodes were used for treatment of hepatic malignancies. The feasibility, safety, and efficacy of this technique were analyzed on follow-up contrast-enhanced computed tomography or magnetic resonance imaging. ResultsHydrodissection was successfully achieved in 15 (100%) patients, displacing the adjacent structures ≥ 10 mm that were originally < 10 mm away from the liver capsule with administration of a mean of 376 mL of dextrose in water or saline solution. The average distance between an adjacent structure and the liver capsule after hydrodissection was 1.50 ± 0.40 cm and 0.11 ± 0.15 cm prior to hydrodissection, which was statistically significant (p < 0.001). No complication related to hydrodissection occurred during the follow-up period. The primary technical success rate of percutaneous RFA for tumor was 100% (15/15) at 1-month follow-up imaging. There were three minor complications (20%, 3/15) related to the RFA procedure. ConclusionComputed tomographic-guided percutaneous RFA with hydrodissection is a feasible, safe, and effective technique in the treatment of hepatic malignancies in the subcapsular location.

Postoperative N-terminal Pro–Brain Natriuretic Peptide Level in Coronary Artery Bypass Surgery With Ventricular Dysfunction After Perioperative Glucose-Insulin-Potassium Treatment

The aim of this study was to clarify the efficacy of perioperative glucose-insulin-potassium (GIK) infusion on preoperative and postoperative N-terminal (NT)-pro-brain natriuretic peptide (BNP) concentrations in patients with a low ejection fraction undergoing isolated on-pump coronary artery bypass graft (CABG) surgery. A double-blind, randomized, controlled study. Modarres Hospital, Tehran, Islamic Republic of Iran. Sixty-six patients with a low ejection fraction who required coronary artery surgery were selected. Patients were allocated to a GIK (n = 36) or a control (n = 30) group. The GIK group received GIK solution (500 mL of dextrose in water (DW) 10% + 40 U of regular insulin + 40 mEq of KCl, and 2 g of MgSO(4)) at a rate of 1 mL/kg/h for 10 hours preoperatively and until the removal of the aortic cross-clamp. The control group received half saline solution as placebo with an equivalent infusion rate during the same interval. Serum NT-proBNP levels were measured before starting the GIK, at the time of anesthesia induction, and 24 hours after surgery. The primary outcome measures were preoperative and postoperative NT-proBNP level. The amount of elevation in postoperative NT-proBNP concentrations was less prominent in the GIK group than in the control group (2,601 ± 1,799 pg/mL v 4,732 ± 4,127 pg/mL; p = 0.02). The patients in the GIK group were extubated sooner (495 ± 92 minutes) than the control group (774 ± 224 minutes; p = 0.002). The overall extubation time was 606 ± 177 minutes. Delayed requirement for mechanical ventilation was significantly more in the controls compared with the GIK group (45.8% v 13.9%, p = 0.004). GIK is of value in the reduction of post-cardiac surgery NT-proBNP elevation. Thus, its infusion should have a protective effect in patients with low ejection fraction undergoing CABG surgery. Further studies may prove GIK infusion benefits in high-risk CABG surgery patients optimize outcome.

Mathematical and physical model of gravity-fed infusion outflow: application to soft-bag-packed solutions

Gravity-fed infusion (GFI) systems are acknowledged as being unable to keep their flow-rate constant. This may affect drug plasma levels such as aminoglycosides. Numerous factors have previously been cited, but their relative importance has never been quantified so far. The objective of this work is to identify the main factors that influence GFI in vitro outflow and to propose a mathematical model of flow-rate evolution as a function of time. In this model, pressure loss and infusion device creep have been considered as the main variation factors. Concomitantly, two experiments were undertaken. Firstly, the flow-rate evolution of an in vitro infusion of 250 mL of dextrose 5% was assessed. Secondly, the creep occurring on an infusion device was measured through a stress relaxation experiment. The experimental infusion flow-rate decreased by as much as 28.5% over 1 h. Simulated and experimental data are well correlated (r = 0.987; P < 0.0001). The maximum creep effect happens during the first 15 min of infusion. In this work, height of the liquid in the bag and tube creep were found to be the main variation factors in GFI flow-rate. This new mathematical model should help to explain the differences observed in drug plasma levels with gravity-fed devices.

The Hypoglycemia Evaluated Mistakenly as Cerebrovascular Disease

We aimed at emphasizing the significance of monitoring and regulating the blood glucose level of type II diabetic patients by presenting the case of a patient who was initially diagnosed as cerebral ischemia by mistake and later treated and healed via regulating the blood glucose level. A 79-year-old female patient who suffered from type II diabetes mellitus (type II DM) and hypertension was operated on because of left intertrochanteric fracture. On the postoperative 4th day, the overall situation of the patient worsened. She was unconscious, showing no responses to vocal stimulations. Cerebrovascular disease was not eliminated because of clinical findings, and the patient was intubated as mechanical ventilation was applied. The blood glucose level was 12 mg/dl at the time. As 500 ml of dextrose 10% was applied in twenty minutes, the blood glucose level increased to 237 mg/dl and the neurological findings improved. The next day, the patient was extubated. In cases where factors such as stress and starvation are present, the level of blood glucose should be examined frequently for diabetic patients during pre-, per-, and postoperative periods. In our case, our recommendation is to think systematically even from the simplest syndrome to the most complicated one. J Neurol Res. 2011;1(1):34-36 doi: https://doi.org/10.4021/jnr15e

The Hypoglycemia Evaluated Mistakenly as Cerebrovascular Disease

We aimed at emphasizing the significance of monitoring and regulating the blood glucose level of type II diabetic patients by presenting the case of a patient who was initially diagnosed as cerebral ischemia by mistake and later treated and healed via regulating the blood glucose level. A 79-year-old female patient who suffered from type II diabetes mellitus (type II DM) and hypertension was operated on because of left intertrochanteric fracture. On the postoperative 4th day, the overall situation of the patient worsened. She was unconscious, showing no responses to vocal stimulations. Cerebrovascular disease was not eliminated because of clinical findings, and the patient was intubated as mechanical ventilation was applied. The blood glucose level was 12 mg/dl at the time. As 500 ml of dextrose 10% was applied in twenty minutes, the blood glucose level increased to 237 mg/dl and the neurological findings improved. The next day, the patient was extubated. In cases where factors such as stress and starvation are present, the level of blood glucose should be examined frequently for diabetic patients during pre-, per-, and postoperative periods. In our case, our recommendation is to think systematically even from the simplest syndrome to the most complicated one. doi:10.4021/jnr15e

Use of calcium and magnesium infusions in prevention of oxaliplatin induced sensory neuropathy

Oxaliplatin-related neurotoxicity is frequently dose-limiting. Following retrospective studies suggesting neuroprotective effects of calcium and magnesium (Ca and Mg), we conducted a prospective study using nerve conduction studies (NCS) to evaluate the effectiveness of such infusions in oxaliplatin-related neuropathy. Colorectal cancer patients receiving FOLFOX-4 or capecitabine plus oxaliplatin were randomized to (Arm A) calcium gluconate 1g +15% magnesium sulphate 1g diluted in 100 mL of dextrose 5% or (Arm B) placebo. Neuropathy was assessed using the National Cancer Center common toxicity criteria, oxaliplatin-specific scale and NCS. This study was terminated prematurely based on the initial negative results of the CONcePT trial. Median follow up was 8.7 months. Overall 22 out of 27 patients experienced neuropathy. The subjective neuropathy rate was 77% in Arm A and 86% in Arm B, (P = 0.6). At the end of treatment, three patients in Arm A and 0 in Arm B had grade 3 numbness (P = 0.09). There was no significant difference in neuropathy between arms, whether during or at the end of treatment. Median objective neuropathy score was 6 in Arm A and 0 in Arm B, (P = 0.02). Premature closure of this study limits the interpretation of results. While there was a trend towards reduced subjective acute sensory neuropathy with Ca and Mg, this was not significant. Ca and Mg failed to reduce the rate of cumulative sensory neuropathy and instead increased the rate of abnormal NCS, suggesting a significant difference in perceived sensory and objective neuropathy.

Phase I/II study of topical imiquimod and intralesional interleukin-2 in the treatment of accessible metastases in malignant melanoma

Patients with metastatic skin disease in malignant melanoma can be difficult to treat effectively, often requiring repeated treatments with different modalities in an attempt to control their disease. Treatment of nonsurgically resectable melanoma deposits is unsatisfactory, as they are often multiple and recurring. Anecdotal evidence from individual use of imiquimod in superficial metastases and intralesional interleukin (IL)-2 in subcutaneous deposits suggests that the combination may be more effective in bulky subcutaneous disease. To investigate the combination of topical imiquimod and, for selected lesions, intralesional IL-2, to treat a small cohort of patients with accessible melanoma metastases resistant to other treatments. Thirteen patients were recruited: all had evidence of multiple cutaneous and/or subcutaneous metastases. Imiquimod was applied to the metastases on a daily basis for 4 weeks, before the introduction of intralesional IL-2. This was injected up to three times a week, into selected lesions, with 0.1 mL injected per lesion at a concentration of 3.6 MIU mL(-1), a total of 1 mL being given at each session. The treated lesions were assessed individually at intervals of 3 months. Thirteen patients were treated, with 10 being eligible for assessment. In total, 182 lesions were treated: 137 purely cutaneous lesions and 41 subcutaneous lesions. Overall, a clinical response was seen in 92 lesions (50.5%) with 74 (40.7%) of these being a complete response (CR) with 91% of the CRs being in the cutaneous lesions. New lesions did appear during the treatment course; however, patients with cutaneous disease experienced a marked slowing of the appearance of new cutaneous lesions. No cutaneous lesions that responded reappeared on cessation of treatment. The combination of imiquimod and IL-2 is effective in controlling this mixed cutaneous and subcutaneous disease, and is well tolerated. Imiquimod alone is often enough to elicit a response in purely cutaneous lesions. The addition of intralesional IL-2 increases the response rates in subcutaneous lesions, and in otherwise refractory cutaneous lesions.

Effect of Freezing, Long-Term Storage, and Microwave Thawing on the Stability of Ketorolac Tromethamine

Ketorolac tromethamine is a nonsteroidal agent with potent analgesic and moderate antiinflammatory activity. Advance preparation of intravenous solution could be useful to improve quality assurance, time management, and cost-savings of drug delivery. To investigate the effect of freezing, long-term storage, and microwave thawing on the stability of ketorolac tromethamine in dextrose 5% infusion. Five polyolefin bags of solution containing ketorolac tromethamine 20 mg per 100 mL of dextrose 5% were frozen for 3 months at -20 degrees C, thawed in a microwave oven with a validated cycle, and stored at 4 degrees C. The concentration of ketorolac was measured by HPLC. Visual inspection and pH measurement were also carried out. No color change or precipitation was observed. Ketorolac was stable for at least 60 days under refrigeration after freeze-thaw. Throughout this period, the lower confidence limit of the estimated regression line of the concentration-time profile remained >90% of the initial concentration, and the pH value decreased slightly without affecting chromatographic parameters. Within these limits, ketorolac tromethamine in dextrose 5% infusion may be prepared and frozen in advance by a centralized intravenous admixture service, then thawed before use in clinical units.

Effect of the Freezing Conditions and Microwave Thawing Power on the Stability of Cefuroxime in Dextrose 5% Infusion Polyolefin Bags at 4 °C

Intravenous cefuroxime sodium solution could be prepared in advance by a centralized hospital pharmacy service to improve safety and time management. To investigate the effect of freezing and microwave thawing on the solution stability of cefuroxime. Cefuroxime 1.5 g in 100 mL of dextrose 5% in polyolefin bags was frozen individually (group A) or in one package (group B) for 98 days at -20 degrees C. The solutions were then thawed using microwaves at 270 (light cycle) or 800 watts (hard cycle) and stored at 4 degrees C. The cefuroxime concentration was measured by HPLC. Visual inspection was performed and pH was measured at that time. Stability of the solution was defined as a concentration remaining superior to 90% of the initial concentration by regression analysis. No color change or precipitation in the solutions was observed. In group A, stability was at least 23 and 21 days after light and hard cycle thawing, respectively. In group B, stability was at least 21 and 18 days, respectively, with the pH increasing without affecting chromatographic parameters. The optimal conditions for advance preparation of a solution containing cefuroxime 1.5% in dextrose 5% may be freezing of individual containers followed by a light cycle of microwave thawing.

Detection of Graft Nonfunction After Liver Transplantation by Assessment of Indocyanine Green Kinetics

Detection of Graft Nonfunction After Liver Transplantation by Assessment of Indocyanine Green Kinetics

Urinary excretion of cyclohexanediol, a metabolite of the solvent cyclohexanone, by infants in a special care unit

Using gas chromatography-mass spectrometry, we investigated the urinary excretion of organic acids of 278 newborn babies in a special care unit to obtain reference data and monitor metabolism. In 101 of 584 urine samples analyzed, we found isomers of cyclohexanediol. trans-1,2-Cyclohexanediol was always most abundant, with small amounts of 1,3- and 1,4-cyclohexanediol and, sometimes, traces of cis-1,2-cyclohexanediol. Glucuronide conjugates were not detected. The probable source was the solvent cyclohexanone, which was found as a contaminant of intravenous dextrose and the parenteral feeding solution, and was also leached into the infusion fluids from the administration set. We recovered 0.89 mg (range 0.74-0.98 mg, n = 5) of cyclohexanone from 150 mL of dextrose pumped through the infusion apparatus over 24 h, the normal rate for a 1-kg premature baby. Although this is well below toxic doses reported for mature animals, more data are needed for the newborn, particularly preterm infants who have a decreased capacity for glucuronide conjugation.