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1

Potential life-threatening variations of drug concentrations in intravenous infusion systems: potassium chloride, insulin, and heparin  

Energy Technology Data Exchange (ETDEWEB)

The investigation of concentrations of active agents in common carrier media for intravenous infusion revealed that potassium chloride tends to form a pool when it is added without mixing to carrier media in glass or polyvinyl chloride (PVC) containers which are already suspended in their functional position with ports pointing downwards. Heparin behaves in a similar fashion when added without mixing to carrier media in PVC containers. Such uneven distribution may expose a patient to potentially dangerous, possibly lethal, concentrations of a drug even when a relatively small amount of it is used. Insulin floats to the top of a Haemaccel container if its contents are not adequately mixed after addition of insulin. The resultant irregularity of insulin dosage may make the management of diabetic ketoacidosis more difficult. It is recommended that the instructions for the adequate mixing of contents should appear on all containers of carrier media for intravenous infusions.

Bergman, N.; Vellar, I.D.

1982-09-18

2

Potential life-threatening variations of drug concentrations in intravenous infusion systems: potassium chloride, insulin, and heparin.  

Science.gov (United States)

The investigation of concentrations of active agents in common carrier media for intravenous infusion revealed that potassium chloride tends to form a pool when it is added without mixing to carrier media in glass or polyvinyl chloride (PVC) containers which are already suspended in their functional position with ports pointing downwards. Heparin behaves in a similar fashion when added without mixing to carrier media in PVC containers. Such uneven distribution may expose a patient to potentially dangerous, possibly lethal, concentrations of a drug even when a relatively small amount of it is used. Insulin floats to the top of a Haemaccel container if its contents are not adequately mixed after addition of insulin. The resultant irregularity of insulin dosage may make the management of diabetic ketoacidosis more difficult. It is recommended that the instructions for the adequate mixing of contents should appear on all containers of carrier media for intravenous infusions. PMID:6755202

Bergman, N; Vellar, I D

1982-09-18

3

Potential life-threatening variations of drug concentrations in intravenous infusion systems: potassium chloride, insulin, and heparin.  

UK PubMed Central (United Kingdom)

The investigation of concentrations of active agents in common carrier media for intravenous infusion revealed that potassium chloride tends to form a pool when it is added without mixing to carrier media in glass or polyvinyl chloride (PVC) containers which are already suspended in their functional position with ports pointing downwards. Heparin behaves in a similar fashion when added without mixing to carrier media in PVC containers. Such uneven distribution may expose a patient to potentially dangerous, possibly lethal, concentrations of a drug even when a relatively small amount of it is used. Insulin floats to the top of a Haemaccel container if its contents are not adequately mixed after addition of insulin. The resultant irregularity of insulin dosage may make the management of diabetic ketoacidosis more difficult. It is recommended that the instructions for the adequate mixing of contents should appear on all containers of carrier media for intravenous infusions.

Bergman N; Vellar ID

1982-09-01

4

Effects of intravenous lipopolysaccharide infusion on glucose and insulin dynamics in horses with equine metabolic syndrome.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To test the hypothesis that glucose and insulin dynamics during endotoxemia differ between healthy horses and horses with equine metabolic syndrome (EMS). ANIMALS: 6 healthy adult mares and 6 horses with EMS. PROCEDURES: Each horse randomly received an IV infusion of lipopolysaccharide (20 ng/kg [in 60 mL of sterile saline {0.9% NaCl} solution]) or saline solution, followed by the other treatment after a 7-day washout period. Baseline insulin-modified frequently sampled IV glucose tolerance tests were performed 27 hours before and then repeated at 0.5 and 21 hours after infusion. Results were assessed via minimal model analysis and area under the curve values for plasma glucose and serum insulin concentrations. RESULTS: Lipopolysaccharide infusion decreased insulin sensitivity and increased area under the serum insulin concentration curve (treatment × time) in both healthy and EMS-affected horses, compared with findings following saline solution administration. The magnitude of increase in area under the plasma glucose curve following LPS administration was greater for the EMS-affected horses than it was for the healthy horses. Horses with EMS that received LPS or saline solution infusions had decreased insulin sensitivity over time. CONCLUSIONS AND CLINICAL RELEVANCE: Glucose and insulin responses to endotoxemia differed between healthy horses and horses with EMS, with greater loss of glycemic control in EMS-affected horses. Horses with EMS also had greater derangements in glucose and insulin homeostasis that were potentially stress induced. It may therefore be helpful to avoid exposure of these horses to stressful situations.

Tadros EM; Frank N; De Witte FG; Boston RC

2013-07-01

5

Computerization of the yale insulin infusion protocol and potential insights into causes of hypoglycemia with intravenous insulin.  

UK PubMed Central (United Kingdom)

BACKGROUND: The management of critically ill hyperglycemic patients in the intensive care unit (ICU) has been fraught with recent controversy. Only one randomized trial has demonstrated a mortality benefit to intensive glycemic control, with all subsequent studies failing to confirm this benefit and revealing a markedly increased risk of severe hypoglycemia (SH) in intensively treated patients. In most of these trials, adherence to the protocols were neither tracked nor reported. METHODS: A retrospective analysis of all patients admitted to an ICU who were treated with an insulin infusion directed by the GlucoCare™ IGC System, an FDA-cleared insulin-dosing calculator (Yale 100-140 mg/dL protocol). Mean blood glucose (BG) levels, time to target range and incidence of SH (<40 mg/dL) and moderate hypoglycemia (MH) (40-69 mg/dL) were determined, and potential causes of hypoglycemic episodes were assessed. RESULTS: Mean post-target BG was approximately 123 mg/dL. Of >55,000 readings in 1,657 patients, overall incidence of SH was 0.01% of readings and 0.3% of patients. MH occurred in 1.1% of readings and 17.6% of patients. The top potential causes of MH were: (1) Protocol-directed recommendations including continuation of insulin with BG <100 mg/dL and decreases in the frequency of BG checks (63.7%), and (2) Staff non-adherence to protocol directives (15.3%). CONCLUSIONS: The results of the GlucoCare-directed Yale 100-140 mg/dL protocol experience revealed an extremely low incidence of SH and an incidence of MH of 1.1%. The incidence of SH in this study was lower than the control group of the NICE-SUGAR study and are supportive of the new Society of Critical Care guidelines to target BG levels of 100-150 mg/dL in critically ill patients. Further refinements to the original protocol and emphasis on staff adherence to protocol directives could potentially further reduce these very low hypoglycemia rates.

Marvin MR; Inzucchi SE; Besterman BJ

2013-03-01

6

Pharmacokinetics and pharmacodynamics of different modes of insulin pump delivery. A randomized, controlled study comparing subcutaneous and intravenous administration of insulin aspart  

DEFF Research Database (Denmark)

To study the pharmacokinetics and pharmacodynamics of three different modes of insulin infusion delivered by means of an insulin pump: subcutaneous bolus insulin injection once an hour, continuous subcutaneous insulin infusion and continuous intravenous insulin infusion.

Ihlo, C A; Lauritzen, Torsten

2011-01-01

7

Pharmacokinetics of continuous subcutaneous insulin infusion  

DEFF Research Database (Denmark)

One of the reasons for the variability of blood glucose regulation in Type 1 (insulin-dependent) diabetic patients is the huge variation in subcutaneous absorption of intermediate-acting insulin. We have investigated the variation in insulin absorption during continuous subcutaneous insulin infusion in eight such patients. The content of insulin in the subcutaneous tissue was measured using 125I-labelled insulin. The concentration of free serum insulin and blood glucose was followed from 1 h before and from 7 h after breakfast on two consecutive days. The amount of insulin absorbed during 24 h differed in all cases by less than 3% from the daily insulin dose given by the pumps. Mean insulin absorption rates and mean free insulin concentration showed peak values 30-90 min after meal bolus injections; this was sufficient to maintain near-normal blood glucose. Mean free serum insulin correlated strongly with disappearance of insulin from the subcutaneous tissue (r = 0.98). From the insulin absorption rates and free insulin concentrations during basal constant insulin infusion, the half-time of serum insulin was calculated as 6 min. Compared with the known large variability in the absorption of intermediate-acting insulin, continuous subcutaneous insulin infusion offers a precise and reproducible way of insulin administration resulting in post-prandial serum insulin peaks sufficient to maintain near-normal blood glucose levels. The half-time of serum insulin during subcutaneous infusion corresponds to values for intravenous infusion given in the literature, indicating that local degradation of insulin in subcutaneous tissue is of minor importance.

Lauritzen, Torsten; Pramming, S

1983-01-01

8

Survival of intravenous chemotherapy infusion sites.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Factors associated with the failure of intravenous infusions due to phlebitis and extravasation were studied with 218 infusions delivering cytotoxic drugs. The survival rate of these infusions was not significantly different from that of 56 non-cytotoxic infusions in oncology patients. Although surv...

Hecker, J. F.

9

Effects of an overnight intravenous lipid infusion on intramyocellular lipid content and insulin sensitivity in African-American versus Caucasian adolescents.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To explain the predisposition for insulin resistance among African American (AA) adolescents, this study aimed to: 1) examine changes in intramyocellular lipid content (IMCL), and insulin sensitivity with intralipid (IL) infusion; and 2) determine whether the increase in IMCL is comparable between AA and Caucasian adolescents. MATERIALS AND METHODS: Thirteen AA and 15 Caucasian normal-weight adolescents (BMI <85th) underwent a 3-h hyperinsulinemic-euglycemic clamp, on two occasions in random order, after an overnight 12-h infusion of: 1) 20% IL and 2) normal saline (NS). IMCL was quantified by (1)H magnetic resonance spectroscopy in tibialis anterior muscle before and after IL infusion. RESULTS: During IL infusion, plasma TG, glycerol, FFA and fat oxidation increased significantly, with no race differences. Hepatic insulin sensitivity decreased with IL infusion with no difference between the groups. IL infusion was associated with a significant increase in IMCL, which was comparable between AA (? 105%; NS: 1.9±0.8 vs. IL: 3.9±1.6 mmol/kg wet weight) and Caucasian (? 86%; NS: 2.8±2.1 vs. IL: 5.2±2.4 mmol/kg wet weight), with similar reductions (P<0.01) in insulin sensitivity between the groups (? -44%: NS: 9.1±3.3 vs. IL: 5.1±1.8 mg/kg/min per ?U/ml in AA) and (? -39%: NS: 12.9±6.0 vs. IL: 7.9±3.8 mg/kg/min per ?U/ml in Caucasian) adolescents. CONCLUSIONS: In healthy adolescents, an acute elevation in plasma FFA with IL infusion is accompanied by significant increases in IMCL and reductions in insulin sensitivity with no race differential. Our findings suggest that AA normal-weight adolescents are not more susceptible than Caucasians to FFA-induced IMCL accumulation and insulin resistance.

Lee S; Boesch C; Kuk JL; Arslanian S

2013-03-01

10

Safety of rapid intravenous of infusion acetaminophen.  

UK PubMed Central (United Kingdom)

Intravenous acetaminophen, Ofirmev®, is approved for management of mild to moderate pain, management of moderate to severe pain with adjunctive opioids, and reduction of fever. The product is supplied as a 100 mL glass vial. As stated in the prescribing information, it is recommended to be infused over 15 minutes. This recommendation is related to the formulation propacetamol, the prodrug to acetaminophen, approved in Europe, which caused pain on infusion, and data from the clinical development of acetaminophen. The objective of this retrospective chart review study was to show the lack of side effects of rapidly infusing intravenous acetaminophen. Charts of American Society of Anesthesiology (ASA) Class I-III ambulatory surgical patients who received only acetaminophen in the preoperative setting were reviewed for any infusion-related side effects. Using standard binomial proportion analyses and employing SAS/JMP software, all vital signs were analyzed for statistically significant changes between pre- and postinfusion values. One hundred charts were reviewed. Only one patient had pain on infusion, which lasted 10 seconds. No reported side effects or erythema was seen at the injection site. No infusions had to be slowed or discontinued. The median infusion time was 3:41 minutes. Of the vital signs monitored, only the systolic (P < 0.0001) and diastolic (P < 0.0099) blood pressures had statistically significant changes from pre- to postinfusion; however, they were of no clinical relevance. Acetaminophen can be administered as a rapid infusion with no significant infusion-related side effects or complications.

Needleman SM

2013-07-01

11

Comparing subcutaneous fluid infusion with intravenous fluid infusion in children.  

UK PubMed Central (United Kingdom)

INTRODUCTION: This study examined subcutaneous (SC) infusion as a parenteral alternative for children with mild to moderate illness. The purpose was to compare the difference in infusion start time of parenteral fluid between an initial SC order and an initial intravenous (IV) order. In addition, the number of needlesticks a child received for each method was evaluated. This study also sought to address the following question: If SC fluids were given and an IV attempt was made later, did the administration of SC fluids enhance the success of venous cannulation? METHODS: A retrospective descriptive design was used for review of medical records for 36 children from November 2008 to May 2010 who had received SC fluids only or received SC fluids after 2 or more failed IV attempts. RESULTS: The IV/SC group had significantly longer time to infusion (M = 97.33 minutes) than did the SC group (M = 20.95 minutes; U = .000; P < .001). The IV/SC group included the number of needlesticks for the intravenous attempts plus the needle stick needed for the subcutaneous infusion. A significant difference was found between the 2 groups (mean IV = 4.87; mean SC = 1; Z = .000; P < .001). DISCUSSION: In a child who is not seriously ill, SC infusions appear to facilitate the initiation of parenteral rehydration. SC infusions minimized the number of needlesticks a child endured. More study is needed to determine if SC fluids enhance success of subsequent venous cannulation.

Kuensting LL

2013-01-01

12

[Calcium and endocrine pancreas secretion. II. Effects of an infusion of calcium on insulin and glucagon secretion induced by intravenous administration of glucose  

UK PubMed Central (United Kingdom)

IRI, IRG and blood glucose levels after I.V.G.T.T. in normal subjects were not significantly modified when I.V.G.T.T. was repeated during a prolonged calcium infusion (15 mg/Kg body weight per 90'). The Authors advance the hypothesis that no closed relationships exist between serum calcium levels and insulin secretion, in these experimental conditions; with regard to glucagon secretion, further experiences are of course required namely during alpha-cell stimulation.

Cucinotta D; Quartarone M; Longo G; Toscano A; Saitta A; Musolino C; Squadrito G

1980-02-01

13

Low-dose insulin infusions in diabetic patients with high insulin requirements.  

Science.gov (United States)

Six patients with high insulin requirements (range 120-3000 units daily) have been infused with much smaller doses (range 50-63 units daily) of insulin intravenously. All six maintained adequate glucose homoestasis on this regimen. It is suggested that subcutaneous tissue at the site of injection may alter insulin or impair its absorption. Insulin resistance in some patients may be due to these mechanisms. PMID:79081

Dandona, P; Foster, M; Healey, F; Greenbury, E; Beckett, A G

1978-08-01

14

Intravenous infusions in chronic pain management.  

UK PubMed Central (United Kingdom)

In the United States, millions of Americans are affected by chronic pain, which adds heavily to national rates of morbidity, mortality, and disability, with an ever-increasing prevalence. According to a 2011 report titled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research by the Institute of Medicine of the National Academies, pain not only exacts its toll on people's lives but also on the economy with an estimated annual economic cost of at least $560 - 635 billion in health care costs and the cost of lost productivity attributed to chronic pain. Intravenous infusions of certain pharmacologic agents have been known to provide substantial pain relief in patients with various chronic painful conditions. Some of these infusions are better, and although not necessarily the first therapeutic choice, have been widely used and extensively studied. The others show promise, however are in need of further investigations. This article will focus on non-opiate intravenous infusions that have been utilized for chronic painful disorders such as fibromyalgia, neuropathic pain, phantom limb pain, post-herpetic neuralgia, complex regional pain syndromes (CRPS), diabetic neuropathy, and central pain related to stroke or spinal cord injuries. The management of patients with chronic pain conditions is challenging and continues to evolve as new treatment modalities are explored and tested. The following intravenous infusions used to treat the aforementioned chronic pain conditions will be reviewed: lidocaine, ketamine, phentolamine, dexmedetomidine, and bisphosphonates. This overview is intended to familiarize the practitioner with the variety of infusions for patients with chronic pain. It will not, however, be able to provide guidelines for their use due to the lack of sufficient evidence.

Kosharskyy B; Almonte W; Shaparin N; Pappagallo M; Smith H

2013-05-01

15

Intravenous infusions in chronic pain management.  

Science.gov (United States)

In the United States, millions of Americans are affected by chronic pain, which adds heavily to national rates of morbidity, mortality, and disability, with an ever-increasing prevalence. According to a 2011 report titled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research by the Institute of Medicine of the National Academies, pain not only exacts its toll on people's lives but also on the economy with an estimated annual economic cost of at least $560 - 635 billion in health care costs and the cost of lost productivity attributed to chronic pain. Intravenous infusions of certain pharmacologic agents have been known to provide substantial pain relief in patients with various chronic painful conditions. Some of these infusions are better, and although not necessarily the first therapeutic choice, have been widely used and extensively studied. The others show promise, however are in need of further investigations. This article will focus on non-opiate intravenous infusions that have been utilized for chronic painful disorders such as fibromyalgia, neuropathic pain, phantom limb pain, post-herpetic neuralgia, complex regional pain syndromes (CRPS), diabetic neuropathy, and central pain related to stroke or spinal cord injuries. The management of patients with chronic pain conditions is challenging and continues to evolve as new treatment modalities are explored and tested. The following intravenous infusions used to treat the aforementioned chronic pain conditions will be reviewed: lidocaine, ketamine, phentolamine, dexmedetomidine, and bisphosphonates. This overview is intended to familiarize the practitioner with the variety of infusions for patients with chronic pain. It will not, however, be able to provide guidelines for their use due to the lack of sufficient evidence. PMID:23703410

Kosharskyy, Boleslav; Almonte, Wilson; Shaparin, Naum; Pappagallo, Marco; Smith, Howard

16

Critical parameters in drug delivery by intravenous infusion.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Intravenous infusion is commonly used to deliver medications and fluids to patients. The duration of an infusion is short (hours) in the operating room where intravenous agents are infused to anesthetize patients and to manage circulation. Critically ill patients often receive infusions for days. Infusion technology has become increasingly sophisticated and complex. The technical advances broaden the clinical application of intravenous infusion methodology and provide safety features. AREAS COVERED: This article provides an historical overview of intravenous infusion and discusses components of infusion systems. A section describes configuration of components to meet clinical needs. The article describes physical properties of infusion systems, emphasizing how critical parameters of resistance to flow, infusion pump performance and interactions between fluid flows and the dead volume influence medication and fluid delivery. The authors emphasize the use of infusions in the intensive care and operating room environments, although the general principles apply to other clinical settings. EXPERT OPINION: Intravenous infusion systems contribute significantly to clinical care, but in a deceptively simple way. Several critical parameters combine to influence the performance of an infusion system, with a number of pitfalls potentially confounding utility of the technology. Safe and effective clinical application of intravenous infusion technology depends on an appreciation of this complexity which impacts the performance of infusion systems.

Peterfreund RA; Philip JH

2013-08-01

17

Warmed intravenous infusion for controlling intraoperative hypothermia.  

UK PubMed Central (United Kingdom)

OBJECTIVE: to verify the effectiveness of warmed intravenous infusion for hypothermia prevention in patients during the intraoperative period. METHOD: experimental, comparative, field, prospective and quantitative study undertaken at a federal public hospital. The sample was composed of 60 adults, included based on the criteria of axillary temperature between 36ºC and 37.1ºC and surgical abdominal access, divided into control and experimental groups, using the systematic probability sampling technique. RESULTS: 22 patients (73.4%) from both groups left the operating room with hypothermia, that is, with temperatures below 36ºC (p=1.0000). The operating room temperature when patients arrived and patients' temperature when they arrived at the operating room were statistically significant to affect the occurrence of hypothermia. CONCLUSION: the planning and implementation of nursing interventions carried out by baccalaureate nurses are essential for preventing hypothermia and maintaining perioperative normothermia.

Mattia AL; Barbosa MH; Freitas JP Filho; Rocha AD; Pereira NH

2013-06-01

18

Intravenous insulin use: technical aspects and caveats.  

UK PubMed Central (United Kingdom)

Insulin has been in use for nearly a century, but its real clinical worth has been utilized only in the last one and half decade after the landmark study on tight glycaemic control by van Den Berghe. Intravenous (i.v.) insulin is the mainstay of treatment for hyperglycaemia in many acute settings as well as in managing diabetic complications. However, i.v. insulin usage may be associated with numerous potential errors which may have unintended consequences. A thorough knowledge of various aspects associated with insulin injection techniques such as preparations of i.v. insulin, calculation of correct dosage, precautions while using insulin with various i.v. fluids, formulating strategies to minimize insulin adsorption to tubing surface, choosing appropriate insulin injection accessories and devices, can help in optimal control of hyperglycaemia with minimal errors. Improvisation of insulin injection techniques is often necessary in resource challenged settings to minimize the morbidity and mortality associated with uncontrolled hyperglycaemia.

Kalra S; Bajwa SJ

2013-05-01

19

Intravenous insulin use: technical aspects and caveats.  

Science.gov (United States)

Insulin has been in use for nearly a century, but its real clinical worth has been utilized only in the last one and half decade after the landmark study on tight glycaemic control by van Den Berghe. Intravenous (i.v.) insulin is the mainstay of treatment for hyperglycaemia in many acute settings as well as in managing diabetic complications. However, i.v. insulin usage may be associated with numerous potential errors which may have unintended consequences. A thorough knowledge of various aspects associated with insulin injection techniques such as preparations of i.v. insulin, calculation of correct dosage, precautions while using insulin with various i.v. fluids, formulating strategies to minimize insulin adsorption to tubing surface, choosing appropriate insulin injection accessories and devices, can help in optimal control of hyperglycaemia with minimal errors. Improvisation of insulin injection techniques is often necessary in resource challenged settings to minimize the morbidity and mortality associated with uncontrolled hyperglycaemia. PMID:23758001

Kalra, Sanjay; Bajwa, Sukhminder Jit Singh

2013-05-01

20

Subcutaneous insulin infusion: change in basal infusion rate has no immediate effect on insulin absorption rate  

International Nuclear Information System (INIS)

[en] Eight insulin-dependent diabetic patients were simultaneously given subcutaneous infusions (1.12 IU/h each) of 125I-labeled Actrapid insulin in each side of the abdominal wall. After 24 h of infusion, the size of the infused insulin depots was measured by external counting for 5 h. The basal infusion rate was then doubled in one side and halved in the other for the next 4 h. Finally, 1.12 IU/h of insulin was given in both sides of the abdominal wall for an additional 3 h. The changes in the size of the depots were measured, and the absorption rates for each hour were calculated. During the first 5 h of infusion, the depot size was almost constant (approximately 5 IU) with an absorption rate that equaled the infusion rate. Doubling the infusion rate led to a significant increase in depot size, but the absorption rate remained unchanged for the first 3 h, and only thereafter was a significant increase seen. When the infusion rate was reduced to the initial 1.12 IU/h, the absorption rate remained elevated during the next 3 h. Correspondingly, when the infusion rate was decreased, the depot size also decreased, but the absorption rate remained unchanged for the first 3 h. The results show that a change in the basal insulin infusion rate does not lead to any immediate change in the insulin absorption rate. This should be considered when planning an insulin-infusion program that includes alteration(s) in the basal-rate setting

1986-01-01

 
 
 
 
21

Subcutaneous insulin infusion: change in basal infusion rate has no immediate effect on insulin absorption rate  

Energy Technology Data Exchange (ETDEWEB)

Eight insulin-dependent diabetic patients were simultaneously given subcutaneous infusions (1.12 IU/h each) of /sup 125/I-labeled Actrapid insulin in each side of the abdominal wall. After 24 h of infusion, the size of the infused insulin depots was measured by external counting for 5 h. The basal infusion rate was then doubled in one side and halved in the other for the next 4 h. Finally, 1.12 IU/h of insulin was given in both sides of the abdominal wall for an additional 3 h. The changes in the size of the depots were measured, and the absorption rates for each hour were calculated. During the first 5 h of infusion, the depot size was almost constant (approximately 5 IU) with an absorption rate that equaled the infusion rate. Doubling the infusion rate led to a significant increase in depot size, but the absorption rate remained unchanged for the first 3 h, and only thereafter was a significant increase seen. When the infusion rate was reduced to the initial 1.12 IU/h, the absorption rate remained elevated during the next 3 h. Correspondingly, when the infusion rate was decreased, the depot size also decreased, but the absorption rate remained unchanged for the first 3 h. The results show that a change in the basal insulin infusion rate does not lead to any immediate change in the insulin absorption rate. This should be considered when planning an insulin-infusion program that includes alteration(s) in the basal-rate setting.

Hildebrandt, P.; Birch, K.; Jensen, B.M.; Kuehl, C.

1986-11-01

22

Cardiovascular effects of intravenous ghrelin infusion in healthy young men  

Digital Repository Infrastructure Vision for European Research (DRIVER)

  Udgivelsesdato: 2007-Nov , Ghrelin infusion improves cardiac function in patients suffering from cardiac failure, and bolus administration of ghrelin increases cardiac output in healthy subjects. The cardiovascular effects of more continuous intravenous ghrelin exposure remain to be studied. We there...

Vestergaard, Esben Thyssen; Andersen, Niels Holmark; Hansen, Troels Krarup; Rasmussen, Lars Melholt; Møller, N

23

Insulin infusion set: the Achilles heel of continuous subcutaneous insulin infusion.  

UK PubMed Central (United Kingdom)

Continuous subcutaneous insulin infusion from an insulin pump depends on reliable transfer of the pumped insulin to the subcutaneous insulin depot by means of an insulin infusion set (IIS). Despite their widespread use, the published knowledge about IISs and related issues regarding the impact of placement and wear time on insulin absorption/insulin action is relatively small. We also have to acknowledge that our knowledge is limited with regard to how often patients encounter issues with IISs. Reading pump wearer blogs, for instance, suggests that these are a frequent source of trouble. There are no prospective clinical studies available on current IIS and insulin formulations that provide representative data on the type and frequency of issues with infusion sets. The introduction of new IISs and patch pumps may foster a reassessment of available products and of patient problems related to their use. The aim of this review is to summarize the current knowledge and recommendations about IISs and to highlight potential directions of IIS development in order to make insulin absorption safer and more efficient.

Heinemann L; Krinelke L

2012-07-01

24

Insulin Infusion Set: The Achilles Heel of Continuous Subcutaneous Insulin Infusion  

Science.gov (United States)

Continuous subcutaneous insulin infusion from an insulin pump depends on reliable transfer of the pumped insulin to the subcutaneous insulin depot by means of an insulin infusion set (IIS). Despite their widespread use, the published knowledge about IISs and related issues regarding the impact of placement and wear time on insulin absorption/insulin action is relatively small. We also have to acknowledge that our knowledge is limited with regard to how often patients encounter issues with IISs. Reading pump wearer blogs, for instance, suggests that these are a frequent source of trouble. There are no prospective clinical studies available on current IIS and insulin formulations that provide representative data on the type and frequency of issues with infusion sets. The introduction of new IISs and patch pumps may foster a reassessment of available products and of patient problems related to their use. The aim of this review is to summarize the current knowledge and recommendations about IISs and to highlight potential directions of IIS development in order to make insulin absorption safer and more efficient.

Heinemann, Lutz; Krinelke, Lars

2012-01-01

25

Technical risks with subcutaneous insulin infusion.  

UK PubMed Central (United Kingdom)

The popularity of continuous subcutaneous insulin infusion (CSII), as a way for achieving long term strict glycaemic control in diabetic patients, has increased over the last ten years. Most reports on technical faults, often leading to metabolic emergencies, mainly ketoacidosis, have been published in the 1980s. Obstruction of infusion set and infection of infusion site are the most frequent events. Insulin precipitation or aggregation is thought to be one of the precipitating factors. Few data are available about failures of the pump itself. We report our experience of pump malfunctions recorded between 2001 and 2004 in 376 pumps used by patients treated with CSII therapy in Brittany. Recent studies indicate a decrease of metabolic complication frequency during CSII. This suggests technical improvements and/or a greater experience of physicians in selecting and educating patients. We report instructions for monitoring insulin pump therapy that should be included in a formal educational program for pump users. Clinical studies using newly available devices should reassess technical risks associated with CSII.

Guilhem I; Leguerrier AM; Lecordier F; Poirier JY; Maugendre D

2006-06-01

26

Accidental intravenous infusion of air: a concise review.  

UK PubMed Central (United Kingdom)

The unintended intravenous infusion of small volumes of air is common in clinical practice. International Electrotechnical Commission guidelines for infusion pumps permit infusion of up to 1 mL in 15 minutes and discount bubbles smaller than 50 ?L. A review of the literature, however, suggests that these limits may be too generous. Neonates and patients with right-to-left cardiac shunts (eg, patent foramen ovale [PFO]) are at risk from lower volumes. Because PFO is prevalent in 20% to 27% of healthy adults and generally asymptomatic, all patients are at risk from small air bubbles, although clinically significant air embolism from intravenous infusion is rare. Attention to good clinical practice and use of an inline air filter should be considered to reduce any risk.

Wilkins RG; Unverdorben M

2012-11-01

27

Evaluating the safety and efficacy of Glucommander, a computer-based insulin infusion method, in management of diabetic ketoacidosis in children, and comparing its clinical performance with manually titrated insulin infusion.  

UK PubMed Central (United Kingdom)

The Glucommander is a computer-based system for directing intravenous insulin infusion. Using a physician-selected glucose target range and a weight-based multiplier, it recommends an insulin infusion rate and interval to next glucose measurement. We evaluated the safety and efficacy of this system by conducting a retrospective chart review of 65 new-onset or existing type 1 diabetic children, admitted with diabetic ketoacidosis (DKA), managed with the Glucommander. We compared outcomes with 22 patients managed using manually titrated infusion. Time to glycemic control and correction of acidosis, number of insulin units used per kilogram per hour, and length of pediatric intensive care unit (PICU) and total hospital stay were analyzed using measures of central tendency. Children managed with Glucommander achieved equally rapid glycemic control and correction of acidosis, used less intravenous insulin, and spent less time in both PICU and hospital overall, compared to those managed with manual insulin infusion.

Fort A; Narsinghani U; Bowyer F

2009-02-01

28

Pharmacokinetics of Ertapenem following Intravenous and Subcutaneous Infusions in Patients?  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Steady-state pharmacokinetics of ertapenem were compared in patients after 1-g intravenous and subcutaneous (s.c.) infusions. Bioavailability was 99% ± 18% after s.c. administration, but peaks were reduced by about (43 ± 29 versus 115 ± 28 ?g/ml) and times to peak were delayed. Simulations based on ...

Frasca, Denis; Marchand, Sandrine; Petitpas, Franck; Dahyot-Fizelier, Claire; Couet, William; Mimoz, Olivier

29

Fat embolism in infancy after intravenous fat infusions.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Four cases of fat embolism are described in infants receiving prolonged intravenous infusion of fat (Intralipid 20%). This therapeutic complication has been termed 'fat overloading syndrome' but bears a clinical similarity to post-traumatic fat embolism. These 4 cases are the first to be recorded in...

Barson, A J; Chistwick, M L; Doig, C M

30

Intravenous sulprostone infusion in the treatment of retained placenta.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To analyze the effectiveness of intravenous sulprostone infusion for the treatment of retained placenta without massive primary hemorrhage among women at an university hospital over a three-year period. DESIGN: Retrospective observational study. SETTING: University teaching hospital. POPULATION: 126 consecutive women with placental retention and intravenous sulprostone infusion as primary treatment performed from October 2007 up to December 2011. METHODS: Hospital records of women who received sulprostone infusion to attempt placental expulsion were reviewed. MAIN OUTCOME MEASURES: Primary endpoints of the study were expulsion of placenta and the total amount of blood loss during delivery. RESULTS: The placenta was successfully expelled in 39.7% of cases, whereas 60.3% of women underwent manual removal of placenta. Blood loss was significantly lower in women with successful placental expulsion than in women who had manual removal of the placenta (582 ± 431 ml vs. 1275 ± 721 ml, p < 0.0001). Sulprostone infusion did not cause adverse effects or significant postpartum morbidity. CONCLUSIONS: Intravenous sulprostone infusion is safe and reduces both blood loss and the need for manual removal of the placenta.

Stefanovic V; Paavonen J; Loukovaara M; Halmesmäki E; Ahonen J; Tikkanen M

2013-04-01

31

Oxytocin administration during cesarean delivery: Randomized controlled trial to compare intravenous bolus with intravenous infusion regimen.  

UK PubMed Central (United Kingdom)

BACKGROUND: Oxytocin is routinely administered during cesarean delivery for uterine contraction. Adverse effects are known to occur after intravenous oxytocin administration, notably tachycardia, hypotension, and electrokardiogram (EKG) changes, which can be deleterious in high-risk patients. AIMS AND OBJECTIVES: To compare the hemodynamic changes and uterotonic effect of equivalent dose of oxytocin administered as an intravenous bolus versus intravenous infusion. STUDY DESIGN: Randomized, double-blind, active controlled trial. MATERIALS AND METHODS: Eighty parturients undergoing elective cesarean delivery, under spinal anesthesia, were randomly allocated to receive 3 IU of oxytocin either as a bolus intravenous injection over 15 seconds (group B, n = 40) or as an intravenous infusion over 5 minutes (group I, n = 40). Uterine tone was assessed as adequate or inadequate by an obstetrician. Intraoperative heart rate, non-invasive blood pressure, and EKG changes were recorded. These data were compared between the groups. Any other adverse events like chest pain, nausea, vomiting, and flushing were noted. RESULTS: There was significant rise in heart rate and significant decrease in mean arterial pressure in bolus group compared to infusion group. Three patients in bolus group had EKG changes in the form of ST-T depression and 5 patients complained of chest pain. No such complications were found in infusion group. CONCLUSION: Bolus oxytocin (at a dose of 3 IU over 15 seconds) and infusion of oxytocin (at a dose of 3 IU over 5 minutes) have comparable uterotonic effect. However, the bolus regime shows significantly more adverse cardiovascular events.

Bhattacharya S; Ghosh S; Ray D; Mallik S; Laha A

2013-01-01

32

Effect of intravenous infusion of propantheline bromide on gastric secretion.  

UK PubMed Central (United Kingdom)

The effect of 2 hours' intravenous infusion (7.5 mg/h) of propantheline bromide (Ercotina, Erco Läkemedel AB) on basal or pentagastrin-stimulated gastric secretion was studied in 7 healthy subjects and in 11 patients with acute duodenal ulcer. A moderate to marked decrease in acid secretion rate and acid output was found both in subjects and patients during the infusion period. The acidity decreased in most of the subjects but did not change much in the patients. Two other dose rates (3.75 and 15 mg/h) were studied in a few subjects and patients. The lowest dose rate gave as good an inhibition of the gastric secretion as the higher ones. No troublesome side effects were noticed. It was concluded that a dose rate of around 5-10 mg/h may be suitable for prolonged i.v. infusion, for example as trial therapy in patients with upper gastro-intestinal bleeding.

Furberg B; Krause U; Rimsten A

1975-01-01

33

Effect of intravenous infusion of propantheline bromide on gastric secretion.  

Science.gov (United States)

The effect of 2 hours' intravenous infusion (7.5 mg/h) of propantheline bromide (Ercotina, Erco Läkemedel AB) on basal or pentagastrin-stimulated gastric secretion was studied in 7 healthy subjects and in 11 patients with acute duodenal ulcer. A moderate to marked decrease in acid secretion rate and acid output was found both in subjects and patients during the infusion period. The acidity decreased in most of the subjects but did not change much in the patients. Two other dose rates (3.75 and 15 mg/h) were studied in a few subjects and patients. The lowest dose rate gave as good an inhibition of the gastric secretion as the higher ones. No troublesome side effects were noticed. It was concluded that a dose rate of around 5-10 mg/h may be suitable for prolonged i.v. infusion, for example as trial therapy in patients with upper gastro-intestinal bleeding. PMID:1145899

Furberg, B; Krause, U; Rimsten, A

1975-01-01

34

[Adverse events in 1395 infusions with different intravenous gammaglobulin products].  

Science.gov (United States)

The processes of isolation and sterilization of intravenous gamma globulin (IVIG) affect the end product characteristics and, therefore, its tolerability. Different products have different incidences of adverse reactions. The aim of this study was to quantify the immediate adverse events (AE) caused by the different IVIG preparations. We analyzed 1 395 infusions in 28 patients, with a median of 32.5 per subject (range 2-214), using six different IVIG preparations, with an average dose 40.3 ± 8.3 g. One thousand and thirty-one infusions were analyzed retrospectively and 364 prospectively. Patients used a mean of 2.68 ± 1.8 different IVIGs, with a median of 2 (range 1-6) per person. The number of trademarks used was related to the number of infusions received, r = 0.73. AE presented in 24 (2.3%) of 1 031 infusions retrospectively analyzed, affecting 11 of 23 patients enrolled, with a mean of 2.18 ± 1.08 AE per subject. Of 24 patients and 364 infusions prospectively analyzed, AE were observed in 14 patients and in 32 (7.2%) procedures. Twenty-four (42.9%) of 56 AE were mild, 31 (55.5%) moderate and one (1.8%) severe. The infusion rate was 9.04 ± 6 g/h for those presenting AE vs. 10.6 ± 4.6 g/h for those who did not (p = 0.31, NS). The incidence, severity and proportion of patients with AE for each brand of IVIG were very different from each other. This information should be taken into account when selecting the IVIG to be used. PMID:24152399

Malbrán, Alejandro; Larrauri, Blas; Juri, María Cecilia; Fernández Romero, Diego S

2013-01-01

35

Case report: hyponatremia and generalized convulsion after intravenous oxytocin infusion  

Directory of Open Access Journals (Sweden)

Full Text Available Most patients with drug-induced hyponatraemia are asymptomatic and the diagnosis is made incidentally following routine blood tests. Mild cases may be managed either by stopping the drug or by careful observation if the drug is considered essential. Severe hyponatremia (serum sodium levels less than 120 mmol/l) is associated with increased morbidity and mortality (confusion, convulsions, coma, congestive heart failure e.g.). We present a case of severe water intoxication with convulsion and prolonged coma, following the use of a high dose syntocinon infusion. A 22-year-old female who has intrauterine anencephalic fetus was refered to our hospital. Intravenous oxytocin was used to induce first-trimester abortion, eight hours later generalized tonic-clonic seizures occured and coma followed. Hyponatremia was found as the cause and treated by intravenous infusion of hypertonic 3% NaCl. The patient recovered and no seizure observed on follow-up. The central nervous system manifestations of acute hyponatremia may be related to cerebral edema. Drugs administration and electrolyte disturbances should be remembered as causes of coma and seizure in obstetric patients.

Ufuk Emre; Gülay Kad?o?lu; Aysun Ünal; H. Tu?rul Atasoy

2009-01-01

36

Estimation of theophylline clearance during intravenous aminophylline infusions.  

Science.gov (United States)

The utility of predicting theophylline clearance (CL) from two serum concentrations obtained during continuous intravenous aminophylline infusion was examined in 16 stable, adult patients. Blood for theophylline measurement was obtained 0, 6, and 12 h after starting infusions and, thereafter, at 12-h intervals. EMIT was used to assay samples in multiple runs as they were obtained. Later, each sample was reassayed by EMIT within a single run. Bayesian least-squares regression and the algebraic method of Chiou were used to predict CL using the 0,6 and 0,12 h concentrations. "Actual" CL was measured by nonlinear least-squares regression of all concentrations obtained during prolonged infusions. Prediction bias and precision were assessed by calculating mean percent error (PCE) and mean absolute percent error (APCE), respectively. A three-way repeated-measures ANOVA was used to examine the effect of the method of CL prediction, assay procedure, and time interval between samples on PCE and APCE. Bayesian predictions were less biased and slightly more precise than Chiou predictions. The assay procedure had no effect on bias but precision was improved using a single-assay run. Predictions were less biased and more precise with 0,12 h versus 0,6 h data. Serum samples for theophylline measurement should be obtained after initiating constant intravenous aminophylline and again 8-12 h later in stable, adult patients. Prediction of CL with either of the concentration-based methods studied will then allow safe and rapid adjustment of dosage to achieve therapeutic serum concentrations. PMID:4020626

Gilman, T M; Muir, K T; Jung, R C; Walberg, C B

1985-05-01

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THE ROLE OF INTRAVENOUS AMINO ACID INFUSION IN OLIGOHYDRAMNIOS  

Directory of Open Access Journals (Sweden)

Full Text Available Oligohydramnios means the fetus is in a compromised condition. Ante partum amniotic fluid index (A.F.I.) assessment is one of the reliable, good predictor and standard technique for assessment of fetal well-being in antenatal period. In the present study 25 cases of Oligohydramnios in the third trimester were given intravenous amino acid in 1000cc of 10% fructodex drip on 1st day and the amino acid infusion drip in 500 ml of 10% fructodex daily till 6 days. After that biweekly till patient deliver or till term. There were 4 cases of severe Oligohydramnios and 21 cases of moderate Oligohydramnios at the time of their first visit. After amino acid infusion therapy, on repeat ultrasonography, 9 (36%) cases patients with moderate Oligohydramnios had improved amniotic fluid index (AFI) to normal whereas two patients with severe Oligohydramnios had improved A.F.I. to moderate Oligohydramnios and remaining 12 and two patients of moderate and severe Oligohydramnios group patients did not show any changes in A.F.I. Maximum cases delivered vaginally.

Ritu Gupta et al

2012-01-01

38

Severe hypertriglyceridaemia in Type 2 diabetes mellitus: beneficial effect of continuous insulin infusion.  

UK PubMed Central (United Kingdom)

BACKGROUND: Severe hypertriglyceridaemia is a recognized complication of Type 2 diabetes mellitus (T2DM); however, there is no consensus on acute management despite the significant risk of developing associated complications such as acute pancreatitis and hyperviscosity syndrome. AIM: To identify the association between hyperglycaemia and severe hypertriglyceridaemia in patients with T2DM and assess the effect of continuous insulin infusion therapy on serum triglyceride (TG) concentrations and report any adverse events associated with this therapeutic approach. DESIGN: Retrospective review of case records. METHODS: Patients with uncontrolled hyperglycaemia and severe hypertriglyceridaemia (serum TG > 15 mmol/l) treated with continuous intravenous insulin infusion between October 2008 and September 2009 were retrospectively evaluated (n = 15). Details recorded included demographics, admission details, lipid profiles, glycaemic control, serum amylase and adverse events. Patients receiving treatment-dose unfractionated heparin infusion were excluded. RESULTS: Severe hypertriglyceridaemia is associated with hyperglycaemia in our heterogeneous group of patients with T2DM presenting with new-onset diabetes or established disease on pre-existing insulin or oral hypoglycaemic agents. Administration of continuous exogenous insulin not only achieved normoglycaemia but also dramatically corrected severe hypertriglyceridaemia in all patients (P = 0.001). CONCLUSION: The administration of continuous insulin in patients with T2DM with severe hypertriglyceridaemia is a simple and safe method of significantly reducing the immediate risk associated with this metabolic complication and should be considered in any T2DM patient presenting with severe hypertriglyceridaemia and hyperglycaemia.

Henderson SR; Maitland R; Mustafa OG; Miell J; Crook MA; Kottegoda SR

2013-04-01

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Effects of intra-abomasal infusion of beta-casomorphins on circulating concentrations of hyperglycaemic insulin and glucose in dairy cows.  

Science.gov (United States)

The effects of intra-abomasal infusion of a mixture of -casomorphins on circulating concentrations of insulin and glucose prestimulated by either abomasal (experiment 1) or intravenous (experiment 2) glucose were studied using non-lactating dairy cows. In both experiments, bolus infusion of 240 mg of a mixture of three beta-casomorphins (beta-casomorphin-4-amide, -5 and -7) was given via an abomasal infusion line. The beta-casomorphins significantly lowered the responses of serum insulin to both abomasal and intravenous glucose infusions (P<0.05). However, the beta-casomorphins did not significantly affect circulating glucose concentrations. The insulinopenic action of the beta-casomorphins is consistent with the action of somatostatin-28 (SS-28) as judged from the effects of SS-28 on the insulin secretion when administered intravenously in experiment 1. PMID:11118935

Kim, T G; Choung, J J; Wallace, R J; Chamberlain, D G

2000-11-01

40

Effect of Insulin Infusion on Liver Protein Synthesis during Hemodialysis  

DEFF Research Database (Denmark)

Background Hemodialysis (HD) is a catabolic procedure that may contribute to the high frequency of protein-energy wasting among patients receiving maintenance HD. The present study investigated the additional effect of glucose and glucose-insulin infusion on liver protein synthesis during HD compared with a meal alone. Methods In a randomized cross-over study with three arms, 11 non-diabetic HD patients were assigned to receive a conventional HD session with either: • no treatment (NT) • IV infusion of glucose (G) • IV infusion of glucose-insulin (GI) During infusions blood glucose levels were maintained at 8.0-10.0 mmol/L by additional glucose infusion. Glucose and glucose-insulin infusions were commenced 2 h prior to HD and continued throughout the HD session. Fasting blood samples were collected at baseline before infusion and followed by the only meal allowed during the study. Results Blood glucose and insulin: The change in blood glucose differed significantly from baseline (-120 min) to end of HD (240 min) between the NT group and the G group (p=0.002); there was no significant difference in the change between the NT group and the GI group (p=0.06), or between the G group and the GI group (p=0.15). Fibrinogen and albumin: There was an overall increase in serum albumin (38.8±2.1 to 40.4±2.5 g/L, p<0.0001) and in serum fibrinogen (11.7±1.7 to 12.8±1.8 µmol/L, p<0.0001) from HD start (0 min) to 2 h post HD (360 min), but no significant difference in the change in either albumin (p=0.12) or fibrinogen (p=0.12) between the groups. IGFBP-1: During the first 4 h after baseline (-120 min) we observed an overall decrease in serum IGF-binding protein 1 (IGFBP-1) (from 267±147 to 140±84 µg/L, p<0.0001), but no difference in the change between groups (p=0.41). However, from 4 h after baseline to the end of the study there was a significant difference in the change in serum IGFBP-1 between the groups (p=0.003) with a significant increase in serum IGFBP-1 in the NT group (p<0.0001), but not in the G group or GI group (p=0.50 and p=0.07, respectively). Conclusions Compared with a meal neither glucose nor glucose-insulin infusion appear to have any extra effects on liver protein synthesis during HD.

Reinhard, Mark; Frystyk, Jan

 
 
 
 
41

Losartan increases muscle insulin delivery and rescues insulin's metabolic action during lipid infusion via microvascular recruitment.  

Science.gov (United States)

Insulin delivery and transendothelial insulin transport are two discrete steps that limit muscle insulin action. Angiotensin II type 1 receptor (AT1R) blockade recruits microvasculature and increases glucose use in muscle. Increased muscle microvascular perfusion is associated with increased muscle delivery and action of insulin. To examine the effect of acute AT1R blockade on muscle insulin uptake and action, rats were studied after an overnight fast to examine the effects of losartan on muscle insulin uptake (protocol 1), microvascular perfusion (protocol 2), and insulin's microvascular and metabolic actions in the state of insulin resistance (protocol 3). Endothelial cell insulin uptake was assessed, using (125)I-insulin as tracer. Systemic lipid infusion was used to induce insulin resistance. Losartan significantly increased muscle insulin uptake (?60%, P AT1R blockade increases muscle insulin uptake mainly via microvascular recruitment and rescues insulin's metabolic action in the insulin-resistant state. This may contribute to the clinical findings of decreased cardiovascular events and new onset of diabetes in patients receiving AT1R blockers. PMID:23299501

Wang, Nasui; Chai, Weidong; Zhao, Lina; Tao, Lijian; Cao, Wenhong; Liu, Zhenqi

2013-01-08

42

Insulin secretion after short- and long-term low-grade free fatty acid infusion in men with increased risk of developing type 2 diabetes.  

DEFF Research Database (Denmark)

We studied the effect of a low-grade short- and long-term 20% Intralipid infusion (0.4 mL(-1) x kg(-1) x h(-1)) on insulin secretion and insulin action in 15 elderly obese men; 7 glucose intolerant first-degree relatives of type 2 diabetic patients (impaired glucose tolerance [IGT] relatives) and 8 healthy controls of similar age and body mass index (BMI). Intravenous glucose tolerance test (IVGTT) and a graded glucose infusion (dose-response test [DORE]) were performed to determine first phase insulin response and to explore the dose response relationship between glucose concentration and insulin secretion rates (ISR). ISR were calculated by deconvolution of plasma C-peptide concentrations. Insulin action was determined by performing a 120-minute hyperinsulinemic euglycemic clamp. All tests were performed 3 times, preceded by 0, 2, or 24 hours Intralipid infusion. Disposition indices (DI) were calculated for the IVGTT. Insulin action was reduced 25% after 2 and 24 hours Intralipid infusion in both groups. In IGT relatives, the beta-cell responsiveness to glucose (measured during DORE) decreased after 2 and 24 hours Intralipid infusion (P=.02), whereas first phase insulin response (measured during IVGTT) decreased after 24 hours Intralipid infusion. Insulin secretion measured during DORE and IVGTT was not affected by Intralipid infusion in controls. DI decreased after 2 and 24 hours Intralipid infusion in the total study population. In conclusion, insulin resistance induced by low-grade short- and long-term Intralipid infusion is not balanced by an adequate compensatory increase in insulin secretion in IGT relatives or in matched controls. IGT relatives appear to be more sensitive to the deleterious effects of low-grade fat infusion on insulin secretion than normal glucose tolerant control subjects.

Storgaard, Heidi; Jensen, Christine B

2003-01-01

43

MECHANISMS OF ENDOTOXIN TOLERANCE : III. THE REFRACTORY STATE DURING CONTINUOUS INTRAVENOUS INFUSIONS OF ENDOTOXIN  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Bacterial endotoxins were administered by continuous intravenous infusions at constant rates to normal man and rabbits. An initial progressive febrile reaction was followed by progressive defervescence to baseline. The resulting pyrogenic refractory state was characterized as follows: (a) reticuloe...

Greisman, Sheldon E.; Woodwards, William E.

44

Acute Cardiovascular Effects of Guanazole (NSC Number 1895) Following Continuous Intravenous Infusion to Anesthetized Beaglehounds.  

Science.gov (United States)

Guanazole, in doses of 1750, 2500 and 5000 mg/kg was given by intravenous infusion over 60 minutes to normal, anesthetized beaglehounds instrumented for monitoring various cardiovascular parameters. Records were taken during two control periods 15 minutes...

R. L. Hamlin F. S. Pipers K. Nguyen P. Mihalko R. M. Folk

1977-01-01

45

Stabilized human insulin prevents catheter occlusion during continuous subcutaneous insulin infusion.  

UK PubMed Central (United Kingdom)

Obstruction of infusion sets is a major cause of metabolic deterioration or even ketoacidosis during continuous subcutaneous insulin infusion (CSII). 21 type I, CSII-treated patients were studied in a prospective, randomized cross over design during two periods of three months to assess the effects of Genapol stabilized human insulin (HOE 21 PH H-TRONIN) on obstruction frequency of PVC catheters in comparison with a neutral preparation of biosynthetic human insulin (BHI). In a total observation time of 9.5 patient-years 79 catheter obstructions by precipitated insulin occurred with an incidence of 0.67 episodes per patient-month for BHI and 0.026 for HOE 21 PH. Improvement of metabolic control paralleled the reduction of obstruction frequency by HOE 21 PH. Thus, a stabilized insulin preparation is recommended for use in CSII to reduce the therapeutic risk.

Walter HM; Timmler R; Mehnert H

1990-02-01

46

Stabilized human insulin prevents catheter occlusion during continuous subcutaneous insulin infusion.  

Science.gov (United States)

Obstruction of infusion sets is a major cause of metabolic deterioration or even ketoacidosis during continuous subcutaneous insulin infusion (CSII). 21 type I, CSII-treated patients were studied in a prospective, randomized cross over design during two periods of three months to assess the effects of Genapol stabilized human insulin (HOE 21 PH H-TRONIN) on obstruction frequency of PVC catheters in comparison with a neutral preparation of biosynthetic human insulin (BHI). In a total observation time of 9.5 patient-years 79 catheter obstructions by precipitated insulin occurred with an incidence of 0.67 episodes per patient-month for BHI and 0.026 for HOE 21 PH. Improvement of metabolic control paralleled the reduction of obstruction frequency by HOE 21 PH. Thus, a stabilized insulin preparation is recommended for use in CSII to reduce the therapeutic risk. PMID:2091873

Walter, H M; Timmler, R; Mehnert, H

1990-02-01

47

Localized bullous eruptions away from infusion site due to intravenous acyclovir administration in a child.  

UK PubMed Central (United Kingdom)

Acyclovir is an antiviral agent against herpes virus. Its local adverse effects are common and typically consist of inflammation or phlebitis at the site of intravenous infusion. Here we present a child with bullous eruptions away from infusion site due to acyclovir administration. It is exceptionally rare with only one adult case has been reported to date.

Gurkan A; Erkek N; Senel S

2012-01-01

48

Effect of corticosteroids on phlebitis induced by intravenous infusion of antineoplastic agents in rabbits  

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Purpose: Phlebitis caused by intravenous infusion of antineoplastic agents is one of the critical problems when anticancer therapy is prolonged. We have already reported that both rapid infusion and dilution of the injection solution were effective methods for reducing phlebitis caused by vinorelbin...

Kohno, Emiko; Murase, Saori; Matsuyama, Kenji; Okamura, Noboru

49

Effect of intravenous iron-dextran (Imferon) infusion on antigen induced monarticular arthritis in rabbits.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The effect of intravenously infused iron-dextran (Imferon) on the progression of antigen induced monarticular arthritis in rabbits was studied. A rapid deposition of iron and apoferritin in the synovia of arthritis joints occurred after infusion of iron-dextran during either the acute or chronic pha...

Kind, C N; Blackham, A; Morris, C J

50

Requirement for cardiac telemetry during intravenous phenytoin infusion: guideline fact or guideline fiction?  

UK PubMed Central (United Kingdom)

Guidelines recommend the use of cardiac telemetry when phenytoin is administered intravenously. Clinical areas where telemetry is available may not always be the most suitable place to monitor and treat these sick patients. We sought to clarify the evidence regarding the need for cardiac telemetry during intravenous infusion of phenytoin.

Siebert WJ; McGavigan AD

2013-01-01

51

Blood platelet behaviour during infusion of an Intralipid based intravenous feeding mixture  

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Blood platelet behaviour was studied in six patients during infusion of an Intralipid-based intravenous feeding mixture. Lower concentrations of sodium arachidonate were required to induce platelets to aggregate and to undergo a release reaction during intravenous feeding than were required before o...

Burnham, W. R.; Cockbill, S. R.; Heptinstall, S.; Harrison, S.

52

Acceleration of insulin pharmacodynamic profile by a novel insulin infusion site warming device.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVE: Subcutaneously injected rapid-acting insulin analogs do not replicate physiologic insulin action due to delays in their onset and peak action resulting in postprandial glucose excursions. The InsuPatch (IP) is a novel insulin infusion site warming device developed to accelerate insulin action by increasing blood flow to the area of insulin absorption. Thirteen adolescents with type 1 diabetes (T1D, mean age 14?±?4?yr) were enrolled in this study to investigate the effect of the IP on the pharmacodynamics and pharmacokinetics of a 0.2?unit/kg bolus dose of aspart insulin using the euglycemic clamp technique. RESEARCH DESIGN AND METHODS: Each subject underwent two euglycemic clamp procedures on separate occasions: one with IP and one without IP activation in random order. RESULTS: When the insulin bolus was given with IP activation as compared to without IP activation, time to reach maximum insulin action (T(GIRmax)) and to reach 50% maximum action (T(50%(GIRmax)) were 35 and 18?min earlier (125?±?8?min vs. 90?±?6?min, p?=?0.002 and 58?±?5?min. vs. 40?±?3?min, p?=?0.01, respectively), and the area under curve, AUC(GIR 0-90 min), reflecting early glucodynamic action, was significantly greater (p?=?0.001). IP activation also accelerated the rise in plasma insulin levels after the bolus (p?=?0.03) and resulted in a higher peak (p?=?0.04) and greater overall increase (p?=?0.02) in plasma insulin levels. CONCLUSIONS: Our results show that insulin infusion site warming with IP activation accelerates the time action profile of aspart insulin which may be of benefit to current open-loop and future closed-loop insulin delivery in patients with T1D.

Cengiz E; Weinzimer SA; Sherr JL; Tichy E; Martin M; Carria L; Steffen A; Tamborlane WV

2013-05-01

53

[The treatment of Paget's disease of bone with second-generation bisphosphonates via intravenous infusion  

UK PubMed Central (United Kingdom)

We compared the biochemical effects and safety of pamidronate (30 mg a day for 3 consecutive days) versus clodronate (300 mg a day for 3 consecutive days) via intravenous infusion in 14 patients with Paget's disease of bone (PDB). Both drugs induced a decrease in serum alkaline phosphatase levels as well as the elimination of hydroxyproline from urine, an effect most marked in the group treated with pamidronate. The response was maintained for 6 months after the infusion in the majority of the patients. No relevant side effects were found, except post-infusion febricula and in one patient, self-limiting thrombopenia 6 months after the infusion. We conclude that the intravenous infusion of either of the two drugs may constitute a safe and effective alternative for treatment of PDB with marked biochemical activity or resistant to conventional therapy.

Arboleya L; Sánchez J; Iglesias G; Arranz JL

1993-12-01

54

Intravenous infusion of n-3 polyunsaturated fatty acids.  

UK PubMed Central (United Kingdom)

Dietary supplementation with n-3 polyunsaturated fatty acids (PUFA) is regarded as beneficial for the prevention and treatment of atherosclerosis and thrombosis and chronic inflammatory diseases like rheumatoid arthritis and psoriasis. It may be possible to treat some acute diseases like acute myocardial infarction or acute rejection of grafted organs if it is possible to make n-3 PUFA take effect quickly (in hours instead of days). Three sets of experiments were done. In Experiment 1, emulsion of trieicosapentaenoyl-glycerol (EPA-TG) and tridocosahexaenoyl-glycerol was infused through rabbit ear veins, and the leukotriene B4/B5 production from polymorphonuclear leukocytes was measured at different time points by high-performance liquid chromatography. In Experiment 2, delayed type hypersensitivity (DTH) of mice was measured with sheep red blood cells as an antigen. Pure n-3 PUFA emulsions or a control solution were infused through tail veins just before the second challenge of the antigen. DTH was measured 24 hr after the second challenge. In Experiment 3, human natural killer cell activity was measured using K562 target cells before and after the infusion of pure EPA-TG emulsion to an antecubital vein. Leukotriene B4 production by rabbit polymorphonuclear leukocytes was depressed by 40% by EPA-TG infusion. DTH was suppressed almost completely by n-3 PUFA infusion. Natural killer cell activity was suppressed almost completely by EPA-TG infusion in 8 hr. DTH, natural killer cell activity, and leukotriene B4 production are probably related to acute rejection of grafted organs.(ABSTRACT TRUNCATED AT 250 WORDS)

Hamazaki T

1992-06-01

55

Pharmacokinetics of isepamicin following a single administration by intravenous infusion or intramuscular injections.  

Science.gov (United States)

The pharmacokinetics of isepamicin following administration of a 1-g dose were evaluated for 18 healthy male volunteers between the ages of 26 and 38. In a randomized crossover fashion, each volunteer received doses of isepamicin by a 30-min intravenous infusion and as an intramuscular injection. Blood samples were collected at specified times after dosing and assayed for isepamicin by a validated radioimmunoassay method. The individual plasma concentration-time curves were analyzed by noncompartmental methods. In general, the pharmacokinetics after intravenous infusion and intramuscular injection were similar. As expected, the maximum concentration of isepamicin in serum following intramuscular injection (37.2 microg/ml) was lower than the observed concentration at the end of infusion (66.7 microg/ml). The areas under the concentration-time curves from 0 h to infinity following intramuscular and intravenous administration were 164.8 and 154.5 microg x hr/ml, respectively, indicating complete absorption following intramuscular administration. The respective mean terminal-phase half-life (t1/2) values were 2.6 and 3.6 h. Although t1/2 was slightly longer following intravenous infusion, the small difference in the observed t1/2 values was not considered to be clinically significant. Total body clearances following intramuscular injection and intravenous infusion were 1.3 and 1.4 ml/min/kg, respectively, which were similar to renal serum creatinine clearances in healthy volunteers (> 1.14 ml/min/kg). The drug was safe and well tolerated. The results of the present study clearly show complete absorption of isepamicin following intramuscular administration. The similarity in the pharmacokinetics after intravenous infusion and intramuscular dosing would permit interchangeable administration of isepamicin by either route without compromising clinical efficacy. PMID:9257763

Radwanski, E; Batra, V; Cayen, M; Korduba, C; Cutler, D; Affrime, M; Nomeir, A; Lin, C C

1997-08-01

56

Development of a computerized intravenous insulin application (AutoCal) at Kaiser Permanente Northwest, integrated into Kaiser Permanente HealthConnect: impact on safety and nursing workload.  

UK PubMed Central (United Kingdom)

CONTEXT: The electronic medical record, HealthConnect, at the Kaiser Sunnyside Medical Center in the Northwest used scanned paper protocols for intravenous insulin administration. A chart review of 15 patients on intravenous insulin therapy using state-of-the-art paper-based column protocols revealed 40% deviation from the protocol. A time study of experienced nurses computing the insulin dose revealed an average of 2 minutes per calculation per hour to complete. OBJECTIVE: To improve patient safety and to reduce nursing workload burden with a computerized intravenous insulin calculator application connected to HealthConnect. SOLUTION: Using Kaiser iLab developers through innovation funding, a computerized protocol was developed and integrated into HealthConnect, with a computerized tracking system used to store and to analyze intravenous insulin data. OUTCOME: A review of 35 patient charts using computerized insulin infusion tool indicated 100% accuracy in computations with a reduction of nursing workload from 2 minutes to 30 seconds per calculation. CONCLUSION: Development and operationalizing an integrated intravenous insulin calculator into HealthConnect was successfully completed at the Kaiser Sunnyside Medical Center, with 97% nursing satisfaction scores and a promise to generate data on intravenous insulin therapy to refine the protocol.

Olinghouse C

2012-01-01

57

A semi-closed loop computer-assisted insulin infusion system. Hospital use for control of diabetes in patients.  

UK PubMed Central (United Kingdom)

Closed loop insulin delivery systems are impractical for widespread hospital use. Thus, a semi-closed loop computer-assisted insulin infusion system (CAIIS) was developed for the intravenous delivery of insulin. In its basal program, insulin delivery is determined by blood glucose measurements at intervals of three hours, while the open-loop meal program delivers 7.5 units over three hours. Control of meal-induced hyperglycaemia was satisfactory in six subjects with diabetes tested over two to four days, as was mean glycaemic control in the four non-obese subjects (7.1 +/- 0.8 mmol/L). To allow for variations in insulin sensitivity, an adjustment incrementing or decrementing the basal insulin delivery rate was applied according to the progressive blood glucose response. Empirical use of this adjustment resulted in good control (mean blood glucose level, 4.1-7.5 mmol/L) in 10 additional subjects with diabetes. This study demonstrates the potential usefulness of a semi-closed loop insulin infusion system.

Chisholm DJ; Kraegen EW; Bell DJ; Chipps DR

1984-12-01

58

[Ketamine hydrochloride by continuous drip intravenous infusion in thoracic surgery  

UK PubMed Central (United Kingdom)

The Authors report an open trial on 50 patients anaesthetized with Ketamine hydrochloride, by continuous drip infusion progressively slowed, with the aid of Fentanil, in thoracic surgery. The proposed anaesthetic technique proved to be excellent as for as analgesia during and after operation as well cardiovascular stability and lackness of side effects is concerned. Recovery from anaesthesia was quick and extremely quite and free from side effects which are common in Ketamine anaesthesia.

Pietrobono P; Serafini G; Pagnin A; Venchi G

1980-08-01

59

[Ketamine hydrochloride by continuous drip intravenous infusion in thoracic surgery].  

Science.gov (United States)

The Authors report an open trial on 50 patients anaesthetized with Ketamine hydrochloride, by continuous drip infusion progressively slowed, with the aid of Fentanil, in thoracic surgery. The proposed anaesthetic technique proved to be excellent as for as analgesia during and after operation as well cardiovascular stability and lackness of side effects is concerned. Recovery from anaesthesia was quick and extremely quite and free from side effects which are common in Ketamine anaesthesia. PMID:7219752

Pietrobono, P; Serafini, G; Pagnin, A; Venchi, G

1980-08-01

60

Intracranial hemodynamics during intravenous infusion of glyceryl trinitrate  

DEFF Research Database (Denmark)

The mechanisms of glyceryl trinitrate (GTN)-induced headache are not fully elucidated. In this study we administered GTN 0.5 microg/kg/min i.v. for 20 min in six healthy volunteers. Before, during and 60 min after the infusion, we investigated regional cerebral blood flow (rCBF), cerebral blood volume (CBV), both estimated with SPECT, and blood flow velocity (BFV) in the middle cerebral artery (MCA), measured with transcranial Doppler. Headache was scored on a numerical verbal rating (0-10) scale. rCBF was unchanged, CBV was slightly increased (13%) during GTN infusion, whereas BFV decreased both during (20%) and 60 min (15%) after GTN. Headache was short-lived and maximal during infusion. This discrepancy of time-effect curves for the effect of GTN on headache and dilatation of MCA indicates that MCA is most likely not the primary source of pain in GTN-induced headache. The time-effect curves for the effect of GTN on headache and on dilation of MCA differed markedly. This indicates that MCA is most likely not the primary source of pain in GTN-induced headache Udgivelsesdato: 2008/6

Iversen, H.K.; Holm, S.

2008-01-01

 
 
 
 
61

Liposome distribution after intravenous and selective intraarterial infusion in dogs  

International Nuclear Information System (INIS)

In an effort to improve hepatic uptake of liposomes for drug delivery, empty vesicles were administered by means of selective arterial infusion. Negatively charged, multilamellar liposomes were labeled with technetium-99m and infused into healthy adult dogs. Each dog received 100 mg/m2 of lipid over 10 minutes at 2 mL/min. Liposomes were administered via the common hepatic artery after proximal occlusion of the gastroduodenal artery, via the cranial mesenteric artery, and via the cephalic vein. Distribution (liver, spleen, and lungs) was determined by computer-assisted external imaging techniques. On the average, after arterial infusion, 69.2% of the total activity was located in the liver, 3.6% in the spleen, 3.2% in the lungs, and 3.5% in the general circulation. Following venous injection, 50.7% of the radioactivity was found in the liver, 9.1% in the spleen, 8.6% in the lungs, and 6.7% in the peripheral blood. Once the liposomes entered the systemic circulation, they were cleared at the same rate (half-life beta = 21.5 hours) independent of their route of administration. Increased hepatic liposome uptake should translate into higher local and lower systemic liposomal drug levels.

1990-01-01

62

INTRAVENOUS INFUSION OF CURCUMIN AND A CALCIUM CHANNEL BLOCKER  

UK PubMed Central (United Kingdom)

Compositions and methods for treating systemic diseases by intravenous administration of formulations of synthesized curcumin (diferuloylmethane) and concomitantly a calcium channel blocker to human subjects with neoplastic and neurodegenerative diseases are disclosed herein. The diseases are treated by prolonged administration of sub-optimal doses of liposomal curcumin or polymeric nanocurcumin or the sustained release curcumin from PLGA nanocurcumin at dosages below systemic hemolytic thresholds concomitantly with or without calcium channel blockers.

HELSON LAWRENCE

63

[Insulin extraction by the isolated perfused rat liver using infusion conditions of a biphasic insulin concentration profile  

UK PubMed Central (United Kingdom)

Rat liver was perfused in vitro at 37 degrees C in an open system with Krebs-Ringer-Bicarbonate buffer, pH 7.4, in the presence of 20 vol% freshly prepared bovine erythrocytes. A biphasic insulin concentration profile, imitating the glucose induced insulin secretion of the isolated perfused rat pancreas was infused by means of a gradient mixer into the portal vein of the liver. The quality of the infused gradient was tested in a series of preliminary experiments by dye-infusion into the portal vein. It could be shown by synchronous fractionation of medium samples immediatly prior and after liver passage and by subsequent radioimmunological insulin determination that the biphasic profile of the infused insulin gradient was preserved after a single liver passage. The insulin concentration in the portal vein under experimental conditions ranged from 0 to 3.2 ng insulin/ml perfusate. About 70-80% of the insulin was removed by the liver. It could be further demonstrated that the hepatic insulin removal rate is rising with increasing insulin concentration in the liver input. The highest hepatic insulin removal rate obtained under the used portal insulin concentrations amounted to 2 ng insulin/min X g liver ww.

Brömme HJ; Blech W

1984-01-01

64

MECHANISMS OF ENDOTOXIN TOLERANCE : IV. SPECIFICITY OF THE PYROGENIC REFRACTORY STATE DURING CONTINUOUS INTRAVENOUS INFUSIONS OF ENDOTOXIN  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The mechanisms underlying the pyrogenic refractory state which develops rapidly during a continuous intravenous infusion of bacterial endotoxin have been further explored. The findings demonstrate that: (a) rabbits rendered refractory to a continuous intravenous infusion of E. coli endotoxin at a s...

Greisman, Sheldon E.; Young, Edward J.; Woodward, William E.

65

Pharmacokinetics of isepamicin following a single administration by intravenous infusion or intramuscular injections.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The pharmacokinetics of isepamicin following administration of a 1-g dose were evaluated for 18 healthy male volunteers between the ages of 26 and 38. In a randomized crossover fashion, each volunteer received doses of isepamicin by a 30-min intravenous infusion and as an intramuscular injection. Bl...

Radwanski, E; Batra, V; Cayen, M; Korduba, C; Cutler, D; Affrime, M; Nomeir, A; Lin, C C

66

Dose proportional pharmacokinetics of alprostadil (prostaglandin E1) in healthy volunteers following intravenous infusion.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Prostaglandin E1 (PGE1) (30, 60, 120 micrograms) was administered by intravenous infusion over a 120 min period in an open, three way randomized, cross-over study to 12 healthy male volunteers. For the evaluation of PGE1, PGE0 and 15-keto-PGE0, blood samples were drawn prior to, during and after the...

Cawello, W; Leonhardt, A; Schweer, H; Seyberth, H W; Bonn, R; Lomeli, A L

67

Comparative dose accuracy of durable and patch insulin infusion pumps.  

UK PubMed Central (United Kingdom)

BACKGROUND: As all major insulin pump manufacturers comply with the international infusion pump standard EN 60601-2-24:1998, there may be a general assumption that all pumps are equal in insulin-delivery accuracy. This research investigates single-dose and averaged-dose accuracy of incremental basal deliveries for one patch model and three durable models of insulin pumps. METHOD: For each pump model, discrete single doses delivered during 0.5 U/h basal rate infusion over a 20 h period were measured using a time-stamped microgravimetric system. Dose accuracy was analyzed by comparing single doses and time-averaged doses to specific accuracy thresholds (±5% to ±30%). RESULTS: The percentage of single doses delivered outside accuracy thresholds of ±5%, ±10%, and ±20% were as follows: Animas OneTouch® Ping® (43.2%, 14.3%, and 1.8%, respectively), Roche Accu-Chek® Combo (50.6%, 24.4%, and 5.5%), Medtronic Paradigm® Revel™/Veo™ (54.2%, 26.7%, and 6.6%), and Insulet OmniPod® (79.1%, 60.5%, and 34.9%). For 30 min, 1 h, and 2 h averaging windows, the percentage of doses delivered outside a ±15% accuracy were as follows: OneTouch Ping (1.0%, 0.4%, and 0%, respectively), Accu-Chek Combo (4.2%, 3.5%, and 3.1%), Paradigm Revel/Veo (3.9%, 3.1%, and 2.2%), and OmniPod (33.9%, 19.9%, and 10.3%). CONCLUSIONS: This technical evaluation demonstrates significant differences in single-dose and averaged-dose accuracy among the insulin pumps tested. Differences in dose accuracy were most evident between the patch pump model and the group of durable pump models. Of the pumps studied, the Animas OneTouch Ping demonstrated the best single-dose and averaged-dose accuracy. Further research on the clinical relevance of these findings is warranted.

Jahn LG; Capurro JJ; Levy BL

2013-07-01

68

Safety and Feasibility of Long-term Intravenous Sodium Nitrite Infusion in Healthy Volunteers  

Science.gov (United States)

Background Infusion of sodium nitrite could provide sustained therapeutic concentrations of nitric oxide (NO) for the treatment of a variety of vascular disorders. The study was developed to determine the safety and feasibility of prolonged sodium nitrite infusion. Methodology Healthy volunteers, aged 21 to 60 years old, were candidates for the study performed at the National Institutes of Health (NIH; protocol 05-N-0075) between July 2007 and August 2008. All subjects provided written consent to participate. Twelve subjects (5 males, 7 females; mean age, 38.8±9.2 years (range, 21–56 years)) were intravenously infused with increasing doses of sodium nitrite for 48 hours (starting dose at 4.2 µg/kg/hr; maximal dose of 533.8 µg/kg/hr). Clinical, physiologic and laboratory data before, during and after infusion were analyzed. Findings The maximal tolerated dose for intravenous infusion of sodium nitrite was 267 µg/kg/hr. Dose limiting toxicity occurred at 446 µg/kg/hr. Toxicity included a transient asymptomatic decrease of mean arterial blood pressure (more than 15 mmHg) and/or an asymptomatic increase of methemoglobin level above 5%. Nitrite, nitrate, S-nitrosothiols concentrations in plasma and whole blood increased in all subjects and returned to preinfusion baseline values within 12 hours after cessation of the infusion. The mean half-life of nitrite estimated at maximal tolerated dose was 45.3 minutes for plasma and 51.4 minutes for whole blood. Conclusion Sodium nitrite can be safely infused intravenously at defined concentrations for prolonged intervals. These results should be valuable for developing studies to investigate new NO treatment paradigms for a variety of clinical disorders, including cerebral vasospasm after subarachnoid hemorrhage, and ischemia of the heart, liver, kidney and brain, as well as organ transplants, blood-brain barrier modulation and pulmonary hypertension. Clinical Trial Registration Information http://www.clinicaltrials.gov; NCT00103025

Pluta, Ryszard M.; Oldfield, Edward H.; Bakhtian, Kamran D.; Fathi, Ali Reza; Smith, Rene K.; DeVroom, Hetty L.; Nahavandi, Masoud; Woo, Sukyung; Figg, William D.; Lonser, Russell R.

2011-01-01

69

Cis platine (CDDP) in continuous intravenous ambulatory infusion: a new method of administration.  

Science.gov (United States)

Twenty-three patients with metastatic tumors received multiple chemotherapy regimens which included CIS platine (CDDP) by continuous ambulatory infusion for 4 successive days at a rate of 25 mg/m2/day repeated every 4 weeks. Continuous infusion was provided by an external disposable pump, the "Infusor," which delivers the drug in a volume of 48 ml at a constant rate of 2 ml/hour, in conjunction with oral hydration and antiemetics. No incident detrimental to the patient was recorded. The average duration of the infusions was 23 hr. Only 22% of the patients had minor nausea and vomiting, and 1 case of functional renal insufficiency (4%) was easily corrected by simple intravenous hydration. A randomized study is ongoing to compare continuous perfusion with standard infusion for efficiency, side effects and response rate. Patients with "Infusor" are treated at home under Minitel supervision. PMID:3779603

Benahmed, M; Renaux, J; Spielman, M; Rouesse, J

1986-01-01

70

Cis platine (CDDP) in continuous intravenous ambulatory infusion: a new method of administration.  

UK PubMed Central (United Kingdom)

Twenty-three patients with metastatic tumors received multiple chemotherapy regimens which included CIS platine (CDDP) by continuous ambulatory infusion for 4 successive days at a rate of 25 mg/m2/day repeated every 4 weeks. Continuous infusion was provided by an external disposable pump, the "Infusor," which delivers the drug in a volume of 48 ml at a constant rate of 2 ml/hour, in conjunction with oral hydration and antiemetics. No incident detrimental to the patient was recorded. The average duration of the infusions was 23 hr. Only 22% of the patients had minor nausea and vomiting, and 1 case of functional renal insufficiency (4%) was easily corrected by simple intravenous hydration. A randomized study is ongoing to compare continuous perfusion with standard infusion for efficiency, side effects and response rate. Patients with "Infusor" are treated at home under Minitel supervision.

Benahmed M; Renaux J; Spielman M; Rouesse J

1986-01-01

71

Predicting the optimal basal insulin infusion pattern in children and adolescents on insulin pumps.  

UK PubMed Central (United Kingdom)

OBJECTIVE: We aimed at developing and cross-validating a mathematical prediction model for an optimal basal insulin infusion pattern for children with type 1 diabetes on continuous subcutaneous insulin infusion therapy (CSII). RESEARCH DESIGN AND METHODS: We used the German/Austrian DPV-Wiss database for quality control and scientific surveys in pediatric diabetology and retrieved all CSII patients <20 years of age (November 2009). A total of 1,248 individuals from our previous study were excluded (dataset 1), resulting in 6,063 CSII patients (dataset 2) (mean age 10.6 ± 4.3 years). Only the most recent basal insulin infusion rates (BRs) were considered. BR patterns were identified and corresponding patients sorted by unsupervised clustering. Logistic regression analysis was applied to calculate the probabilities for each BR pattern. Equations were based on both independent datasets separately, and probabilities for BR patterns were cross-validated using typical test patients. RESULTS: Of the 6,063 children, 5,903 clustered in one of four major circadian BR patterns, confirming our previous study. The oldest age-group (mean age 12.8 years) was represented by 2,490 patients (42.18%) with a biphasic dawn-dusk pattern (BC). A broad single insulin maximum at 9-10 p.m. (F) was unveiled by 853 patients (14.45%) (mean age 6.3 years). Logistic regression analysis revealed that age, to a lesser extent duration of diabetes, and partly sex predicted BR patterns. Cross-validation revealed almost identical probabilities for BR patterns BC and F in the two datasets but some variation in the remaining two BR patterns. CONCLUSIONS: Reconfirmation of four key BR patterns in two very large independent cohorts supports that these patterns are realistic approximations of the circadian distribution of insulin needs in children with type 1 diabetes. Prediction of an optimal pattern a priori can improve initiation and clinical follow-up of CSII in children and adolescents. In addition, these BR patterns represent valuable information for insulin-infusion algorithms in closed-loop CSII.

Holterhus PM; Bokelmann J; Riepe F; Heidtmann B; Wagner V; Rami-Merhar B; Kapellen T; Raile K; Quester W; Holl RW

2013-06-01

72

Multiorgan crystal deposition following intravenous oxalate infusion in rat  

International Nuclear Information System (INIS)

Deposition of calcium oxalate is responsible for the pathologic manifestations of oxalosis and may contribute to multiorgan dysfunction in uremia and to the progression of renal damage after renal failure is established. We have developed a rat model of oxalosis using a single intravenous injection of sodium oxalate, 0.3 mmol./kg. body weight, in rats. Polarized light microscopy and section freeze-dry autoradiography were used to identify 14C-oxalate within the renal parenchyma and in extrarenal organs. 14C-oxalate crystals under three mu in length were identified within one min. of injection in proximal tubule lumens. Section freeze-dry autoradiography showed occasional minute crystals within glomeruli, heart, lung and liver at one hr. In contrast to concentrative cellular uptake demonstrated in rat renal cortical slices in vitro, intracellular accumulation of 14C-oxalate could not be detected in vivo. Within the first 24 hr., renal oxalate retention reached a maximum of 25 +/- 4 per cent of the injected dose/gm. kidney compared to a maximum of only 7 +/- 3 per cent/gm. kidney after intraperitoneal administration. Although less than one per cent dose/gm. kidney remained after one week, crystal fragments were scattered throughout the cortex and medulla, often surrounded by foci of interstitial nephritis. The retention of crystals in kidney and other body organs following i.v. oxalate provides a model of oxalosis which stimulates pathophysiologic events in a variety of clinical situations characterized by transiently or persistently elevated serum oxalate.

1986-01-01

73

Multiorgan crystal deposition following intravenous oxalate infusion in rat  

Energy Technology Data Exchange (ETDEWEB)

Deposition of calcium oxalate is responsible for the pathologic manifestations of oxalosis and may contribute to multiorgan dysfunction in uremia and to the progression of renal damage after renal failure is established. We have developed a rat model of oxalosis using a single intravenous injection of sodium oxalate, 0.3 mmol./kg. body weight, in rats. Polarized light microscopy and section freeze-dry autoradiography were used to identify /sup 14/C-oxalate within the renal parenchyma and in extrarenal organs. /sup 14/C-oxalate crystals under three mu in length were identified within one min. of injection in proximal tubule lumens. Section freeze-dry autoradiography showed occasional minute crystals within glomeruli, heart, lung and liver at one hr. In contrast to concentrative cellular uptake demonstrated in rat renal cortical slices in vitro, intracellular accumulation of /sup 14/C-oxalate could not be detected in vivo. Within the first 24 hr., renal oxalate retention reached a maximum of 25 +/- 4 per cent of the injected dose/gm. kidney compared to a maximum of only 7 +/- 3 per cent/gm. kidney after intraperitoneal administration. Although less than one per cent dose/gm. kidney remained after one week, crystal fragments were scattered throughout the cortex and medulla, often surrounded by foci of interstitial nephritis. The retention of crystals in kidney and other body organs following i.v. oxalate provides a model of oxalosis which stimulates pathophysiologic events in a variety of clinical situations characterized by transiently or persistently elevated serum oxalate.

Blumenfrucht, M.J.; Cheeks, C.; Wedeen, R.P.

1986-06-01

74

Utilities associated with subcutaneous injections and intravenous infusions for treatment of patients with bone metastases  

Science.gov (United States)

Introduction Although cost-utility models are often used to estimate the value of treatments for metastatic cancer, limited information is available on the utility of common treatment modalities. Bisphosphonate treatment for bone metastases is frequently administered via intravenous infusion, while a newer treatment is administered as a subcutaneous injection. This study estimated the impact of these treatment modalities on health state preference. Methods Participants from the UK general population completed time trade-off interviews to assess the utility of health state vignettes. Respondents first rated a health state representing cancer with bone metastases. Subsequent health states added descriptions of treatment modalities (ie, injection or infusion) to this basic health state. The two treatment modalities were presented with and without chemotherapy, and infusion characteristics were varied by duration (30 minutes or 2 hours) and renal monitoring. Results A total of 121 participants completed the interviews (52.1% female, 76.9% white). Cancer with bone metastases had a mean utility of 0.40 on a standard utility scale (1 = full health; 0 = dead). The injection, 30-minute infusion, and 2-hour infusion had mean disutilities of ?0.004, ?0.02, and ?0.04, respectively. The mean disutility of the 30-minute infusion was greater with renal monitoring than without. Chemotherapy was associated with substantial disutility (?0.17). When added to health states with chemotherapy, the mean disutilities of injection, 30-minute infusion, and 2-hour infusion were ?0.02, ?0.03, and ?0.04, respectively. The disutility associated with injection was significantly lower than the disutility of the 30-minute and 2-hour infusions (P < 0.05), regardless of chemotherapy status. Conclusion Respondents perceived an inconvenience with each type of treatment modality, but injections were preferred over infusions. The resulting utilities may be used in cost-utility models examining the value of treatments for the prevention of skeletal-related events in patients with bone metastases.

Matza, Louis S; Cong, Ze; Chung, Karen; Stopeck, Alison; Tonkin, Katia; Brown, Janet; Braun, Ada; Van Brunt, Kate; McDaniel, Kelly

2013-01-01

75

The influence of insulin infusion on the metabolism of amyloid ? peptides in plasma.  

UK PubMed Central (United Kingdom)

BACKGROUND: Accumulating body of evidence suggests pathophysiologic links between Alzheimer's disease and diabetes mellitus (DM). For example, the two crucial peptides playing a role in both degenerative disorders, amyloid ? (A?) and insulin, are metabolized by the same enzyme, insulin degrading enzyme. Euglycemic hyperinsulinemic clamp is a method of estimating insulin sensitivity, based on the assumption that during steady-state hyperinsulinemic euglycemia, glucose infusion rate equals tissue glucose uptake, that is, the higher the glucose infusion rate, the higher the insulin sensitivity. OBJECTIVE: The aim of this study was to analyze the influence of insulin on the plasma concentrations of A? peptides. METHODS: Blood samples were collected from 20 healthy young male volunteers before insulin infusion (clamp) and then at 120 and 360 minutes. In the second protocol, insulin was accompanied by Intralipid, which is mainly a mixture of triacylglycerols, and heparin, given as an activator of lipoprotein lipase, inducing insulin resistance. Analyses of plasma A?1-42, A?x-42, A?1-40, and A?x-40 were performed with multiplexing technology. Furthermore, concentrations of the A? peptides in healthy persons were compared with those in 16 type 1 DM patients receiving chronic insulin therapy. RESULTS: When applied alone (i.e., without Intralipid), insulin infusion increased concentrations of A?42 (full length and N-terminally shortened) but not of A?40. When combined with Intralipid, infusion of insulin resulted in increased concentrations of all peptides (nonsignificant tendency in case of A?x-40). We did not observe differences between A? peptide concentrations in healthy subjects and those in type 1 DM patients. CONCLUSION: Infusion of insulin in nonphysiologic high doses increases plasma concentrations of A? peptides; in case of A?40, only when applied together with Intralipid, which perhaps might be explained by hypothetical shift of insulin degrading enzyme activity from degradation of A? peptides to the degradation of insulin.

Karczewska-Kupczewska M; Lelental N; Adamska A; Niko?ajuk A; Kowalska I; Górska M; Zimmermann R; Kornhuber J; Str?czkowski M; Lewczuk P

2013-07-01

76

Insulin secretion and cellular glucose metabolism after prolonged low-grade intralipid infusion in young men.  

DEFF Research Database (Denmark)

We examined the simultaneous effects of a 24-h low-grade Intralipid infusion on peripheral glucose disposal, intracellular glucose partitioning and insulin secretion rates in twenty young men, by 2-step hyperinsulinemic euglycemic clamp [low insulin clamp (LI), 10 mU/m(2) x min; high insulin clamp (HI), 40 mU/m(2) x min], 3-(3)H-glucose, indirect calorimetry, and iv glucose tolerance test. Free fatty acid concentrations were similar during basal steady state but 3.7- to 13-fold higher during clamps. P-glucagon increased and the insulin/glucagon ratio decreased at both LI and HI during Intralipid infusion. At LI, glucose oxidation decreased by 10%, whereas glucose disposal, glycolytic flux, glucose storage, and glucose production were not significantly altered. At HI, glucose disposal, and glucose oxidation decreased by 12% and 24%, respectively, during Intralipid infusion. Glycolytic flux, glucose storage, and glucose production were unchanged. Insulin secretion rates increased in response to Intralipid infusion, but disposition indices (DI = insulin action.insulin secretion) were unchanged. In conclusion, a 24-h low-grade Intralipid infusion caused insulin resistance in the oxidative (but not in the nonoxidative) glucose metabolism in young healthy men. Moreover, insulin hypersecretion perfectly countered the free-fatty acid-induced insulin resistance. Future studies are needed to determine the role of a prolonged moderate lipid load in subjects at increased risk of developing diabetes.

Jensen, Christine B; Storgaard, Heidi

2003-01-01

77

Intravenous infusion of paracetamol versus intravenous pethidine as an intrapartum analgesic in the first stage of labor.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate the efficacy and adverse effects of an intravenous infusion of 1000 mg of paracetamol as compared with an intravenous injection of 50mg of pethidine hydrochloride for intrapartum analgesia. METHODS: In a randomized prospective study at Ain Shams University, Cairo, Egypt, between April and August 2010, 102 low-risk primiparous women in active labor were allocated to received either paracetamol (n=52) or pethidine hydrochloride (n=50). The primary outcome was the efficacy of the drug to supply adequate analgesia as measured by a change in the visual analog scale (VAS) pain intensity score at various times after drug administration. The secondary outcomes included the need for additional rescue analgesia and the presence of adverse maternal or fetal events. RESULTS: As recorded by the VAS score, there was significant pain reduction at 15 minutes, and at 1 and 2 hours in both groups (P<0.001). The reduction in pain was significantly greater in the pethidine group only at 15 minutes (P=0.004). None of the women in the paracetamol group had adverse effects, as compared with 64% of the women receiving pethidine. CONCLUSION: The effectiveness of intravenous paracetamol was comparable to that of intravenous pethidine, but paracetamol had fewer maternal adverse effects.

Elbohoty AE; Abd-Elrazek H; Abd-El-Gawad M; Salama F; El-Shorbagy M; Abd-El-Maeboud KH

2012-07-01

78

Treatment of lung cancer with bronchial artery infusion of cisplatin and intravenous sodium thiosulfate rescue  

Energy Technology Data Exchange (ETDEWEB)

Forty-nine patients with primary lung cancer were treated with bronchial artery infusion of cisplatin and intravenous injection of an antidote, sodium thiosulfate. More than 50% reduction of tumor size (PR) was observed in 8 of 9 small cell carcinomas (SCLC) and in 16 of 40 non-small cell carcinomas (NSCLC). In NSCLC patients PR was obtained in 71% (12/17) after repeated infusions (greater than or equal to 200 mg cisplatin) and in 17% (4/23) after a single infusion (less than or equal to 150 mg cisplatin). There was a significant linear relationship between cisplatin dose and tumor reduction in this group. No severe adverse effects were encountered.

Uchiyama, N.; Kobayashi, H.; Nakajo, M.; Shinohara, S.

1988-01-01

79

Vascular effects of intravenous intralipid and dextrose infusions in obese subjects.  

UK PubMed Central (United Kingdom)

Hyperglycemia and elevated free fatty acids (FFA) are implicated in the development of endothelial dysfunction. Infusion of soy-bean oil-based lipid emulsion (Intralipid®) increases FFA levels and results in elevation of blood pressure (BP) and endothelial dysfunction in obese healthy subjects. The effects of combined hyperglycemia and high FFA on BP, endothelial function and carbohydrate metabolism are not known. Twelve obese healthy subjects received four random, 8-h IV infusions of saline, Intralipid 40 mL/h, Dextrose 10% 40 mL/h, or combined Intralipid and dextrose. Plasma levels of FFA increased by 1.03±0.34 mmol/L (p=0.009) after Intralipid, but FFAs remained unchanged during saline, dextrose, and combined Intralipid and dextrose infusion. Plasma glucose and insulin concentrations significantly increased after dextrose and combined Intralipid and dextrose (all, p<0.05) and were not different from baseline during saline and lipid infusion. Intralipid increased systolic BP by 12±9 mmHg (p<0.001) and diastolic BP by 5±6 mmHg (p=0.022),and decreased flow-mediated dilatation (FMD) from baseline by 3.2%±1.4% (p<0.001). Saline and dextrose infusion had neutral effects on BP and FMD. The co-administration of lipid and dextrose decreased FMD by 2.4%±2.1% (p=0.002) from baseline, but did not significantly increase systolic or diastolic BP. Short-term Intralipid infusion significantly increased FFA and BP; in contrast, FFA and BP were unchanged during combined infusion of Intralipid and dextrose. Combined Intralipid and dextrose infusion resulted in endothelial dysfunction similar to Intralipid alone.

Gosmanov AR; Smiley DD; Peng L; Siquiera J; Robalino G; Newton C; Umpierrez GE

2012-10-01

80

Computer simulations of propofol infusions for total intravenous anaesthesia in dogs.  

UK PubMed Central (United Kingdom)

The volatile anaesthetic agents halothane, isoflurane and enflurane are all chlorofluorocarbons and according to international treaties, their emission into the atmosphere will be prohibited from the year 2030. The agents desflurane and sevoflurane are fluorinated hydrocarbons and act as greenhouse gases. The future of veterinary anaesthesia could be dependent on the development of total intravenous anaesthesia. Drugs utilised in total intravenous anaesthesia (TIVA) should have a short duration of action and no tendency to accumulate in the body. Propofol has been the dominant agent used. Computer technology has enabled targeted plasma concentration controlled infusions to replace manual infusion regimens. This study simulated the pharmacokinetics of various infusion regimens similar to those used in clinical practice using previously published pharmocokinetic data. Bolus doses of 0, 4, 6 and 8 mg/kg were simulated in combination with infusion rates of 0, 0.2, 0.3 and 0.4 mg/kg/min for either 240 or 1440 min. The computer was also programmed to maintain a steady state plasma concentration based on the previous simulated data. Generated data were then compared with published data. Changes in the context-sensitive half-life for propofol were also evaluated. Results showed that the generated data were similar to published data. A decrease in plasma concentration to levels associated with a light plane of anaesthesia was evident even when the highest bolus dose and infusion rate were used. There was a slow rise in plasma concentration when only an infusion was used. A lightening of anaesthetic plane may be evident early in the course of TIVA and careful monitoring of anaesthetic depth is required. As the duration of the infusion increased, plasma concentration steadily rose but achieved 95% of the steady state by 204 min. The most dramatic changes in plasma concentration occurred in the first hour of an infusion. Similarly, the infusion rates decreased most in the first 70 min. Most changes in anaesthetic depth are likely to occur early in the course of TIVA and careful observation of anaesthetic depth is required.

Joubert KE

2009-03-01

 
 
 
 
81

Utilities associated with subcutaneous injections and intravenous infusions for treatment of patients with bone metastases  

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Full Text Available Louis S Matza,1 Ze Cong,2 Karen Chung,2 Alison Stopeck,3 Katia Tonkin,4 Janet Brown,5 Ada Braun,2 Kate Van Brunt,6 Kelly McDaniel1 1Outcomes Research, United BioSource Corporation, Bethesda, MD, USA; 2Amgen, Inc, Thousand Oaks, CA, USA; 3Department of Medicine, University of Arizona, Tucson, AZ, USA; 4Department of Oncology, University of Alberta, Edmonton, Alberta, Canada; 5Leeds Institute of Molecular Medicine, St James University Hospital, Leeds, UK; 6formerly with Outcomes Research, United BioSource Corporation, Bethesda, MD, USA Introduction: Although cost-utility models are often used to estimate the value of treatments for metastatic cancer, limited information is available on the utility of common treatment modalities. Bisphosphonate treatment for bone metastases is frequently administered via intravenous infusion, while a newer treatment is administered as a subcutaneous injection. This study estimated the impact of these treatment modalities on health state preference. Methods: Participants from the UK general population completed time trade-off interviews to assess the utility of health state vignettes. Respondents first rated a health state representing cancer with bone metastases. Subsequent health states added descriptions of treatment modalities (ie, injection or infusion) to this basic health state. The two treatment modalities were presented with and without chemotherapy, and infusion characteristics were varied by duration (30 minutes or 2 hours) and renal monitoring. Results: A total of 121 participants completed the interviews (52.1% female, 76.9% white). Cancer with bone metastases had a mean utility of 0.40 on a standard utility scale (1 = full health; 0 = dead). The injection, 30-minute infusion, and 2-hour infusion had mean disutilities of ?0.004, ?0.02, and ?0.04, respectively. The mean disutility of the 30-minute infusion was greater with renal monitoring than without. Chemotherapy was associated with substantial disutility (?0.17). When added to health states with chemotherapy, the mean disutilities of injection, 30-minute infusion, and 2-hour infusion were ?0.02, ?0.03, and ?0.04, respectively. The disutility associated with injection was significantly lower than the disutility of the 30-minute and 2-hour infusions (P < 0.05), regardless of chemotherapy status. Conclusion: Respondents perceived an inconvenience with each type of treatment modality, but injections were preferred over infusions. The resulting utilities may be used in cost-utility models examining the value of treatments for the prevention of skeletal-related events in patients with bone metastases. Keywords: skeletal-related event, infusion, injection

Matza LS; Cong Z; Chung K; Stopeck A; Tonkin K; Brown J; Braun A; Van Brunt K; McDaniel K

2013-01-01

82

Transitional NPH insulin therapy for critically ill patients receiving continuous enteral nutrition and intravenous regular human insulin.  

UK PubMed Central (United Kingdom)

BACKGROUND: The intent of this study was to evaluate the efficacy and safety of transitioning from a continuous intravenous (IV) regular human insulin (RHI) or intermittent IV RHI therapy to subcutaneous neutral protamine Hagedorn (NPH) insulin with intermittent corrective IV RHI for critically ill patients receiving continuous enteral nutrition (EN). METHODS: Data were obtained from critically ill trauma patients receiving continuous EN during transitional NPH insulin therapy. Target blood glucose concentration (BG) range was 70-149 mg/dL. BG was determined every 1-4 hours. RESULTS: Thirty-two patients were transitioned from a continuous IV RHI infusion (CIT) to NPH with intermittent corrective IV RHI therapy. Thirty-four patients had NPH added to their preexisting supplemental intermittent IV RHI therapy (SIT). BG concentrations were maintained in the target range for 18 ± 3 and 15 ± 4 h/d for the CIT and SIT groups, respectively (P < .05). Thirty-eight percent of patients experienced a BG <60 mg/dL, and 9% had a BG <40 mg/dL. Hypoglycemia was more prevalent for those who were older (P < .01) or exhibited greater daily BG variability (P < .01) or worse HgbA1C (p < 0.05). CONCLUSION: Transitional NPH therapy with intermittent corrective IV RHI was effective for achieving BG concentrations within 70-149 mg/dL for the majority of the day. NPH therapy should be implemented with caution for those who are older, have erratic daily BG control, or have poor preadmission glycemic control.

Dickerson RN; Wilson VC; Maish GO 3rd; Croce MA; Minard G; Brown RO

2013-07-01

83

Consequences of delayed pump infusion line change in patients with type 1 diabetes mellitus treated with continuous subcutaneous insulin infusion.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To systematically investigate the effect of lack of adherence to the recommended change in insulin pump infusion line use beyond 48 h and determine whether the type of insulin made a difference. RESEARCH DESIGN AND METHODS: This was a double-blind, randomized, crossover trial with 20 patients with diabetes mellitus I using insulins aspart and lispro without a line change for up to 100 h. Using retrospective continuous glucose monitoring, we analyzed the average glucose over the day. Changes in serum 1,5-anhydroglucitol, carboxymethyllysine, and free 15-F(2t) isoprostane were also studied. RESULTS: From Day 2 to Day 5 of the pump line use, the daily average glucose level increased from 122.7 to 163.9 mg/dl (P<.05), fasting glucose from 120.3 to 154.5 mg/dl (P<.05), postprandial glucose from 114.6 to 172.1 mg/dl (P<.05), and the daily maximum glucose from 207.7 to 242.8 dl (P<.05 for the trend). Time period that the glucose was >180 mg/dl increased from 14.5% to 38.3% (P<.05). Loss of control occurred despite increase in total daily insulin dose from 48.5+/-11.8 to 55.3+/-17.9 U (P=.05). There was no difference in loss of control between insulin types, and biomarkers measured did not change significantly. CONCLUSIONS: The insulin pump infusion should be changed every 48 h in patients using continuous subcutaneous insulin infusion (CSII), to avoid loss of glycemic control. In the short-term, this loss of glycemic control has no impact on oxidative stress and glycation.

Thethi TK; Rao A; Kawji H; Mallik T; Yau CL; Christians U; Fonseca V

2010-03-01

84

Effects of intravenous infusion of amino acids and glucose on the yield and concentration of milk protein in dairy cows.  

Science.gov (United States)

To test the hypothesis that the availability of glucose or its precursors can influence the response of milk protein concentration to the intravenous infusion of amino acids, five cows were used in a 5 x 5 Latin square design with period lengths of 7 d. The five treatments were the basal diet of grass silage ad lib. plus 5 kg/d of a cereal-based supplement containing feather meal (Basal); Basal plus 4 g/d histidine, 8 g/d methionine and 26 g/d lysine (4H); Basal plus 8 g/d histidine, 8 g/d methionine and 26 g/d lysine (SH); and these two amino acid mixtures together with 600 g/d of gluctose (4HG and 8HG respectively). Earlier experiments with this basal diet had shown that histidine was first-limiting for secretion of milk protein, followed by methionine and lysine. The yield of milk protein was increased progressively with the amount of histidine infused. The efficiency of transfer of histidine into milk protein was 0.42 for the 4H and 4HG and 0.35 for the 8H and 8HG treatments, and the concentration of milk protein was increased over Basal by all infusion treatments. However, milk protein concentrations were higher, and lactose concentrations in the milk were lower, in the absence of added glucose. Concentrations of insulin in blood plasma were not affected by treatment. It is concluded that, with the treatments without added glucose, a shortage of glucose prevented an increase in lactose secretion, and hence limited the increase in milk yield, leading to an increased concentration of protein in the milk. PMID:11289267

Kim, C H; Kim, T G; Choung, J J; Chamberlain, D G

2001-02-01

85

Effect of intravenous infusion of verapamil in patients of severe hypertension.  

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Full Text Available Thirty patients with diastolic blood pressure of 120 mm Hg or more were administered a bolus dose of verapamil (0.15 mg/kg) followed immediately by an intravenous infusion at a rate of 0.005 mg/kg/min for one hour. The patients were monitored during this period and three hours following the discontinuation of the infusion. The systolic, diastolic and mean blood pressures before verapamil administration were 221.4 +/- 7.5, 134.3 +/- 2.7 and 163.4 +/- 4.1 mm Hg respectively, which decreased to 170.1 +/- 5.2, 99.1 +/- 3.7 and 122.8 +/- 3.6 mm Hg after intravenous bolus of verapamil. The fall in all the levels of blood pressure was significant (p less than 0.001) and was maintained at the lower levels throughout the infusion period and even three hours after discontinuation of the therapy. No untowards effects were observed and there was no significant change in heart rate and electrocardiogram. It, thus, proves to be an useful addition to the therapeutic armamentarium in the acute management of severe hypertension.

Verma S; Dosi R; Kaushik S; Bordia A

1990-01-01

86

Effect of corticosteroids on phlebitis induced by intravenous infusion of antineoplastic agents in rabbits  

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Full Text Available Purpose: Phlebitis caused by intravenous infusion of antineoplastic agents is one of the critical problems when anticancer therapy is prolonged. We have already reported that both rapid infusion and dilution of the injection solution were effective methods for reducing phlebitis caused by vinorelbine (VNR) in rabbits. The aim of this study was to explore other practical methods for preventing phlebitis caused by VNR and doxorubicin (DXR) in a rabbit model. VNR is often used with cisplatin, and dexamethasone (DEX) has been co-administered for prevention of cisplatin-induced nausea. DXR is used with prednisolone (PSL) in the CHOP regimen for the treatment of non-Hodgkin's lymphoma. Therefore, the present study investigated the prevention of phlebitis due to VNR with DEX and that due to DXR with PSL. Methods: VNR and DXR were diluted with normal saline to prepare test solutions at concentrations of 0.6 mg/mL and 1.4 mg/mL, respectively. Each test solution was infused into the auricular veins of rabbits. Two days after VNR infusion and three days after DXR infusion, the veins were evaluated histopathologically. The effect of DEX on VNR-induced phlebitis was evaluated by infusion of DEX before or after VNR. The effect of PSL on DXR-induced phlebitis was similarly evaluated by co-infusion of PSL. Results: The histopathological features of phlebitis caused by the antineoplastic agents differed between VNR and DXR: VNR did not cause the loss of venous endothelial cells, but caused inflammatory cell infiltration, edema, and epidermal degeneration. In contrast, DXR caused the loss of venous endothelial cells and chrondrocyte necrosis. Pre-treatment and post-treatment with DEX significantly decreased VNR-induced phlebitis compared with the control group and pre-treatment was particularly effective. Co-infusion of PSL also significantly decreased phlebitis caused by DXR, but its effect was less marked. Conclusion: The present findings suggested that pre-treatment with DEX may be a useful method for preventing phlebitis due to VNR, and that co-infusion of PSL has the potential to prevent phlebitis caused by DXR.

Emiko Kohno, Saori Murase, Kenji Matsuyama, Noboru Okamura

2009-01-01

87

The exchangeable splenic platelet pool in response to intravenous infusion of isoprenaline  

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8 healthy volunteers and 4 asplenic subjects, in whom autologous platelets had been labelled with radioactive sodium chromate, received intravenous infusions of isoprenaline in a dose of 0.03 ?g x kg-1 x min-1 over a period of 6 min. In the former group these infusions caused a significant decrease in the concentration of labelled as well as unlabelled platelets in the peripheral blood. Body surface countings showed that a significant increase in the count rate over the spleen occurred concomitantly with the decrease in the circulating platelet-bound radioactivity (PBR). In the group of asplenic subjects no change in PBR occurred. It is concluded that adrenergic beta-receptor stimulation causes a transitory trapping of platelets in the exchangeable splenic platelet pool. (author)

1978-01-01

88

Effectiveness of Intravenous Infusion Algorithms for Glucose Control in Diabetic Patients Using Different Simulation Models.  

UK PubMed Central (United Kingdom)

The effectiveness of closed-loop insulin infusion algorithms is assessed for three different mathematical models describing insulin and glucose dynamics within a Type I diabetes patient. Simulations are performed to assess the effectiveness of proportional plus integral plus derivative (PID) control, feedforward control, and a physiologically-based control system with respect to maintaining normal glucose levels during a meal and during exercise. Control effectiveness is assessed by comparing the simulated response to a simulation of a healthy patient during both a meal and exercise and establishing maximum and minimum glucose levels and insulin infusion levels, as well as maximum duration of hyperglycemia. Controller effectiveness is assessed within the minimal model, the Sorensen model, and the Hovorka model. Results showed that no type of control was able to maintain normal conditions when simulations were performed using the minimal model. For both the Sorensen model and the Hovorka model, proportional control was sufficient to maintain normal glucose levels. Given published clinical data showing the ineffectiveness of PID control in patients, the work demonstrates that controller success based on simulation results can be misleading, and that future work should focus on addressing the model discrepancies.

Farmer TG Jr; Edgar TF; Peppas NA

2009-03-01

89

Multiple daily injections of insulin versus continuous subcutaneous insulin infusion for pregnant women with type 1 diabetes.  

UK PubMed Central (United Kingdom)

AIMS: The aim was to evaluate the outcome of pregnancies with type 1 diabetes (T1DM) treated from the first trimester with continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI). METHODS: In a retrospective, observational study, we matched 64 CSII patients for age, age at onset and duration of diabetes and HbA1c in the first trimester with 64 MDI pregnancies. We analysed carbohydrate metabolism, insulin requirements, development of PIH, progression of retinopathy and fetal outcome. RESULTS: In CSII group, we found a significantly smaller insulin requirement both at the beginning of pregnancy and before delivery, significant decrease in HbA1c levels and significantly smaller number of hypoglycaemic episodes in the second trimester and significantly more hyperglycaemic episodes in the first trimester. In both groups, maternal, fetal and perinatal outcomes were similar and the number of hypo- and hyperglycaemic episodes decreased throughout pregnancy. CONCLUSION: Continuous subcutaneous insulin infusion (CSII) treatment in pregnant women with type 1 diabetes is associated with a reduced number of hypoglycaemia and decreased insulin requirement. We noted no difference in perinatal outcome comparing women on multiple insulin injections with those on continuous insulin infusion.

Wender-Ozegowska E; Zawiejska A; Ozegowska K; Wroblewska-Seniuk K; Iciek R; Mantaj U; Olejniczak D; Brazert J

2013-04-01

90

[Normoglycemic control by artificial pancreas in patients with pancreatic diabetes or with primary diabetes mellitus--analysis of patterns of insulin infusion and nocturnal glucose infusion].  

UK PubMed Central (United Kingdom)

It has been reported that patients with pancreatic diabetes (PD) show nocturnal hypoglycemia frequently when compared to patients with diabetes mellitus (DM). Present study was carried out to compare patterns of insulin infusion and nocturnal glucose infusion under normoglycemic control in between PD and DM. Eleven PD patients whose onset of diabetes mellitus appeared after the onset of chronic pancreatitis (PD group), and 10 patients with insulin-dependent diabetes mellitus without pancreatic disease (DM group) were studied. To control the blood glucose level, a closed loop insulin delivery system (Biostator GCIIS, Miles Laboratories) was used. 24 hours infused amount of insulin in PD group was not different from that in DM group, while patterns of insulin infusion in both groups were different. Thus, most of 24 h-infused insulin were given during 2 hours postprandial period in PD group, while in DM group, insulin was given mostly as a basal infusion. In this study glucose infusion occur in a state of hypoglycemia (less than 90 mg/dl). 7 of 11 in PD group and 2 of 10 in DM group had glucose infusion which mostly occurred at a night time.

Yoshida Y; Koizumi M; Abe N; Ishizuka J; Sanoyama K; Goto Y

1989-03-01

91

Central and renal haemodynamic effects of intravenous infusion of non-ionic and ionic contrast media  

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[en] The central and renal haemodynamic effects after intravenous infusion (1 ml/s) of a non-ionic (iohexol) and an ionic (metrizoate) contrast medium were investigated in 16 pigs. The injected contrast media induced marked haemodynamic changes compared with normal saline. However, there were no significant differences between the ionic and the non-ionic media. It was concluded that the effects were only partially caused by an increase in the blood volume due to the injected volume. In addition, the effects related to the viscosity, the osmolality and other not specified pharmacodynamic properties of the media are proposed to be of importance. (orig.)

1985-01-01

92

Complications of continuous intraperitoneal insulin infusion with an implantable pump  

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Full Text Available AIM: To monitor the course of continuous intraperitoneal insulin infusion (CIPII) and to gain more insight into possible complications. METHODS: A retrospective, longitudinal observational cohort study in patients with type 1 diabetes mellitus (T1DM) was performed. Only patients with “brittle” T1DM who started CIPII between January 1, 2000 and June 1, 2011, and were treated in the only centre in The Netherlands providing CIPII treatment (Isala clinics, Zwolle) were eligible for inclusion. Outcomes were defined as operation-free period (OFP), rate and type of complications. Subanalyses were made between patients starting CIPII from 2000 to 2007 and from 2007 onwards in order to study possible changes over time in complications and/or OFP. The OFP was calculated as the time from initial implantation to the date of first documented re-operation. If patients had not experienced an operation, their data were recorded at the date of last follow up or death. Kaplan-Meier curves were constructed to visualize the OFP. A (two-sided) P value of less than 0.05 was considered statistically significant. RESULTS: Fifty-seven patients were treated with CIPII, although one patient was excluded from analyses because of self-induced complications. In the remaining 56 patients, 70 complications occurred during 283 patient years. Catheter occlusion (32.9%), pump dysfunction (17.1%), pain at the pump site (15.7%) and infections (10.0%) were the most frequent complications. This resulted in a median OFP of 4.5 years (95% confidence interval 4.1-4.8 years) without any difference between the time periods. Fifty re-operations were performed because of complications, one per 5.6 patient years, with a decrease in pump dysfunction (P = 0.04) and pump explantations (P = 0.02) after 2007. In total, 9 episodes of ketoacidosis occurred during follow up and there were 69 hospital re-admissions, with a median duration of 6 d. CIPII was ceased in five patients due to recurrent infections (n = 2), pain (n = 1), inadequate glycaemic control (n = 1) or by own choice (n = 1). No CIPII related mortality was reported. CONCLUSION: The OFP has been stable over the last decade. No CIPII related mortality was reported. A significant decrease in pump dysfunction and explantation was seen after 2007 compared to the period 2000-2007. CIPII remains a safe treatment modality for specific patient groups.

Peter R van Dijk; Susan JJ Logtenberg; Klaas H Groenier; Jan Willem Haveman; Nanno Kleefstra; Henk JG Bilo

2012-01-01

93

Insulin dose adjustment when changing from multiple daily injections to continuous subcutaneous insulin infusion in the pediatric age group.  

Science.gov (United States)

The aim of this study is to determine the proper initial dose adjustment when switching from multiple daily injections to continuous subcutaneous insulin infusion for type-1 diabetic pediatric patients. Our hypothesis is that the insulin adjustment varies depending on the pubertal status and the previous long-acting insulin used. Charts of 60 patients were reviewed. Data regarding insulin dose, type of insulin administrated, HbA1c, BMI, severe hypoglycemia and DKA events were collected during the previous year and after 6 weeks of pump therapy. In the prepubertal patients the reduction was 19% (26% if the previous insulin used was detemir). Pubertal patients experienced a decrease of 26%, and the detemir group 33%. The ratio long acting-basal/short acting-bolus insulin changed from 1.26 ± 0.84 to 0.93 ± 0.46 (P daily insulin dose needs to be decreased. Basal insulin constitutes 40-45% in prepubertal and 45-50% in pubertal patients. The reduction is different depending on the previous long-acting insulin used; being greater if the insulin is detemir. PMID:19319468

Colino, Esmeralda; Álvarez, Ma Ángeles; Carcavilla, Atilano; Alonso, Milagros; Ros, Purificación; Barrio, Raquel

2009-03-25

94

Insulin dose adjustment when changing from multiple daily injections to continuous subcutaneous insulin infusion in the pediatric age group.  

UK PubMed Central (United Kingdom)

The aim of this study is to determine the proper initial dose adjustment when switching from multiple daily injections to continuous subcutaneous insulin infusion for type-1 diabetic pediatric patients. Our hypothesis is that the insulin adjustment varies depending on the pubertal status and the previous long-acting insulin used. Charts of 60 patients were reviewed. Data regarding insulin dose, type of insulin administrated, HbA1c, BMI, severe hypoglycemia and DKA events were collected during the previous year and after 6 weeks of pump therapy. In the prepubertal patients the reduction was 19% (26% if the previous insulin used was detemir). Pubertal patients experienced a decrease of 26%, and the detemir group 33%. The ratio long acting-basal/short acting-bolus insulin changed from 1.26 ± 0.84 to 0.93 ± 0.46 (P < 0.05). The total daily insulin dose needs to be decreased. Basal insulin constitutes 40-45% in prepubertal and 45-50% in pubertal patients. The reduction is different depending on the previous long-acting insulin used; being greater if the insulin is detemir.

Colino E; Álvarez MÁ; Carcavilla A; Alonso M; Ros P; Barrio R

2010-12-01

95

Differential effects of cranial radiation on growth hormone response to arginine and insulin infusion  

International Nuclear Information System (INIS)

The growth hormone responses to arginine infusion and to insulin-induced hypoglycemia were studied in 13 patients with neoplastic disease after treatment with radiation and chemotherapy. Patients who received intensive cranial radiation (greater than 2,400 rads) had no response to either arginine or insulin; those who received moderate cranial radiation (greater than or equal to 2,400 rads) had GH response to arginine but not to insulin; patients receiving no cranial radiation responded to both arginine and insulin. These data support the hypothesis that GH secretion in response to arginine infusion has a different mechanism in contrast to the response to insulin-induced hypoglycemia and that the latter is more vulnerable to cranial radiation

1978-01-01

96

Effect of intravenous magnesium infusion on salbutamol-induced bronchodilatation in patients with asthma.  

Science.gov (United States)

In vitro experimental data show that magnesium increases beta-receptor affinity to agonists. We studied the effect of a mild increase in serum magnesium level on the bronchial dose-response curve to salbutamol in six patients with asthma (age 54 +/- 3.6 years, FEV1 49.2 +/- 4.9 per cent of predicted), with a normal serum magnesium level, in a double blind placebo-controlled design. The salbutamol dose-response curve was obtained on two separate days, starting 30 min after an intravenous infusion of saline or MgSO4 (20 mg/kg over 10 min, followed by 10 mg/kg/h). The baseline FEV1 values and the values after 30 min infusion on the two test days were not significantly different. During MgSO4 infusion, the serum magnesium level increased significantly from 0.86 +/- 0.01 to 1.31 +/- 0.19 mmol/litre after 30 min and 1.29 +/- 0.17 mmol/litre at the end of the study. FEV1 values after salbutamol were significantly higher during MgSO4 than during saline infusion at the low doses of salbutamol: 1480 +/- 253 vs. 1368 +/- 212 ml, P < 0.05, after 5 micrograms, and 1596 +/- 585 vs. 1378 +/- 532 ml, P < 0.01, after 10 micrograms of salbutamol. The maximum increase in FEV1 obtained after the maximum dose of salbutamol (400 micrograms) was not significantly different during saline and MgSO4 infusion. In conclusion, a mild sustained increase in serum magnesium level increases the bronchodilating effect of low doses of salbutamol, possibly through an increased beta-receptor affinity. There was no effect on the maximum bronchodilating effect of salbutamol. PMID:7999527

Rolla, G; Bucca, C; Brussino, L; Colagrande, P

1994-06-01

97

Langerhans cells that migrate to skin after intravenous infusion regulate the induction of contact hypersensitivity  

International Nuclear Information System (INIS)

Intravenous infusion of hapten-derivatized epidermal cells (EC) in syngeneic mice leads to two competing signals for contact hypersensitivity (CH), a dominant effector signal attributable to Langerhans cells (LC) and a suppressor signal from Thy-1+ EC. In vitro exposure of LC to low dose ultraviolet B (UVB) radiation before hapten-derivatization and infusion not only results in the abrogation of their effector signal but also causes the down-regulation of subsequent CH responses. To delineate the relevance of i.v. immunization to the study of CH and of LC as the immunologic targets of low dose UVB radiation, we examined the migratory and immunogenic properties of EC after i.v. infusion. Unsorted EC migrated from blood to skin and lymphoid tissues, reaching steady state distributions at 16 h after infusion. No significant differences were observed between the trafficking of EC in syngeneic and allogeneic transfers. LC localized preferentially to skin, whereas Thy-1+ EC trafficked to skin, the thymus, mesenteric lymph nodes, and spleen. The pattern of trafficking of unirradiated and low dose UVB-irradiated LC were identical, suggesting that low dose UVB radiation had little effect on LC migration. Finally, skin graft experiments demonstrated i.v. infused, hapten-derivatized LC that migrate to skin to retain their capacity to induce CH, a property that was converted by in vitro pretreatment with low dose UVB radiation into down-regulation. These findings confirm the relevance and utility of the i.v. immunization model in the study of CH and the influence of low dose UVB on this immune response. Our data also provide a basis for investigating the role of disparate trafficking patterns in generating effector and suppressor signals when hapten-derivatized EC are employed for CH

1990-04-01

98

Langerhans cells that migrate to skin after intravenous infusion regulate the induction of contact hypersensitivity  

Energy Technology Data Exchange (ETDEWEB)

Intravenous infusion of hapten-derivatized epidermal cells (EC) in syngeneic mice leads to two competing signals for contact hypersensitivity (CH), a dominant effector signal attributable to Langerhans cells (LC) and a suppressor signal from Thy-1+ EC. In vitro exposure of LC to low dose ultraviolet B (UVB) radiation before hapten-derivatization and infusion not only results in the abrogation of their effector signal but also causes the down-regulation of subsequent CH responses. To delineate the relevance of i.v. immunization to the study of CH and of LC as the immunologic targets of low dose UVB radiation, we examined the migratory and immunogenic properties of EC after i.v. infusion. Unsorted EC migrated from blood to skin and lymphoid tissues, reaching steady state distributions at 16 h after infusion. No significant differences were observed between the trafficking of EC in syngeneic and allogeneic transfers. LC localized preferentially to skin, whereas Thy-1+ EC trafficked to skin, the thymus, mesenteric lymph nodes, and spleen. The pattern of trafficking of unirradiated and low dose UVB-irradiated LC were identical, suggesting that low dose UVB radiation had little effect on LC migration. Finally, skin graft experiments demonstrated i.v. infused, hapten-derivatized LC that migrate to skin to retain their capacity to induce CH, a property that was converted by in vitro pretreatment with low dose UVB radiation into down-regulation. These findings confirm the relevance and utility of the i.v. immunization model in the study of CH and the influence of low dose UVB on this immune response. Our data also provide a basis for investigating the role of disparate trafficking patterns in generating effector and suppressor signals when hapten-derivatized EC are employed for CH.

Cruz, P.D. Jr.; Tigelaar, R.E.; Bergstresser, P.R. (Univ. of Texas Southwestern Medical Center, Dallas (USA))

1990-04-01

99

Effects of abomasal infusion of tallow or camelina oil on responses to glucose and insulin in dairy cows during late pregnancy.  

Science.gov (United States)

Late pregnancy is associated with moderate insulin resistance in ruminants. Reduced suppression of lipolysis by insulin facilitates mobilization of nonesterified fatty acids (NEFA) from adipose tissue, resulting in elevated plasma NEFA concentrations. Decrease in dry matter intake (DMI) before parturition leads to accelerated lipomobilization and increases plasma NEFA, which may further impair insulin sensitivity. The aim of the study was to evaluate the effects of elevation of plasma NEFA concentration by abomasal infusions tallow (TAL) or camelina oil (CAM) on whole-body responses to exogenous glucose and insulin. We further assessed whether CAM, rich in C18:3n-3, enhances whole-body insulin sensitivity compared with TAL. Six late-pregnant, second-parity, rumen-cannulated dry Ayrshire dairy cows fed grass silage to meet 95% of metabolizable energy requirements were used in a replicated 3 × 3 Latin square with 5-d periods and 5 recovery days between each period. Treatments consisted of abomasal infusion of 500 mL/d (430 g of lipids/d) of water (control), TAL, or CAM administered in 10 equal doses daily. Intravenous glucose tolerance test (IVGTT) and i.v. insulin challenge (IC) were performed on d 5 after 98 and 108 h of treatment infusions, respectively. Infusion of lipids increased basal plasma NEFA concentrations on d 5 (CAM: 0.25; TAL: 0.28; control: 0.17 mmol/L). Following glucose injection, the rate of glucose clearance (CR) was lower in lipid-treated cows (CAM: 1.34; TAL: 1.48; control: 1.74%/min) and time to reach half-maximal glucose concentration (T(1/2)) was longer (CAM: 54; TAL: 47; control: 42 min). Similar responses were observed after insulin injection. Increased plasma NEFA concentration tended to decrease insulin secretion in IVGTT. Infusion of CAM increased plasma C18:3n-3 content (CAM: 26.4; TAL: 16.1; control: 20.9 g/100g of fatty acids). Data suggest that CAM had an insulin-sensitizing effect, because the disposition index and insulin sensitivity index, derived from minimal model analysis, were higher in CAM than in TAL during IVGTT, and lower insulin concentrations during IC led to similar glucose clearance in CAM as in TAL. These results indicate that elevated plasma NEFA concentration per se induces whole-body insulin resistance in late-pregnant dry cows. PMID:22720937

Salin, S; Taponen, J; Elo, K; Simpura, I; Vanhatalo, A; Boston, R; Kokkonen, T

2012-07-01

100

Effects of abomasal infusion of tallow or camelina oil on responses to glucose and insulin in dairy cows during late pregnancy.  

UK PubMed Central (United Kingdom)

Late pregnancy is associated with moderate insulin resistance in ruminants. Reduced suppression of lipolysis by insulin facilitates mobilization of nonesterified fatty acids (NEFA) from adipose tissue, resulting in elevated plasma NEFA concentrations. Decrease in dry matter intake (DMI) before parturition leads to accelerated lipomobilization and increases plasma NEFA, which may further impair insulin sensitivity. The aim of the study was to evaluate the effects of elevation of plasma NEFA concentration by abomasal infusions tallow (TAL) or camelina oil (CAM) on whole-body responses to exogenous glucose and insulin. We further assessed whether CAM, rich in C18:3n-3, enhances whole-body insulin sensitivity compared with TAL. Six late-pregnant, second-parity, rumen-cannulated dry Ayrshire dairy cows fed grass silage to meet 95% of metabolizable energy requirements were used in a replicated 3 × 3 Latin square with 5-d periods and 5 recovery days between each period. Treatments consisted of abomasal infusion of 500 mL/d (430 g of lipids/d) of water (control), TAL, or CAM administered in 10 equal doses daily. Intravenous glucose tolerance test (IVGTT) and i.v. insulin challenge (IC) were performed on d 5 after 98 and 108 h of treatment infusions, respectively. Infusion of lipids increased basal plasma NEFA concentrations on d 5 (CAM: 0.25; TAL: 0.28; control: 0.17 mmol/L). Following glucose injection, the rate of glucose clearance (CR) was lower in lipid-treated cows (CAM: 1.34; TAL: 1.48; control: 1.74%/min) and time to reach half-maximal glucose concentration (T(1/2)) was longer (CAM: 54; TAL: 47; control: 42 min). Similar responses were observed after insulin injection. Increased plasma NEFA concentration tended to decrease insulin secretion in IVGTT. Infusion of CAM increased plasma C18:3n-3 content (CAM: 26.4; TAL: 16.1; control: 20.9 g/100g of fatty acids). Data suggest that CAM had an insulin-sensitizing effect, because the disposition index and insulin sensitivity index, derived from minimal model analysis, were higher in CAM than in TAL during IVGTT, and lower insulin concentrations during IC led to similar glucose clearance in CAM as in TAL. These results indicate that elevated plasma NEFA concentration per se induces whole-body insulin resistance in late-pregnant dry cows.

Salin S; Taponen J; Elo K; Simpura I; Vanhatalo A; Boston R; Kokkonen T

2012-07-01

 
 
 
 
101

The evolution of insulin resistance in muscle of the glucose infused rat.  

UK PubMed Central (United Kingdom)

Glucose infusion into rats causes skeletal muscle insulin resistance that initially occurs without changes in insulin signaling. The aim of the current study was to prolong glucose infusion and evaluate other events associated with the transition to muscle insulin resistance. Hyperglycemia was produced in rats by glucose infusion for 3, 5 and 8 h. The rate of infusion required to maintain hyperglycemia was reduced at 5 and 8 h. Glucose uptake into red quadriceps (RQ) and its incorporation into glycogen decreased between 3 and 5 h, further decreasing at 8 h. The earliest observed change in RQ was decreased AMPK?2 activity associated with large increases in muscle glycogen content at 3 h. Activation of the mTOR pathway occurred at 5 h. Akt phosphorylation (Ser(473)) was decreased at 8 h compared to 3 and 5, although no decrease in phosphorylation of downstream GSK-3? (Ser(9)) and AS160 (Thr(642)) was observed. White quadriceps showed a similar but delayed pattern, with insulin resistance developing by 8 h and decreased AMPK?2 activity at 5 h. These results indicate that, in the presence of a nutrient overload, alterations in muscle insulin signaling occur, but after insulin resistance develops and appropriate changes in energy/nutrient sensing pathways occur.

Brandon AE; Hoy AJ; Wright LE; Turner N; Hegarty BD; Iseli TJ; Julia Xu X; Cooney GJ; Saha AK; Ruderman NB; Kraegen EW

2011-05-01

102

Urinary iron excretion induced by intravenous infusion of deferoxamine in ß-thalassemia homozygous patients  

Directory of Open Access Journals (Sweden)

Full Text Available The purpose of the present study was to identify noninvasive methods to evaluate the severity of iron overload in transfusion-dependent ß-thalassemia and the efficiency of intensive intravenous therapy as an additional tool for the treatment of iron-overloaded patients. Iron overload was evaluated for 26 ß-thalassemia homozygous patients, and 14 of them were submitted to intensive chelation therapy with high doses of intravenous deferoxamine (DF). Patients were classified into six groups of increasing clinical severity and were divided into compliant and non-compliant patients depending on their adherence to chronic chelation treatment. Several methods were used as indicators of iron overload. Total gain of transfusion iron, plasma ferritin, and urinary iron excretion in response to 20 to 60 mg/day subcutaneous DF for 8 to 12 h daily are useful to identify iron overload; however, urinary iron excretion in response to 9 g intravenous DF over 24 h and the increase of urinary iron excretion induced by high doses of the chelator are more reliable to identify different degrees of iron overload because of their correlation with the clinical grades of secondary hemochromatosis and the significant differences observed between the groups of compliant and non-compliant patients. Finally, the use of 3-9 g intravenous DF for 6-12 days led to a urinary iron excretion corresponding to 4.1 to 22.4% of the annual transfusion iron gain. Therefore, continuous intravenous DF at high doses may be an additional treatment for these patients, as a complement to the regular subcutaneous infusion at home, but requires individual planning and close monitoring of adverse reactions.

Boturão-Neto E.; Marcopito L.F.; Zago M.A.

2002-01-01

103

Dose proportional pharmacokinetics of alprostadil (prostaglandin E1) in healthy volunteers following intravenous infusion.  

Science.gov (United States)

Prostaglandin E1 (PGE1) (30, 60, 120 micrograms) was administered by intravenous infusion over a 120 min period in an open, three way randomized, cross-over study to 12 healthy male volunteers. For the evaluation of PGE1, PGE0 and 15-keto-PGE0, blood samples were drawn prior to, during and after the infusion. Analytical measurements were performed by gas chromatography/negative ion chemical ionization triple stage quadruple mass spectrometry, a highly specific and sensitive GC/MS/MS-method. During intravenous infusion of 30, 60 and 120 micrograms PGE1, endogenous plasma PGE1 concentrations increased from 1.7 +/- 0.8 to 4.2 +/- 1.1, 6.7 +/- 1.0 and 11.0 +/- 1.9 pg ml-1 respectively. PGE0 plasma concentrations increased from endogenous levels of 1.3 +/- 1.0 pg ml-1 to 7.6 +/- 2.1, 14.1 +/- 3.7 and 28.0 +/- 3.0 pg ml-1 respectively, whilst 15-keto-PGE0 plasma concentrations increased from endogenous levels of 10.2 +/- 13.9 pg ml-1 to 99.3 +/- 27.9, 190.4 +/- 52.5 and 357.2 +/- 72.6 pg ml-1 respectively. Within the dose range of 30-120 micrograms PGE1 2 h-1 there was a linear increase of Cmax and AUC with the dose. The results of the analysis of variance after baseline and dose-correction show a 90% confidence interval in the bioequivalence acceptance range of 80 to 125%. PMID:8527291

Cawello, W; Leonhardt, A; Schweer, H; Seyberth, H W; Bonn, R; Lomeli, A L

1995-09-01

104

Continuous subcutaneous insulin infusion allows tolerance induction and diabetes treatment in a type 1 diabetic child with insulin allergy.  

UK PubMed Central (United Kingdom)

AIM: Insulin allergy is a rare but serious and challenging condition in patients with type 1 diabetes (T1D). This is a case report of an 8-year-old boy with T1D and an allergy to insulin. CASE REPORT: Three months after being diagnosed with T1D, the patient developed progressive skin reactions to insulin, characterized by small 1.5-cm pruritic wheals at injection sites that persisted for several days. Seven months after diagnosis, he experienced two episodes of generalized urticaria with systemic symptoms that were seen within a few seconds of insulin injection. Examination revealed lipoatrophy of the thighs. Intradermal skin tests were positive for protamine, glargine and lispro. The patient was started on a continuous subcutaneous insulin infusion (CSII) tolerance induction protocol, consisting of a very low basal rate that was progressively increased, with the first bolus given under medical supervision, and was well tolerated for 4 months. After this period of time, the skin wheals reappeared, localized to the infusion sites, but without urticaria or any other generalized reactions. Intradermal skin tests were repeated and were again positive. Serum insulin-specific IgE measured 30 months after the first allergic reactions were positive. After 3 years, pump therapy is ongoing and blood glucose control has remained relatively good (HbA1c 7.6%). CONCLUSION: In T1D children with insulin allergy, CSII can successfully be used to both induce insulin tolerance and allow diabetes insulin therapy, although insulin desensitization cannot always be fully achieved. The induction protocol was easily manageable partly due to the "honeymoon" period that the patient was still in, but it should nonetheless be used even when the patient has higher insulin requirements.

Hasselmann C; Pecquet C; Bismuth E; Raverdy C; Sola-Gazagnes A; Lobut JB; Carel JC; Tubiana-Rufi N

2013-04-01

105

High antigenicity of intraperitoneal insulin infusion via implantable devices: preliminary rat studies.  

Science.gov (United States)

Intraperitoneal insulin infusion of Genapol stabilized insulin via implantable devices significantly improves diabetes control and hypoglycemia frequency in type 1 diabetes while it increases insulin antibody levels. Causes for this particular antigenicity remain unknown. The role of insulin modifications occurring in the reservoir on the antigenicity observed was assessed by comparing the antigenicities of the insulin coming from the vial or from the pump reservoir. Rats were injected intraperitoneally with insulin sampled either from a vial (group 1) or from a pump reservoir during a refill of a clinical trial (group 2). Two control groups, one without insulin, the second one receiving a mixture of silicone and insulin were also studied. Human insulin antibody levels were assessed by RIA 10 days after 4 weekly immunizations. AIA levels were higher in group 1 compared to group 2 (P = 0.003 for the first experiment, P = 0.04 in the second experiment). The increased antigenicity of the insulin sampled from the implanted pump might be due to the insulin modifications occurring during the storage in the device. Insulin aggregates could be involved in this antigenicity since they are known to be antigenic and their concentration was shown to be related to the amplitude of the antigenic response. PMID:11280713

Jeandidier, N; Boullu, S; Delatte, E; Sapin, R; Steibel, J; Meyer, P; Uhl, C; Pinget, M

2001-01-01

106

High antigenicity of intraperitoneal insulin infusion via implantable devices: preliminary rat studies.  

UK PubMed Central (United Kingdom)

Intraperitoneal insulin infusion of Genapol stabilized insulin via implantable devices significantly improves diabetes control and hypoglycemia frequency in type 1 diabetes while it increases insulin antibody levels. Causes for this particular antigenicity remain unknown. The role of insulin modifications occurring in the reservoir on the antigenicity observed was assessed by comparing the antigenicities of the insulin coming from the vial or from the pump reservoir. Rats were injected intraperitoneally with insulin sampled either from a vial (group 1) or from a pump reservoir during a refill of a clinical trial (group 2). Two control groups, one without insulin, the second one receiving a mixture of silicone and insulin were also studied. Human insulin antibody levels were assessed by RIA 10 days after 4 weekly immunizations. AIA levels were higher in group 1 compared to group 2 (P = 0.003 for the first experiment, P = 0.04 in the second experiment). The increased antigenicity of the insulin sampled from the implanted pump might be due to the insulin modifications occurring during the storage in the device. Insulin aggregates could be involved in this antigenicity since they are known to be antigenic and their concentration was shown to be related to the amplitude of the antigenic response.

Jeandidier N; Boullu S; Delatte E; Sapin R; Steibel J; Meyer P; Uhl C; Pinget M

2001-01-01

107

Prevention of drug delivery disturbances during continuous intravenous infusion: An in vitro study on a new multi-lumen infusion access device.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Stopping and restarting carrier fluid flow and performing simultaneous drug infusions can lead to hazardous disturbances in drug delivery. The present study was designed to assess in vitro whether using a multi-lumen infusion access device could prevent noradrenaline disturbances. STUDY DESIGN: In vitro laboratory work. METHODS: Two infusion devices were studied: a standard device with a four-port manifold and a 150cm extension line and a nine-lumen infusion device (Edelvaiss-Multiline(®)) with eight accesses connected to nine separate lumens in a single tube of 150cm: seven accesses connected to seven peripheral lumens and one for the carrier fluid access connected to two lumens. Two experimental protocols of noradrenaline infusion were made: (a) drug flow rate change and (b) stop-and-go carrier fluid flows. Two parameters were studied: drug mass flow rate and flow change efficiency (FCE) calculated from the ratio of the area under the experimental mass flow rate curve to the area under the theoretical instantaneous mass flow rate curve. RESULTS: Variations in noradrenaline mass flow rate were more rapid with the Edelvaiss-Multiline(®) when the noradrenaline infusion rate was increased or decreased. FCE was significantly different from one infusion device to the other during both noradrenaline flow rate increase (standard vs. nine-lumen: 58% vs. 84%; P=0.008) and decrease (175% vs. 108%; P=0.008). Decreased drug delivery after stopping carrier fluid flow (standard vs. nine-lumen: 21% vs. 98%; P=0.008) and sudden temporary increases on resumption (253% vs. 103%; P=0.008) were reduced in magnitude and duration when using the Edelvaiss-Multiline(®) with a significant difference in FCE between the two infusion devices. CONCLUSIONS: Using the nine-lumen infusion device reduces drug delivery disturbances during continuous intravenous infusion.

Foinard A; Décaudin B; Barthélémy C; Debaene B; Odou P

2013-09-01

108

Metabolic changes following the intravenous infusion of Corynebacterium parvum in man.  

UK PubMed Central (United Kingdom)

The acute changes in concentrations of key blood metabolites and liver function tests were measured following intravenous infusion of Corynebacterium parvum in 9 healthy patients who had recently undergone resection of a colorectal cancer. The following results were obtained: 1) Blood glucose, lactate and ketone body concentrations significantly increased over a 5 hour study period; 2) blood alanine fell during the same period; 3) plasma bilirubin, GOT and urea were significantly elevated 24 hours after C. parvum 4) plasma albumin and cholesterol concentrations were significantly lower 24 hours after C. parvum. These changes are similar to the alterations in hepatic metabolism previously described in clinical bacterial infections, and indicate parenchymal cell damage and reduced synthetic activity. They are potentially important in relation to the treatment of cancer with combined modalities where drug metabolism or excretion may be affected.

Royle G; Gill PG

1979-04-01

109

Reducing risk of harm from extravasation: a 3-tiered evidence-based list of pediatric peripheral intravenous infusates.  

UK PubMed Central (United Kingdom)

Extravasation of medications during peripheral intravenous (PIV) therapy can result in harm to pediatric patients. These medications have physical and/or biologic factors that cause tissue damage. To assist in clinical decisions when using these infusates, an evidence-based table of medications stratified by their relative risk of causing harm if extravasated was developed. Local data and experience, a systematic review of the pediatric literature, and measured pH and osmolality of common pediatric preparations of PIV infusates were used to create a 3-tiered table of PIV infusates categorized by relative risk of causing harm if extravasated.

Clark E; Giambra BK; Hingl J; Doellman D; Tofani B; Johnson N

2013-01-01

110

Insulin glulisine compared to insulin aspart and to insulin lispro administered by continuous subcutaneous insulin infusion in patients with type 1 diabetes: a randomized controlled trial.  

UK PubMed Central (United Kingdom)

BACKGROUND: In a previous pilot study comparing insulin glulisine (GLU) with insulin aspart (ASP) administered by continuous subcutaneous insulin infusion (CSII), GLU-treated patients did show a trend toward fewer catheter occlusions compared with ASP-treated patients. Here we performed a randomized open-label, three-way crossover, controlled multicenter study comparing GLU with ASP and insulin lispro (LIS). METHODS: Subjects with type 1 diabetes were allocated to one of three treatment orders-GLU-ASP-LIS, ASP-LIS-GLU, or LIS-GLU-ASP-with each insulin used for 13 weeks. The study was designed to demonstrate the superiority of GLU over ASP and LIS on unexplained hyperglycemia and/or perceived infusion set occlusion. A prespecified P value of 0.025 was considered significant to correct for multiple testing. RESULTS: Percentages of subjects with at least one unexplained hyperglycemia and/or infusion set occlusion were not significantly different between GLU and ASP (68.4% [62.7-74.1%] vs. 62.1% [56.2-68.1%], P?=?0.04) and GLU and LIS (68.4% [62.7-74.1%] vs. 61.3% [55.4-67.3%], P?=?0.03). No differences were seen in hemoglobin A1c at end point, most points of the seven-point glucose curves, severe hypoglycemia, and symptomatic ketoacidosis. The overall rate of hypoglycemia with a plasma glucose level below 70?mg/dL per patient-year was significantly different between GLU and ASP (73.84 vs. 65.01, P?=?0.008) and GLU and LIS (73.84 vs. 62.69, P?Insulin doses remained unchanged during the trial. CONCLUSIONS: GLU was not superior to ASP and LIS with no significant difference seen among GLU, ASP, and LIS in CSII use with respect to unexplained hyperglycemia and/or perceived catheter set occlusion. GLU was associated with a higher frequency of symptomatic hypoglycemia, possibly because of slight overdosing, as previous trials suggested lower insulin requirements when GLU is initiated in type 1 diabetes.

van Bon AC; Bode BW; Sert-Langeron C; DeVries JH; Charpentier G

2011-06-01

111

Dose proportionality of treprostinil sodium administered by continuous subcutaneous and intravenous infusion.  

Science.gov (United States)

This study assessed the relationship between dose and plasma concentration following administration of treprostinil sodium infusion therapy in pulmonary arterial hypertension patients. This was a multicenter, open-label, multiple-cohort, steady-state, pharmacokinetic study in subjects with pulmonary arterial hypertension receiving treprostinil by continuous intravenous or subcutaneous infusion at doses between 10 and 125 ng/kg/min. A blood sample was obtained from each patient at steady state and analyzed via a liquid chromatography/tandem mass spectrometry method. Forty-nine subjects receiving treprostinil were enrolled. Treprostinil doses ranged from 12.1 to 125 ng/kg/min; treprostinil plasma concentrations ranged from 14.9 to 18 248 pg/mL. Linear regression analysis revealed a correlation between treprostinil dose and treprostinil plasma concentration with an R2 value of 0.561. Using a power model to assess dose proportionality, the estimated nonproportionality parameter was 0.641 (95% confidence interval: 0.083-1.199), reflecting consistency with dose proportionality. Subset linear regression analysis, which excluded 2 subjects with anomalous treprostinil plasma concentrations, increased the R2 value to 0.796. Using a power model to assess dose proportionality of this subset, the estimated nonproportionality parameter was 0.941 (95% confidence interval: 0.809-1.073). This study supports previous findings of linearity at lower doses up to 15 ng/kg/min and demonstrates linearity at treprostinil doses up to 125 ng/kg/min. PMID:18094217

McSwain, C Shane; Benza, Ray; Shapiro, Shelley; Hill, Nicholas; Schilz, Robert; Elliott, C Gregory; Zwicke, Dianne L; Oudiz, Ronald J; Staszewski, James P; Arneson, Carl P; Wade, Michael; Zaccardelli, David; McLaughlin, Vallerie

2008-01-01

112

Response of colo-rectal hepatic metastases to concomitant radiotherapy and intravenous infusion 5 fluorouracil  

International Nuclear Information System (INIS)

[en] Twenty-three patients with colo-rectal hepatic metastases were retrospectively reviewed after completing treatment with split course liver irradiation and continually infused concomitant intravenous 5-fluorouracil. Although no patient attained a complete response, an objective partial response was documented in 15 (Responders). The Responders had a median survival of 45 weeks whereas Non-responders had a median survival of 17 weeks. Patients with metastatic disease solely in the liver or those with a Karnofsky performance score (k.p.s) of over sixty, had a median survival of 49 weeks. Patients with multiple organ metastatic involvement had a median survival of 25 weeks and those with a Karnofsky with less than 60 had a median survival of 27 weeks. (p values of 0.006 and 0.03, respectively.) The overall survival of the group completing treatment was 30 weeks, and 19 patients (83%) achieved subjective palliation. The patients tolerated therapy well. There was minimal hematological toxicity; 3 patients developed a leucocyte count of less than 2000 and 1 developed a platelet count of 30,000. The palliation and prolongation of survival attained with minimal complications suggest that adjuvant liver irradiation with concomitant infusion 5-fluorouracil radiosensitization may be an option to offer patients identified to be at high risk of developing subclinical liver disease

1986-01-01

113

Prolonged intravenous infusion of sodium nitrite delivers nitric oxide (NO) in humans.  

UK PubMed Central (United Kingdom)

In preclinical studies, infusion of sodium nitrite delivers nitric oxide (NO) as treatment of vasospasm after subarachnoid hemorrhage. We evaluated safety and toxicity of intravenous nitrite administration in healthy volunteers infused with increasing doses of sodium nitrite for 48 h. Twelve volunteers (5 men, 7 women; mean age was 38.8 years, range 27-56 years) participated in the study. The starting sodium nitrite dose was 4.2 mg/kg/h, and it was doubled for each subsequent volunteer up to a maximal dose of 533.8 mg/kg/h at which a clinically silent dose-limiting toxicity (DLT) was observed. Toxicity included a transient decrease of mean arterial blood pressure or asymptomatic increase of methemoglobin level above 5%. The maximal tolerated dose (MTD) was 267 mg/kg/h. S-Nitrosothiols increased significantly in plasma, confirming in vivo sodium nitrite reduction to NO and encouraging its use against vasospasm and ischemia-reperfusion injury to the brain, kidneys, liver, and heart.

Pluta RM

2013-01-01

114

Response of colo-rectal hepatic metastases to concomitant radiotherapy and intravenous infusion 5 fluorouracil  

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Twenty-three patients with colo-rectal hepatic metastases were retrospectively reviewed after completing treatment with split course liver irradiation and continually infused concomitant intravenous 5-fluorouracil. Although no patient attained a complete response, an objective partial response was documented in 15 (Responders). The Responders had a median survival of 45 weeks whereas Non-responders had a median survival of 17 weeks. Patients with metastatic disease solely in the liver or those with a Karnofsky performance score (k.p.s) of over sixty, had a median survival of 49 weeks. Patients with multiple organ metastatic involvement had a median survival of 25 weeks and those with a Karnofsky with less than 60 had a median survival of 27 weeks. (p values of 0.006 and 0.03, respectively.) The overall survival of the group completing treatment was 30 weeks, and 19 patients (83%) achieved subjective palliation. The patients tolerated therapy well. There was minimal hematological toxicity; 3 patients developed a leucocyte count of less than 2000 and 1 developed a platelet count of 30,000. The palliation and prolongation of survival attained with minimal complications suggest that adjuvant liver irradiation with concomitant infusion 5-fluorouracil radiosensitization may be an option to offer patients identified to be at high risk of developing subclinical liver disease.

Rotman, M.; Kuruvilla, A.M.; Choi, K.; Bhutiani, I.; Aziz, H.; Rosenthal, J.; Braverman, A.; Marti, J.; Brandys, M.

1986-12-01

115

Pharmacokinetics of cyclosporin: influence of rate-duration profile of an intravenous infusion in renal transplant patients.  

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1. The pharmacokinetics of cyclosporin were studied in six renal transplant patients, following intravenous administration of 5 mg kg-1 infused over 3, 6 and 24 h. 2. Plasma, separated at 37 degrees C, was analysed for cyclosporin by h.p.l.c. 3. The data were described by a biexponential disposition...

Gupta, S K; Bakran, A; Johnson, R W; Rowland, M

116

Disposition, Metabolism, and Excretion of [14C]Doripenem after a Single 500-Milligram Intravenous Infusion in Healthy Men?  

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In this open-label, single-center study, eight healthy men each received a single 500-mg dose of [14C]doripenem, containing 50 ?Ci of [14C]doripenem, administered as a 1-h intravenous infusion. The concentrations of unchanged doripenem and its primary metabolite (doripenem-M-1) resulting from ?-lact...

Cirillo, Iolanda; Mannens, Geert; Janssen, Cor; Vermeir, Marc; Cuyckens, Filip; Desai-Krieger, Daksha; Vaccaro, Nicole

117

Ceftazidime in Acute Myeloid Leukemia Patients with Febrile Neutropenia: Helpfulness of Continuous Intravenous Infusion in Maximizing Pharmacodynamic Exposure  

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The pharmacokinetic-pharmacodynamic profile of a fixed 6-g daily continuous intravenous infusion of ceftazidime was assessed in 20 febrile neutropenic patients with acute myeloid leukemia. Mean steady-state ceftazidime concentrations averaging 40 mg/liter from day 2 on ensured maximized pharmacodyna...

Pea, Federico; Viale, Pierluigi; Damiani, Daniela; Pavan, Federica; Cristini, Francesco; Fanin, Renato; Furlanut, Mario

118

The pharmacokinetics and bioavailability of rabeprazole following single intravenous infusion and oral administration in healthy Chinese volunteers  

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To investigate the pharmacokinetics and bioavailability of rabeprazole administrated by intravenous infusion and oral administration in healthy Chinese volunteers. A total of 20 male subjects were recruited and randomly assigned at the beginning of the study to receive a single dose of rabeprazole (...

Yongqing Wang; Hongwen Zhang; Ling Meng; Nana Tang; Hongyu Yuan; Ning Ou; Haibo Zhang; Dewang Wang; Xiyong Zhang; Ruihua Shi

119

Feasibility of adjacent insulin infusion and continuous glucose monitoring via the Medtronic Combo-Set.  

UK PubMed Central (United Kingdom)

BACKGROUND: Subcutaneously infused insulin may interfere with the function of nearby glucose-sensing electrodes and vice versa. The prototype of the Combo-Set device (Medtronic) incorporates a subcutaneous insulin delivery catheter and continuous glucose monitoring (CGM) sensor assembled on the same platform and separated by 11 mm. We aim to evaluate Combo-Set's insulin delivery and glucose-sensing functions. METHODS: Ten subjects with type 1 diabetes wore a Combo-Set and a Sof-Sensor inserted subcutaneously in contralateral abdominal areas connected to iPro recorders (Medtronic) for 53.25 ± 0.75 h (mean ± standard deviation). The Combo-Set delivered insulin diluent except during meal tests on days 1 and 3 when insulin lispro was delivered as a meal bolus and postmeal basal. Venous plasma samples were collected at the following time points from meal start: 0, 30, 60, 120, and 180 min for insulin measurements. The accuracy of the Combo-Set sensors was evaluated and compared with that of the Sof-Sensor, with each referenced against capillary glucose values (Contour Link Meter, Bayer). RESULTS: Accuracy of the Combo-Set sensor was comparable to that of the Sof-Sensor. Clarke error grid analysis showed that 97% of Combo-Set and 93% of Sof-Sensor values were in the A+B regions (p = .20, not significant). The Combo-Set showed the expected postbolus peak insulin time (67 ± 9 min, mean ± standard error). One "no delivery" alarm occurred during the 21 patient days of use. CONCLUSION: A device providing for simultaneous adjacent placement of an insulin infusion catheter and a CGM sensor is feasible and functions within acceptable limits. The low "no delivery" alarm rate was similar to that of other infusion sets.

O'Neal DN; Adhya S; Jenkins A; Ward G; Welsh JB; Voskanyan G

2013-01-01

120

The parasympathetic nervous system and the thermic effect of glucose/insulin infusions in humans.  

UK PubMed Central (United Kingdom)

The thermic effect of glucose/insulin infusions was investigated in seven healthy young men before and during either inhibition (atropine sulphate 10 micrograms/kg bolus; 10 micrograms/kg/h) or stimulation (edrophonium chloride, 10 mg bolus; 0.75 mg/min starting rate) of the parasympathetic nervous system. The thermic effects of glucose/insulin were 6.2% +/- 0.4% and 5.6% +/- 0.7% before atropine and edrophonium, respectively, and increased to 7.1% +/- 0.5% (NS) with atropine and 7.5% +/- 1.2% (P less than .05) with edrophonium. In four subjects atropine or edrophonium was infused before the hyperinsulinemic, euglycemic clamp. A significant increase in resting metabolic rate and plasma norepinephrine concentrations was observed with edrophonium alone. When the thermic effects of glucose/insulin were calculated with respect to the metabolic rates observed during the drug infusions alone, they were 5.9% +/- 1.4% and 3.6% +/- 0.6% (NS) for the clamp + atropine and clamp + edrophonium, respectively. These results demonstrate that the increases in the thermic effect of glucose/insulin infusions observed during inhibition or stimulation of the parasympathetic nervous system were due to atropine or edrophonium increasing the resting metabolic rate rather than increasing the thermic response to glucose-insulin infusions. However, because it has been shown that atropine can decrease the thermic effect of an orally administered meal by approximately 60%, it would appear that the parasympathetic nervous system can influence the thermic effect of food by affecting the rate of digestion, absorption and storage of the ingested nutrients.

Dériaz O; Nacht CA; Chioléro R; Jéquier E; Acheson KJ

1989-11-01

 
 
 
 
121

Blood glucose control in healthy subject and patients receiving intravenous glucose infusion or total parenteral nutrition using glucagon-like peptide 1.  

UK PubMed Central (United Kingdom)

AIMS: It was the aim of the study to examine whether the insulinotropic gut hormone GLP-1 is able to control or even normalise glycaemia in healthy subjects receiving intravenous glucose infusions and in severely ill patients hyperglycaemic during total parenteral nutrition. PATIENTS AND METHODS: Eight healthy subjects and nine patients were examined. The volunteers received, in six separate experiments in randomised order, intravenous glucose at doses of 0, 2 and 5mg kg(-1) min(-1), each with intravenous GLP-1 or placebo for 6 h. Patients were selected on the basis of hyperglycaemia (>150 mg/dl) during complete parenteral nutrition with glucose (3.2+/-1.4 mg kg(-1) min(-1)), amino acids (n=8; 0.9+/-0.2 mg kg(-1) min(-1)), with or without lipid emulsions. Four hours (8 a.m. to 12 a.m. on parenteral nutrition plus NaCl as placebo) were compared to 4 h (12 a.m. to 4 p.m.) with additional GLP-1 administered intravenously. The dose of GLP-1 was 1.2 pmol kg(-1) min(-1). Blood was drawn for the determination of glucose, insulin, C-peptide, GLP-1, glucagon, and free fatty acids. RESULTS: Glycaemia was raised dose-dependently by glucose infusions in healthy volunteers (p<0.0001). GLP-1 ( approximately 100-150 pmol/l) stimulated insulin and reduced glucagon secretion and reduced glucose concentrations into the normoglycaemic fasting range (all p<0.05). In hyperglycaemic patients, glucose concentrations during the placebo period averaged 211+/-24 mg/dl. This level was reduced to 159+/-25 mg/dl with GLP-1 (p<0.0001), accompanied by a rise in insulin (p=0.0002) and C-peptide (p<0.0001), and by trend towards a reduction in glucagon (p=0.08) and free fatty acids (p=0.02). GLP-1 was well tolerated. CONCLUSIONS: Hyperglycaemia during parenteral nutrition can be controlled by exogenous GLP-1, e.g. the natural peptide (available today), whereas the chronic therapy of Type 2 diabetes requires GLP-1 derivatives with longer duration of action.

Nauck MA; Walberg J; Vethacke A; El-Ouaghlidi A; Senkal M; Holst JJ; Gallwitz B; Gallwitz JB; Schmidt WE; Schmiegel W

2004-04-01

122

Investigation of the insulin dose and characteristics of continuous subcutaneous insulin infusion in Chinese people with type 2 diabetes.  

UK PubMed Central (United Kingdom)

BACKGROUND: Continuous subcutaneous insulin infusion (CSII) for type 2 diabetes mellitus (T2DM) is a promising therapy. CSII therapy is flexible, but the required insulin dose for different people may vary. Few studies have investigated the insulin dose and characteristics of CSII for T2DM, and none has focused on an Asian Chinese population. METHODS: In total, 171 subjects with T2DM were using CSII and divided into different groups according to their body mass index (BMI) and the course of disease, respectively. The basal rate of CSII was set for four periods per day. We preferentially adjusted the basal insulin dose to control fasting and preprandial blood glucose. RESULTS: Good glycemic control was achieved after 4.8±2.5 days. The mean total daily insulin dose was 31.66±9.85 IU, and the dose per unit body weight was 0.48±0.19 IU/kg/day. The total daily basal and bolus doses were 21.14±7.64 IU and 10.38±3.62 IU, respectively (i.e., about 66.7±6.8% and 33.3±6.8% of the total daily dose). We did not observe any significant difference in total dose of insulin or basal and bolus doses of insulin per day among different groups divided by BMI. Only in the group with BMI of <23 kg/m(2) was the insulin dose of per kilogram of body weight (0.60±0.25 IU/kg/day) significantly higher than in the other two groups (P=0.0001). There was no relationship between the insulin dose and the course of disease. CONCLUSIONS: In individuals with T2DM on CSII short-term intensive therapy, proper increase of basal dose of insulin and preferential adjustment of the basal rate may be the effective method that can achieve good glycemic control with a lower total daily dose.

Gao GQ; Dong QY; Li SJ; Zhang YY; Li WX; Du WH; Liang CG; Wang YL

2011-11-01

123

Effect of Intravenously Administered Fat on Serum Insulin Levels.  

Science.gov (United States)

The effect of the commercial fat emulsion, Intralipid, on serum insulin levels was investigated in 15 baboons. One group received Intralipid alone, another received only heparin and a third group Intralipid and heparin. Intralipid alone or with heparin re...

A. G. Coran P. E. Cryer D. L. Horwitz

1972-01-01

124

Blood pressure, metabolic and autonomic responses to insulin and intralipid® infusion in chagasic patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: Intralipid(®) and heparin infusion results in increased blood pressure and autonomic abnormalities in normal and hypertensive individuals. OBJECTIVE: To evaluate insulin sensitivity and the impact of Intralipid(®) and heparin (ILH) infusion on hemodynamic, metabolic, and autonomic response in patients with the indeterminate form of Chagas' disease. METHODS: Twelve patients with the indeterminate form of Chagas' disease and 12 healthy volunteers were evaluated. RESULTS: Baseline blood pressure and heart rate were similar in both groups. Plasma noradrenaline levels were slightly increased in the Chagas' group. After insulin tolerance testing (ITT), a significant decline was noted in glucose in both groups. ILH infusion resulted in increased blood pressure in both groups, but there was no significant change in plasma noradrenaline. The low-frequency component (LF) was similar and similarly increased in both groups. The high-frequency component (HF) was lower in the Chagas' group. CONCLUSION: Patients with the indeterminate form of Chagas' disease had increased sympathetic activity at baseline and impaired response to insulin. They also had a lower high-frequency component and impaired baroreflex sensitivity at baseline and during Intralipid(®) and heparin infusion.

Silva CC; Santos CA; Mostarda C; Krieger EM; Lopes HF

2012-03-01

125

Development of a Web-based Observational Tool for Detecting Intravenous Medication Errors with Smart Infusion Pumps.  

UK PubMed Central (United Kingdom)

Computerized smart infusion pumps have been widely implemented to decrease the rate of intravenous (IV) medication errors in hospitals. However, these devices have not always achieved their potential, and important IV errors still persist. Findings from a previous study [1] that assessed the frequency of IV medication errors and the impact of smart infusion pumps identified major issues related to use of smart infusion pumps in a single facility, but generalizability of these results is uncertain. Additionally, lack of standardized methodology for measuring these errors remains an issue. In this study, we developed an observational tool to capture IV medication errors through iterative participatory design with interdisciplinary experts and then tested the tool by using incident cases regarding smart pump errors. We found that the tool could capture all smart infusion pump errors and is ready for testing for use as standard data collection tool in different hospital settings.

Ohashi K; Dykes P; McIntosh K; Buckley E; Wien M; Kreitzman K; Dumais M; Bates DW

2013-01-01

126

The pharmacokinetics of cytarabine in dogs when administered via subcutaneous and continuous intravenous infusion routes.  

UK PubMed Central (United Kingdom)

This crossover study compared the pharmacokinetics of cytarabine in six healthy dogs following intravenous constant rate infusion (CRI) and subcutaneous (SC) administrations, as these are two routes of administration commonly employed in the treatment of meningoencephalitis of unknown etiology. Each dog received a SC cytarabine injection of 50 mg/m(2) or an 8 h CRI of 25 mg/m(2) per hour, with a 7-day washout before receiving the alternative treatment. Blood samples were collected for 16 h after CRI initiation and for 8 h after SC injection. Plasma concentrations were measured by high-pressure liquid chromatography (HPLC). Pharmacokinetic parameters were estimated using the best-fit compartmental analysis for both CRI and SC routes. Terminal half-life (T(1/2) ) of cytarabine was 1.35 ± 0.3 and 1.15 ± 0.13 h after SC administration and CRI, respectively. Mean peak concentration (Cmax ) was 2.88 and 2.80 ?g/mL for SC and CRI administration, respectively. Volume of distribution was 0.66 ± 0.07 l/kg. The 8-h CRI produced steady-state plasma concentrations as determined by consecutive measurement that did not decline until the end of the infusion. The SC administration did not achieve steady-state concentrations because cytarabine administered by this route was rapidly absorbed and eliminated quickly. The steady state achieved with the cytarabine CRI may produce a more prolonged exposure of cytarabine at cytotoxic levels in plasma compared to the concentrations after SC administration.

Crook KI; Early PJ; Messenger KM; Muñana KR; Gallagher R; Papich MG

2013-08-01

127

Mammary uptake of fatty acids supplied by intravenous triacylglycerol infusion to lactating dairy cows.  

UK PubMed Central (United Kingdom)

Supplementing dairy cows with n-3 fatty acid-rich feeds does not easily increase quantities in milk fat. Previous results demonstrated very long-chain n-3 fatty acids are primarily transported in the PL fraction of blood, making them largely unavailable to the mammary gland for enrichment of milk fat. Our objective was to compare mammary uptake of fatty acids of increasing chain length and unsaturation delivered intravenously as TAG emulsions. Late lactation dairy cows were assigned to a completely randomized block design. Treatments were intravenous TAG emulsions enriched with oleic acid (OLA), linoleic acid (LNA), alpha-linolenic acid (ALA), or docosahexaenoic acid (DHA) and were delivered continuously at 16 mL/h for 72 h. Each treatment supplied 30 g/day of the target fatty acid. Treatment did not affect feed intake, milk yield, or milk composition, but all treatments reduced intake and yield. The proportion of DHA increased in plasma FFA, TAG, and PL with infusion. Increases of n-3 fatty acids, ALA, EPA, and DHA, were evident in the plasma PL fraction, suggesting re-esterification in the liver. Transfer efficiencies were 37.8 ± 4.1, 27.6 ± 5.4, and 10.9 ± 4.1 %, and day 3 total milk fatty acyl yields were 37.0 ± 3.4, 10.8 ± 0.4, and 3.3 ± 0.3 g for LNA, ALA, and DHA. Variation in oleic acyl yield prevented calculation of OLA transfer efficiency. Mammary uptake of fatty acids was reduced with increased chain length and unsaturation. Both liver and mammary mechanisms may regulate transfer of long-chain polyunsaturates.

Stamey Lanier J; Suagee JK; Becvar O; Corl BA

2013-05-01

128

A 12-month naturalistic observation of three patients receiving repeat intravenous ketamine infusions for their treatment-resistant depression.  

UK PubMed Central (United Kingdom)

BACKGROUND: Acute administration of subanesthestic doses of intravenous ketamine have been shown to elicit a rapid antidepressant response in patients with treatment-resistant depression. However, it remains to be seen if repeated doses over a longer period of time will have the same effects. Here, we assess the long-term efficacy of repeated intravenous ketamine infusions in three patients with high treatment-resistant depression via a naturalistic observation study. METHOD: Three patients consented to intravenous ketamine infusions as a therapy for their treatment-resistant depression. Patients were administered ketamine at 0.5mg/kg of ideal body weight over 40 min followed by a saline flush until discharge. Severity of depressive symptoms was rated with the Montgomery-Asberg Depression Rating Scale. RESULTS: All three patients responded to the ketamine infusions, but each went through an individualized course of treatment based on their own response. LIMITATIONS: This was an open-label naturalistic observation without blinding, randomization, or a placebo control. CONCLUSIONS: These cases add to the literature supporting the therapeutic effect of low-dose repeated intravenous ketamine for patients with treatment-resistant depression. Further study is needed to define the risks, benefits, indications, and contraindications of this potential treatment.

Szymkowicz SM; Finnegan N; Dale RM

2013-05-01

129

Intravenous Suitability Studies of Commonly Used Oxacillin Sodium Solutions in the ACCUFUSER® Infusion Device  

Directory of Open Access Journals (Sweden)

Full Text Available Our study compares two commonly used solutions of oxacillin sodium, 5.0 mg/mL in either 0.9% sodium chloride (NS) or 5% dextrose water (D5W), for their continued suitability for IV usage, and stability of active compound over time, when stored at two different controlled temperatures for six weeks. Both solutions were stored in an intravenous infusion device commercially available as Accufuser® and kept at a continuously maintained temperature of either 4 ± 2?C (CT) or 25 ± 2?C (RT). Suitability for IV administration was assessed by measuring changes in macrographical transparency and pH over time, and drug stability was assessed by measuring changes in oxacillin concentration over time using high-performance liquid chromatography (HPLC). After 6 weeks, concentrations of oxacillin were unchanged in the CT solutions, while both RT solutions showed significant decreases in the concentration of oxacillin after only two weeks. Final concentration compared to starting concentrations after 6 weeks at RT, were 36.57% in NS, while virtually no oxacillin was detectable in D5W. Also pH measurements showed a slight decrement at 2 weeks with RT, and at 6 weeks, there was a significant change in pH in both NS and D5W at RT. There was no significant change in color, transparency or appearance after 6 weeks in any of the oxacillin solutions stored in the Accufuser® infusion device. In summary, two commonly used IV solutions for oxacillin administration(5 mg/mL in NS or D5W) stored ready to use in the Accufuser® showed significant changes over time when maintained at RT, that would make the solutions inappropriate for therapeutic use. Both solutions when maintained in CT were not significantly altered and continued to be appropriate in pH and drug concentration for IV therapy. This suggests that ready-to-use solutions of oxacillin sodium in the Accufuser® infusion device can be kept at CT for up to 6 weeks safely but should not be stored at RT due to loss of potency and changes in pH.

Min-Jeong Kim; Ga-Young Lee; Yoo-Shin Park; Shin-Hee Kim; Sang-Yeon Kim; Mina Kang; Min-Ji Kim; Ju-Seop Kang

2011-01-01

130

Absorption, disposition, metabolic fate, and elimination of the dopamine agonist rotigotine in man: administration by intravenous infusion or transdermal delivery.  

Science.gov (United States)

The dopamine agonist rotigotine was developed for the treatment of Parkinson's disease and restless legs syndrome. Disposition, metabolism, elimination, and absolute bioavailability of rotigotine were determined in six healthy male subjects by using two different forms of administration in a randomized sequence with a crossover design. Treatment A (continuous infusion) consisted of a single radiolabeled 12-h intravenous infusion of 1.2 mg of rotigotine (0.6 mg of [(14)C] and 0.6 mg of unlabeled rotigotine, 3.7 MBq) solution. Treatment B (transdermal application) consisted of a single 10-cm(2) patch containing 4.5 mg of unlabeled rotigotine with a patch-on period of 24 h. During the 12 h-infusion, total radioactivity concentration rapidly increased within 2 h; there was a slight additional increase toward the end of infusion. Plasma concentrations of total radioactivity declined by 75% within 12 h after completion of infusion. More than 94% of the radioactivity was excreted 216 h after the start of infusion, 71% by the kidneys and 23% by feces. Renal elimination of the parent compound was rotigotine was rapidly metabolized. The major rotigotine biotransformation pathway was conjugation of the parent compound, mainly by sulfation; a second pathway was the formation of phase 1 metabolites (N-desalkylation) with subsequent conjugation. Plasma concentration-time profiles of unchanged rotigotine during and after infusion and during and after patch administration were comparable. Absolute bioavailability of transdermally applied rotigotine was 37%. PMID:19608695

Cawello, Willi; Braun, Marina; Boekens, Hilmar

2009-07-16

131

Continuous subcutaneous infusion of insulin lispro in children and adolescents with type 1 diabetes mellitus.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To provide a comprehensive review of insulin lispro administered by continuous subcutaneous insulin infusion (CSII) in children and adolescents. METHODS: We performed PubMed literature searches to identify clinical studies of insulin lispro administered via CSII within pediatric and adolescent populations. RESULTS: Twenty-six studies involving 2521 pediatric patients with type 1 diabetes mellitus met inclusion criteria. Of these, 10 were randomized controlled trials (RCTs), 6 of which compared insulin lispro CSII with multiple daily injection (MDI) therapy. We identified 7 additional prospective, nonrandomized studies and 9 retrospective studies. Within the RCTs, endpoint hemoglobin A1c levels ranged from 6.3% to 8.5% for insulin lispro CSII therapy and from 6.2% to 8.7% for those trials with MDI comparator arms. In those trials that compared insulin lispro CSII with MDI, the endpoint hemoglobin A1c achieved with insulin lispro was similar or improved compared with observations in the MDI treatment arm. In the RCTs, severe hypoglycemia rates of 0.1 to 0.3 episodes/patient per year were reported for insulin lispro CSII therapy; those trials with MDI comparator arms reported relatively similar severe hypoglycemia rates (0.1 to 0.5 episodes/patient per year). Events of diabetic ketoacidosis (DKA) were rare. Where reported, insulin lispro CSII and MDI therapy demonstrated a similar occurrence of DKA and incidence of severe hypoglycemia. Prospective and retrospective studies demonstrated results similar to the RCT findings. CONCLUSIONS: In 26 studies of more than 2500 pediatric and adolescent patients with type 1 diabetes, with more than 1000 patients specifically receiving insulin lispro CSII, insulin lispro CSII therapy consistently demonstrated similar or improved efficacy and safety vs studied comparators.

Kaiserman K; Rodriguez H; Stephenson A; Wolka L; Fahrbach JL

2012-05-01

132

Oral midodrine treatment accelerates the liberation of intensive care unit patients from intravenous vasopressor infusions.  

UK PubMed Central (United Kingdom)

PURPOSE: Persistent low-level hypotension represents a barrier to discharging patients from the intensive care unit (ICU). Midodrine may be an effective adjunct to wean intravenous (IV) vasopressors and permit ICU discharge. We tested the hypothesis that midodrine, given to patients on IV vasopressors who otherwise met ICU discharge criteria, increased the magnitude of change in IV vasopressor rate. MATERIALS AND METHODS: This was a prospective, observational study in 20 adult surgical ICU patients who met ICU discharge criteria except for an IV vasopressor requirement. We compared the change in phenylephrine equivalent rates during the day before midodrine to the change in phenylephrine equivalent rates after midodrine initiation and analyzed changes in total body fluid balance, heart rate, mean arterial pressure, and white blood cell count during this period. RESULTS: Patients received 41.0 ± 33.4 ?g/min of phenylephrine equivalents and the change in IV vasopressor rate (slope) decreased significantly from -0.62 ?g/min per hour of phenylephrine equivalents before midodrine to -2.20 ?g/min per hour following the initiation of midodrine treatment (P = .012). Change in total body fluid balance, heart rate, mean arterial pressure, and white blood cell count did not correlate with change in IV vasopressor rate. CONCLUSION: Midodrine treatment was associated with an increase in the magnitude of decline of the IV vasopressor rate. Oral midodrine may facilitate liberation of surgical ICU patients from an IV vasopressor infusion, and this may affect discharge readiness of patients from the ICU.

Levine AR; Meyer MJ; Bittner EA; Berg S; Kalman R; Stanislaus AB; Ryan C; Ball SA; Eikermann M

2013-10-01

133

Continuous subcutaneous insulin infusion (CSII) of insulin aspart versus multiple daily injection of insulin aspart/insulin glargine in type 1 diabetic patients previously treated with CSII.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Multiple daily injection (MDI) therapy of bolus insulin aspart and basal insulin glargine was compared with continuous subcutaneous insulin infusion (CSII) with aspart in type 1 diabetic patients previously treated with CSII. RESEARCH DESIGN AND METHODS: One hundred patients were enrolled in a randomized, multicenter, open-label, crossover study. After a 1-week run-in period with aspart by CSII, 50 subjects were randomly assigned to MDI therapy (aspart immediately before each meal and glargine at bedtime) and 50 subjects continued CSII. After 5 weeks of the first treatment, subjects crossed over to the alternate treatment for 5 weeks. During the last week of each treatment period, subjects wore a continuous glucose monitoring system for 48-72 h. RESULTS: Mean serum fructosamine levels were significantly lower after CSII therapy than after MDI therapy (343 +/- 47 vs. 355 +/- 50 micromol/l, respectively; P = 0.0001). Continuous glucose monitoring profiles over a 24-h time period showed that glucose exposure was 24 and 40% lower for CSII than MDI as measured by area under the curve (AUC) glucose >/=80 mg/dl (1,270 +/- 742 vs. 1,664 +/- 1,039 mg . h . dl(-1); P < 0.001) and AUC glucose >/=140 mg/dl (464 +/- 452 vs. 777 +/- 746 mg . h . dl(-1), CSII vs. MDI, respectively; P < 0.001). Similar percentages of subjects reported hypoglycemic episodes (CSII: 92%, MDI: 94%) and nocturnal (12:00 a.m. to 8:00 a.m.) hypoglycemic episodes (CSII: 73%, MDI: 72%). Major hypoglycemia was infrequent (CSII: two episodes, MDI: five episodes). CONCLUSIONS: In a trial of short duration, CSII therapy with insulin aspart resulted in lower glycemic exposure without increased risk of hypoglycemia, as compared with MDI with insulin aspart and glargine.

Hirsch IB; Bode BW; Garg S; Lane WS; Sussman A; Hu P; Santiago OM; Kolaczynski JW

2005-03-01

134

A placebo-controlled trial of continuous intravenous diltiazem infusion for 24-hour heart rate control during atrial fibrillation and atrial flutter: a multicenter study.  

UK PubMed Central (United Kingdom)

The safety and efficacy of a 10- to 15-mg/h continuous infusion of intravenous diltiazem were evaluated in 47 patients with atrial fibrillation or flutter who first responded to 20 mg or 20 mg followed by one or more 25-mg bolus doses of open label intravenous diltiazem. Of the 47 patients, 44 responded to the bolus injection and were randomized under double-blind conditions to receive either a continuous infusion of intravenous diltiazem (10 to 15 mg/h) (23 patients) or placebo (21 patients) for up to 24 h. Seventeen (74%) of the 23 patients receiving diltiazem infusion and none of the 21 with placebo infusion maintained a therapeutic response for 24 h (p less than 0.001). Over 24 h, patients receiving diltiazem infusion lost response significantly more slowly than did those receiving placebo infusion (p less than 0.001). Nonresponders to the double-blind infusion were given an additional bolus injection of open label intravenous diltiazem and administered an open label 24-h intravenous diltiazem infusion. The overall proportion of patients maintaining a response to a 24-h infusion of intravenous diltiazem under double-blind or open label conditions combined was 83% (34 of 41). Efficacy of the 24-h infusion of intravenous diltiazem was similar in elderly versus young patients, those who did versus those who did not receive digoxin and those weighing less than 84 versus greater than or equal to 84 kg. However, intravenous diltiazem appeared to be more effective in atrial fibrillation than in atrial flutter. No significant untoward effects were noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Ellenbogen KA; Dias VC; Plumb VJ; Heywood JT; Mirvis DM

1991-10-01

135

A placebo-controlled trial of continuous intravenous diltiazem infusion for 24-hour heart rate control during atrial fibrillation and atrial flutter: a multicenter study.  

Science.gov (United States)

The safety and efficacy of a 10- to 15-mg/h continuous infusion of intravenous diltiazem were evaluated in 47 patients with atrial fibrillation or flutter who first responded to 20 mg or 20 mg followed by one or more 25-mg bolus doses of open label intravenous diltiazem. Of the 47 patients, 44 responded to the bolus injection and were randomized under double-blind conditions to receive either a continuous infusion of intravenous diltiazem (10 to 15 mg/h) (23 patients) or placebo (21 patients) for up to 24 h. Seventeen (74%) of the 23 patients receiving diltiazem infusion and none of the 21 with placebo infusion maintained a therapeutic response for 24 h (p less than 0.001). Over 24 h, patients receiving diltiazem infusion lost response significantly more slowly than did those receiving placebo infusion (p less than 0.001). Nonresponders to the double-blind infusion were given an additional bolus injection of open label intravenous diltiazem and administered an open label 24-h intravenous diltiazem infusion. The overall proportion of patients maintaining a response to a 24-h infusion of intravenous diltiazem under double-blind or open label conditions combined was 83% (34 of 41). Efficacy of the 24-h infusion of intravenous diltiazem was similar in elderly versus young patients, those who did versus those who did not receive digoxin and those weighing less than 84 versus greater than or equal to 84 kg. However, intravenous diltiazem appeared to be more effective in atrial fibrillation than in atrial flutter. No significant untoward effects were noted.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1894861

Ellenbogen, K A; Dias, V C; Plumb, V J; Heywood, J T; Mirvis, D M

1991-10-01

136

A simple intravenous glucose tolerance test for assessment of insulin sensitivity  

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Background: The aim of the study was to find a simple intravenous glucose tolerance test (IVGTT) that can be used to estimate insulin sensitivity. Methods: In 20 healthy volunteers aged between 18 and 51 years (mean, 28) comparisons were made between kinetic parameters derived from a 12-sample, 75-m...

Hahn, Robert; Ljunggren, Stefan; Larsen, Filip; Nystrom, Thomas

137

Lidocaine infusion adjunct to total intravenous anesthesia reduces the total dose of propofol during intraoperative neurophysiological monitoring.  

UK PubMed Central (United Kingdom)

Total intravenous anesthesia (TIVA) with propofol and opioids is frequently utilized for spinal surgery where somatosensory evoked potentials (SSEP) and motor evoked potentials (tcMEP) are monitored. Lidocaine infusions can contribute to antinociception and unconsciousness, thus allowing for a reduction in the total dose of propofol. We examined our recent experience with lidocaine infusions to quantify this effect. After institutional review board approval, we conducted a retrospective review of propofol usage in propofol-opioid TIVA (with and without lidocaine) for spine cases monitored with SSEP and tcMEP over a 7 months period. The propofol infusion rate, cortical amplitudes of the SSEP (median nerve, posterior tibial nerve), amplitudes and stimulation voltage of the tcMEP (adductor pollicis brevis, tibialis anterior) were evaluated. The savings of propofol and sufentanil were estimated based on utilization in 50 milliliter (ml) bottles and 5 ml ampules, respectively. 129 cases were evaluated. Propofol infusion rates were reduced with lidocaine infusion from an average of 115-99 ?g/kg/min (p = 0.00038) and sufentanil infusions from an average of 0.36-0.29 ?g/kg/h (p = 0.0059). This reduction in propofol infusion was also seen when the cases were divided into anterior cervical, posterior cervical, or posterior thoraco-lumbar procedures. No significant differences in the cortical SSEP or tcMEP amplitudes or the tcMEP stimulation voltages used were observed. No complications were associated with the use of the lidocaine infusion. The total estimated drug savings included 104 50 ml bottles of propofol and 5 5 ml ampules of sufentanil. These cases indicate that a lidocaine infusion can be effectively utilized in spine surgery with SSEP and tcMEP monitoring as a means to reduce propofol and sufentanil usage without a negative effect on the monitoring.

Sloan TB; Mongan P; Lyda C; Koht A

2013-08-01

138

Euglycemic Infusion of Insulin Detemir Compared With Human Insulin Appears to Increase Direct Current Brain Potential Response and Reduces Food Intake While Inducing Similar Systemic Effects  

Science.gov (United States)

OBJECTIVE In the treatment of diabetic patients, the long-acting insulin analog insulin detemir is less prone to induce weight gain than other insulin formulations. Assuming that because of its pharmacologic properties, detemir displays stronger central nervous anorexigenic efficacy than human insulin, we compared acute effects of human insulin and detemir on electroencephalography (EEG) measures and food intake. RESEARCH DESIGN AND METHODS Frontocortical EEG direct current (DC) potentials were recorded in 15 healthy men during two hyperinsulinemic-euglycemic clamps that included an insulin bolus injection (human insulin, 17.75 mU/kg body wt; detemir, 90 mU/kg body wt) followed by a steady 90-min infusion (1.0 vs. 2.0 mU · kg?1 · min?1). A higher dosage was chosen for detemir to compensate for its delay in impact relative to human insulin and to elicit similar systemic effects. At 20 min after infusion, subjects were allowed to eat ad libitum from a test buffet. RESULTS Mean glucose infusions to maintain euglycemia (P > 0.93) and blood glucose concentrations (P > 0.34) did not differ between conditions. Detemir infusion induced a negative DC-potential shift, averaging ?372.2 ?V from 21 to 90 min that was not observed during human insulin infusion (146.5 ?V, P = 0.02). Detemir, in comparison with human insulin, reduced subsequent food intake by 303 kcal (1,257 vs. 1,560, P < 0.04). CONCLUSIONS While inducing comparable peripheral effects, detemir exerts stronger acute effects on brain functions than human insulin and triggers a relative decrease in food consumption, suggesting an enhanced anorexigenic impact of detemir compared with human insulin on central nervous networks that control nutrient uptake.

Hallschmid, Manfred; Jauch-Chara, Kamila; Korn, Oliver; Molle, Matthias; Rasch, Bjorn; Born, Jan; Schultes, Bernd; Kern, Werner

2010-01-01

139

Efficacy of intravenous lidocaine to reduce pain and distress associated with propofol infusion in pediatric patients during procedural sedation.  

UK PubMed Central (United Kingdom)

BACKGROUND: Research suggests that young children experience an increased incidence and severity of discomfort during propofol infusion. Evaluations of varied interventions to reduce or eliminate this discomfort with adult subjects suggest that premedication with intravenously administered lidocaine (0.5 mg/kg) offers the best overall effectiveness. OBJECTIVE: Because this regimen's efficacy in a pediatric population is undocumented, we conducted a randomized, double-blind, placebo-controlled study to determine the effectiveness of intravenous lidocaine pretreatment to alleviate pain in pediatric subjects before propofol infusion. METHODS: Subjects (aged 2-7 years) scheduled for painless diagnostic procedures received either a saline placebo or 1 of 2 lidocaine doses before administering propofol. To capture the patient's baseline behavioral state, a trained observer administered the validated face, legs, activity, cry, consolability pain assessment scale before propofol infusion. During deep sedation induction, the sedating physician, a trained research assistant, and the patient's parent documented maximum distress using a 100-mm visual analog scale (VAS). RESULTS: Ninety-one subjects participated. We found no difference in VAS pain scores between groups pretreated with lidocaine 0.25 mg/kg, lidocaine 0.5 mg/kg, and placebo. Statistical analysis also found no interrater differences between parents, physician, or observer VAS scores. CONCLUSIONS: Our data do not support using lidocaine pretreatment to alleviate pain/discomfort in pediatric patients during propofol infusion.

Depue K; Christopher NC; Raed M; Forbes ML; Besunder J; Reed MD

2013-01-01

140

Thallium-201 scintigraphy after intravenous infusion of adenosine compared with exercise thallium testing in the diagnosis of coronary artery disease  

International Nuclear Information System (INIS)

Adenosine is an endogenously produced compound that has significant effects as a coronary and systemic vasodilator. Previous studies suggest that intravenous infusion of adenosine, coupled with thallium-201 scintigraphy, may have specific value as a noninvasive means of evaluating coronary artery disease. The purpose of this study was to compare the diagnostic value of adenosine thallium testing with that of standard exercise thallium testing. One hundred subjects were studied with exercise thallium imaging and thallium imaging after adenosine infusion, including 47 with angiographically proved coronary artery disease and 53 control subjects. The overall sensitivity of the thallium procedures was 81% for the exercise study and 83% for the adenosine study (p = NS); the specificity was 74% for the exercise study and 75% for the adenosine study (p = NS). The diagnostic accuracy of the exercise study was 77% and that of the adenosine study was 79%. Ninety-four percent of subjects had an adverse effect due to the adenosine infusion; however, most of these effects were mild and well tolerated. All adverse effects abated within 30 to 45 s of the termination of the study, consistent with the very brief half-life of the agent. Thus, thallium-201 scintigraphy after intravenous infusion of adenosine has a diagnostic value similar to that of exercise thallium testing for evaluation of coronary artery disease. Adenosine thallium testing may be particularly useful in evaluating patients unable to perform treadmill exercise testing

1991-01-01

 
 
 
 
141

Optimal timing of neutron irradiation for boron neutron capture therapy after intravenous infusion of sodium borocaptate in patients with glioblastoma  

International Nuclear Information System (INIS)

Purpose: A cooperative study in Europe and Japan was conducted to determine the pharmacokinetics and boron uptake of sodium borocaptate (BSH: Na2B12H11SH), which has been introduced clinically as a boron carrier for boron neutron capture therapy in patients with glioblastoma. Methods and Materials: Data from 56 patients with glioblastoma who received BSH intravenous infusion were retrospectively reviewed. The pharmacokinetics were evaluated in 50 patients, and boron uptake was investigated in 47 patients. Patients received BSH doses between 12 and 100 mg/kg of body weight. For the evaluation, the infused boron dose was scaled linearly to 100 mg/kg BSH. Results: In BSH pharmacokinetics, the average value for total body clearance, distribution volume of steady state, and mean residence time was 3.6±1.5 L/h, 223.3±160.7 L, and 68.0±52.5 h, respectively. The average values of the boron concentration in tumor adjusted to 100 mg/kg BSH, the boron concentration in blood adjusted to 100 mg/kg BSH, and the tumor/blood boron concentration ratio were 37.1±35.8 ppm, 35.2±41.8 ppm, and 1.53±1.43, respectively. A good correlation was found between the logarithmic value of Tadj and the interval from BSH infusion to tumor tissue sampling. About 12-19 h after infusion, the actual values for Tadj and tumor/blood boron concentration ratio were 46.2±36.0 ppm and 1.70±1.06, respectively. The dose ratio between tumor and healthy tissue peaked in the same interval. Conclusion: For boron neutron capture therapy using BSH administered by intravenous infusion, this work confirms that neutron irradiation is optimal around 12-19 h after the infusion is started.

2001-09-01

142

Renal haemodynamics, sodium and water reabsorption during continuous intravenous infusion of recombinant interleukin-2  

DEFF Research Database (Denmark)

1. Renal haemodynamics, lithium and sodium clearance were measured in 14 patients treated with recombinant interleukin-2 for metastatic renal cell carcinoma. 2. Patients were studied before and after 72 h of continuous intravenous infusion of recombinant interleukin-2 (18x10(6) i.u..24 h-1.m-2) and 48 h post therapy. Cardiac output was measured by impedance cardiography. Effective renal plasma flow and glomerular filtration rate were determined by the renal clearances of 131I-hippuran and 99mTc-diethylenetriaminepenta-acetic acid (DTPA) respectively. Renal clearance of lithium (CLi) was used as an index of proximal tubular outflow. 3. Treatment caused a transient decrease in mean arterial blood pressure and systemic vascular resistance, but cardiac output remained unchanged. Renal blood flow decreased and renal vascular resistance increased during and after treatment. Sodium clearance decreased from 1.10 (0.63/1.19) ml/min to 0.17 (0.18/0.32) ml/min (P=0.003). Glomerular filtration rate remained unchanged, whereas the median CLi decreased from 26 (17/32) ml/min to 17 (10/21) ml/min (P=0.008). Calculated absolute proximal reabsorption rate of water increased from 63 (40/69) ml/min to 71 (47/82) ml/min (P=0.04). The urinary excretion rate of thromboxane B2 and the ratio between excretion rates of thromboxane B2 and 6-keto-prostaglandin-F1alpha increased by 98% (P=0.022) and 175% (P=0.022) respectively. 4. The study suggests a specific recombinant interleukin-2-induced renal vasoconstrictor effect. Changes in renal prostaglandin synthesis may contribute to the decrease in renal blood flow. The lithium clearance data suggest that an increased proximal tubular reabsorption rate may contribute to the decreased sodium clearance during recombinant interleukin-2 treatment.

Geertsen, P F; von der Maase, H

1998-01-01

143

Use of continuous subcutaneous insulin infusion by a portable insulin pump during pregnancy in women with type 1 diabetes mellitus  

Directory of Open Access Journals (Sweden)

Full Text Available Background/aim: Diabetes mellitus is associated with an increased risk for neonatal morbidity and mortality. One of the most important goals in treating pregnancies complicated with diabetes is keeping glucose level within the normal range, especially in the first trimester. A portable insulin pump for continuous subcutaneous insulin infusion (CSII) represents the best form of therapy for patients with type 1 diabetes mellitus during pregnancy. The aim of our study was to evaluate the effects of therapy with a portable insulin pump for continuous subcutaneous insulin infusion during the first trimester of pregnancy on the quality of glycoregulation and pregnancy outcome in women with type 1 diabetes mellitus. Methods. A total of 17 newly diagnosed pregnant women with type 1 diabetes mellitus were treated with CSII therapy for three months. The parameters of glycoregulation (hemoglobin A, glycosylated - HbA1c, mean blood glucose value in daily profiles - MBG, daily requirement for insulin - IJ/kg BM), lipid levels, blood pressure and renal function were estimated before and after the therapy. These parameters were correlated with parameters of pregnancy outcome: fetal weight, APGAR score, duration of pregnancy. Results. There was a significant improvement in HbA1c (8.94±1.62 vs. 6.90±1.22 %, p < 0.05), MBG (9.23±2.22 vs. 6.41±1.72 mmol/l, p < 0.01), and daily requirement for insulin (0.66±0.22 vs. 0.55±0.13 IJ/kg BM, p < 0.05) during the CSII therapy. There were significant correlations between fetal weight and HbA1c (r = -0.60, p < 0.05), triglyceride levels (r = ?0.63, p < 0.01), and the number of pregnancies (r = ?0.62, p < 0.01), as well as between APGAR score and MBG (r = ?0.52, p < 0.05) and cholesterol levels (r = ?0.65, p < 0,01) before a portable insulin pump was applicated. Conclusions. There was a significant improvement in the quality of glycoregulation during CSII therapy in the pregnant women with type 1 diabetes mellitus. The quality of glycoregulation in the moment of conception was the important factor for pregnancy outcome.

Zori? Svetlana; Mici? Dragan; Kendereški Aleksandra; Šumarac-Dumanovi? Mirjana; Cvijovi? Goran; Pejkovi? Danica; Cvetkovi? Miloš; Ljubi? Aleksandar; Dukanac-Stamenkovi? Jelena

2006-01-01

144

Glucose infusion causes insulin resistance in skeletal muscle of rats without changes in Akt and AS160 phosphorylation.  

UK PubMed Central (United Kingdom)

Hyperglycemia is a defining feature of Type 1 and 2 diabetes. Hyperglycemia also causes insulin resistance, and our group (Kraegen EW, Saha AK, Preston E, Wilks D, Hoy AJ, Cooney GJ, Ruderman NB. Am J Physiol Endocrinol Metab Endocrinol Metab 290: E471-E479, 2006) has recently demonstrated that hyperglycemia generated by glucose infusion results in insulin resistance after 5 h but not after 3 h. The aim of this study was to investigate possible mechanism(s) by which glucose infusion causes insulin resistance in skeletal muscle and in particular to examine whether this was associated with changes in insulin signaling. Hyperglycemia (~10 mM) was produced in cannulated male Wistar rats for up to 5 h. The glucose infusion rate required to maintain this hyperglycemia progressively lessened over 5 h (by 25%, P < 0.0001 at 5 h) without any alteration in plasma insulin levels consistent with the development of insulin resistance. Muscle glucose uptake in vivo (44%; P < 0.05) and glycogen synthesis rate (52%; P < 0.001) were reduced after 5 h compared with after 3 h of infusion. Despite these changes, there was no decrease in the phosphorylation state of multiple insulin signaling intermediates [insulin receptor, Akt, AS160 (Akt substrate of 160 kDa), glycogen synthase kinase-3beta] over the same time course. In isolated soleus strips taken from control or 1- or 5-h glucose-infused animals, insulin-stimulated 2-deoxyglucose transport was similar, but glycogen synthesis was significantly reduced in the 5-h muscle sample (68% vs. 1-h sample; P < 0.001). These results suggest that the reduced muscle glucose uptake in rats after 5 h of acute hyperglycemia is due more to the metabolic effects of excess glycogen storage than to a defect in insulin signaling or glucose transport.

Hoy AJ; Bruce CR; Cederberg A; Turner N; James DE; Cooney GJ; Kraegen EW

2007-11-01

145

Incretin hormone and insulin responses to oral versus intravenous lipid administration in humans  

DEFF Research Database (Denmark)

Context: The incretin effect is responsible for the higher insulin response to oral glucose than to iv glucose at matching glucose levels. It is notknownwhetherthis effect is restricted to glucose only. Objective: The aim of the study was to examine whether insulin and incretin hormone responses are higher after oral vs. iv challenge of a lipid emulsion with matching triglyceride levels in humans. Design, Settings, and Participants: A lipid emulsion (Intralipid) was administered orally (3 ml/kg) or iv (variable infusion rates to match triglyceride levels after oral ingestion) in healthy lean males (n 12) at a University Clinical Research Unit. Samples were collected during 300 min. Main Outcome Measures:Wemeasured the suprabasal area under the curve for insulin, glucagonlike peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and the insulin secretory rate based on C-peptide levels by deconvolution. Results: Triglyceride levels increased similarly after oral and iv lipid; also, glucose and free fatty acid levels were similar in the two tests. Oral lipid elicited a clear insulin and C-peptide response, whereas no insulin or C-peptide responses were observed during iv lipid. Total and intact GIP and GLP-1 levels both increased after oral lipid administration but were not significantly altered after iv lipid. Conclusions: At matching triglyceride levels and with no difference in glucose and free fatty acid levels, oral lipid ingestion but not iv lipid infusion elicits a clear insulin response in association with increased GIP and GLP-1 concentrations. This may suggest that the incretin hormones also contribute to the islet response to noncarbohydrate nutrients.

Lindgren, Ola; Carr, Richard D

2011-01-01

146

The pharmacokinetics and bioavailability of rabeprazole following single intravenous infusion and oral administration in healthy Chinese volunteers  

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Full Text Available To investigate the pharmacokinetics and bioavailability of rabeprazole administrated by intravenous infusion and oral administration in healthy Chinese volunteers. A total of 20 male subjects were recruited and randomly assigned at the beginning of the study to receive a single dose of rabeprazole (20 mg) administrated either intravenously or orally. Following a 7-day washout period, all subjects received another 20mg dose via the alternate route. Intravenous dose was given in constant infusion over 30 min, and the oral dose was given in two 10mg tablets. Intravenous administration yielded the following measurements: the terminal half-life was (62.4±10.7) min; the Cmax was (1308.6±266.4) ng·ml-1; the total body clearance was (0.21±0.05) L·min-1; the AUC0-? and AUC0-? were (99.6±21.9) mg?min?L-1 and (102. 4±23.3) mg?min?L-1, respectively. Oral administration yielded the following measurements: the half-life was (64.2±15.5) min; the Cmax was (508.3±180.2) ng·ml-1; Tmax was attained at about 229.5 min; the total body clearance was (0.31±0.10) L·min-1; the AUC0-? and AUC0-? were (69.5±20.0) mg?min?L-1 and (70.6±20.2) mg?min?L-1, respectively. The bioavailability of rabeprazole was estimated to be 70.1% in healthy Chinese volunteers. The total body clearance after oral administration was significantly higher than that measured following intravenous administration (P <0.01).

Yongqing Wang; Hongwen Zhang; Ling Meng; Nana Tang; Hongyu Yuan; Ning Ou; Haibo Zhang; Dewang Wang; Xiyong Zhang; Ruihua Shi

2010-01-01

147

Toxicity of Guanazole (NSC 1895) Administered by 48-Hour Intravenous Infusions in Dogs.  

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Two dogs were administered 5.0 gm/kg Guanazole, Triazole 3,5-diamino-S (NSC 1895) by 48-hour i.v. infusion followed by an observation period of 183 days and a second infusion of 7.5 gm/kg. Clinical signs were minimal but liver damage was indicated by tran...

P. E. Palm E. P. Arnold P. C. Rachwall C. J. Kensler

1972-01-01

148

Modelling the Effect of Exercise on Insulin Pharmacokinetics in "Continuous Subcutaneous Insulin Infusion" Treated Type 1 Diabetes Patients  

DEFF Research Database (Denmark)

Introduction: The artificial pancreas is believed to ease the burden of constant management of type 1 diabetes for the patients substantially. An important aspect of the artificial pancreas development is the mathematical models used for control, prediction or simulation. A major challenge to the realization of the artificial pancreas is the effect of exercise on the insulin and plasma glucose dynamics. In this report, we take the first step towards a population model of exercise effects in type 1 diabetes. We focus on the effect on the insulin pharmacokinetics in continuous subcutaneous insulin infusion (CSII) treated patients by modelling the absorption rate as a function of exercise. Methods: Three models are estimated from 17 data sequences. All of them are based on a linear three-compartment base model. The models are based on stochastic differential equations to allow noise to enter the dynamics. In the first model, the insulin absorption rate parameter is replaced by a random walk. In the second model, the relationship between the absorption rate and exercise is modelled as a linear dependency, while in the third model this linear relationship depends on the intensity. A Lamperti transformation is used to ensure non-negative state values. A special focus is put on the structural identiflability of the base model, while the posterior identiflability is checked for all models from the conditional likelihood profiles. Results: The first model is disregarded due to the small number of observations during the exercise bout. From likelihood-ratio tests and information criteria, the third model is appointed as the best model to model the relationship between exercise and the insulin absorption. The posterior identiflability check showed that it was not possible to identify the variance of the measurement variance. Conclusion: A model to predict the insulin appearance in plasma during exercise in CSII treated patients is identified. Further clinical studies are needed to confirm the increase in insulin plasma concentration during exercise in type 1 diabetes patients. These studies should include dense sampling to allow for a fully data driven identification of an appropriate model.

Duun-Henriksen, Anne Katrine; Juhl, Rune

2013-01-01

149

Serum insulin and growth hormone responses to arginine infusion before and during treatment with contraceptive steroids.  

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To determine the responses of plasma glucose, serum growth hormone (HGH), and serum insulin to arginine infusion before and during cyclic administration of 100 mcg ethinyl estradiol 3-methyl ether (mestranol) plus 1 mg ethynodiol diacetate (Ovulen) 12 young, healthy, nonobese women (at least 6 weeks postpartum with no family or obstetric history suggestive of diabetes) were observed. The mean cumulative glucose was unchanged, while the mean cumulative insulin (p less than .05 at 30 minutes) and HGH increased (p less than .05 at 30 minutes and p less than .01 at 120 minutes) during 2 hour tests. These data indicate that contraceptive steroids induced a peripheral antiinsulin effect which may be due to increased HGH secretion. A direct antiinsulin action or insulinogenic effect of steroids remains to be determined. PMID:12332173

Vela, P; Yen, S S

1969-09-01

150

Vasoactive intestinal peptide and secretin: effects of combined and separate intravenous infusions on bile secretion in man  

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The effects of intravenously administered vasoactive intestinal peptide (VIP) and secretin on bile secretion were studied in 12 patients with complete biliary fistulas. The two peptides were administered both simultaneously and separately. During VIP infusion, bile volume increased by 60%, and during the combined VIP and secretin infursion bile volume increased by another 70%. VIP increased bile bicarbonate concentration by some 30%. Although secretin did not increase the concentration, bicarbonate output increased threefold during secretin infusion but only twofold during VIP infusion. The outputs of bile acids were not significantly affected by the two peptides, whereas the concentration decreased by 40% and 70% after VIP and secretin, respectively. The canalicular bile flow, measured by [14C]erythritol, was unaffected by VIP infusion, whereas secretin alone and the combination of the two peptides increased the canalicular clearance by 80%. The choleretic effect of VIP thus seems to occur only at the ductular level. Secretin exerts its effect at the ductular level and possibly also at the canalicular level. It is concluded that the two peptides have additive effects on the ductular bile flow.. 32 refs., 5 figs., 5 tabs.

1991-01-01

151

Vasoactive intestinal peptide and secretin: effects of combined and separate intravenous infusions on bile secretion in man  

Energy Technology Data Exchange (ETDEWEB)

The effects of intravenously administered vasoactive intestinal peptide (VIP) and secretin on bile secretion were studied in 12 patients with complete biliary fistulas. The two peptides were administered both simultaneously and separately. During VIP infusion, bile volume increased by 60%, and during the combined VIP and secretin infursion bile volume increased by another 70%. VIP increased bile bicarbonate concentration by some 30%. Although secretin did not increase the concentration, bicarbonate output increased threefold during secretin infusion but only twofold during VIP infusion. The outputs of bile acids were not significantly affected by the two peptides, whereas the concentration decreased by 40% and 70% after VIP and secretin, respectively. The canalicular bile flow, measured by ({sup 14}C)erythritol, was unaffected by VIP infusion, whereas secretin alone and the combination of the two peptides increased the canalicular clearance by 80%. The choleretic effect of VIP thus seems to occur only at the ductular level. Secretin exerts its effect at the ductular level and possibly also at the canalicular level. It is concluded that the two peptides have additive effects on the ductular bile flow.. 32 refs., 5 figs., 5 tabs.

Nyberg, B.; Sonnenfeld, T.; Einarsson, K. (Karolinska Inst., Stockholm (Sweden))

1991-01-01

152

Central infusion of ketone bodies modulates body weight and hepatic insulin sensitivity by modifying hypothalamic leptin and insulin signaling pathways in type 2 diabetic rats.  

UK PubMed Central (United Kingdom)

Although the effects of ketogenic diets on energy and glucose homeostasis have been controversial, elevation of serum ketone levels by subcutaneous injection of ?-hydroxybutyrate (BHB) can improve glucose homeostasis. Ketones may work through the brain; therefore, we evaluated whether the intracerebroventricular (ICV) infusion of ?-hydroxybutyrates would also modulate peripheral energy and glucose homeostasis, and through what mechanisms, in diabetic rats fed a high fat diet in short- and long-term studies. Short-term (3h) central injection of BHB (50 ?g/h) improved serum glucose levels and peripheral insulin sensitivity compared to the artificial cerebrospinal fluid (CSF) group among 90% pancreatectomized (Px) diabetic rats, but not in non-diabetic Sham rats. In addition to short-term infusion, long-term (28 days) central infusion of BHB (12 ?g/h) elevated serum BHB levels. Long-term infusion of BHB potentiated leptin and insulin signaling in the hypothalamus to slightly decrease body weight in Px rats. Central BHB infusion had a greater effect on peripheral glucose metabolism than overall energy metabolism. Hepatic insulin signaling (tyrosine phosphorylation of IRS2?serine phosphorylation of Akt?reduced expression of PEPCK) was potentiated and hepatic glucose production in the hyperinsulinemic state was suppressed in the diabetic rats. In addition, glucose tolerance was improved by central BHB infusion through enhanced whole body glucose disposal rates, but insulin secretion was not affected in the diabetic rats. In conclusion, mild ketosis by central infusion of ketones improves energy and glucose metabolism through the potentiation of leptin and insulin signaling in the hypothalamus of diabetic rats.

Park S; Kim da S; Daily JW

2011-07-01

153

Central infusion of ketone bodies modulates body weight and hepatic insulin sensitivity by modifying hypothalamic leptin and insulin signaling pathways in type 2 diabetic rats.  

Science.gov (United States)

Although the effects of ketogenic diets on energy and glucose homeostasis have been controversial, elevation of serum ketone levels by subcutaneous injection of ?-hydroxybutyrate (BHB) can improve glucose homeostasis. Ketones may work through the brain; therefore, we evaluated whether the intracerebroventricular (ICV) infusion of ?-hydroxybutyrates would also modulate peripheral energy and glucose homeostasis, and through what mechanisms, in diabetic rats fed a high fat diet in short- and long-term studies. Short-term (3h) central injection of BHB (50 ?g/h) improved serum glucose levels and peripheral insulin sensitivity compared to the artificial cerebrospinal fluid (CSF) group among 90% pancreatectomized (Px) diabetic rats, but not in non-diabetic Sham rats. In addition to short-term infusion, long-term (28 days) central infusion of BHB (12 ?g/h) elevated serum BHB levels. Long-term infusion of BHB potentiated leptin and insulin signaling in the hypothalamus to slightly decrease body weight in Px rats. Central BHB infusion had a greater effect on peripheral glucose metabolism than overall energy metabolism. Hepatic insulin signaling (tyrosine phosphorylation of IRS2?serine phosphorylation of Akt?reduced expression of PEPCK) was potentiated and hepatic glucose production in the hyperinsulinemic state was suppressed in the diabetic rats. In addition, glucose tolerance was improved by central BHB infusion through enhanced whole body glucose disposal rates, but insulin secretion was not affected in the diabetic rats. In conclusion, mild ketosis by central infusion of ketones improves energy and glucose metabolism through the potentiation of leptin and insulin signaling in the hypothalamus of diabetic rats. PMID:21652033

Park, Sunmin; Kim, Da Sol; Daily, James W

2011-05-24

154

Systemic, pulmonary and renal haemodynamic and renal morphologic effects of intravenously infused iodixanol; A study in the pig of a new iso-osmolar contrast medium  

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The systemic, pulmonary and renal haemodynamic effects following an intravenous infusion (1 ml/s, 4 ml/kg) of a non-ionic isoosmolar contrast medium (iodixanol) were investigated in 8 pigs. Histopathologic changes occurring after infusion of iodixanol were studied by repeated renal biopsies. Iodixanol caused a significant increase of cardiac output, mean right atrial pressure, mean pulmonary arterial pressure, mean pulmonary arterial occlusion pressure and mean arterial pressure. There was a decrease of the systemic and pulmonary vascular resistances. Most renal biopsies showed no pathologic findings after infusion of iodixanol but in 3 specimens proteinaceous content was observed 15 min after infusion. (orig.).

Sunnegaardh, O.; Hietala, S.O.; Holtz, E. (Umeaa Univ. Hospital (Sweden). Dept. of Diagnostic Radiology Nycomed A/S, Oslo (Norway). Dept. of Pharmacology and Toxicology)

1990-09-01

155

Impaired prolactin response to arginine infusion and insulin hypoglycaemia in chronic renal failure.  

UK PubMed Central (United Kingdom)

The elevated level of circulating prolactin present in the majority of uraemic patients on chronic haemodialysis is primarily due to hypothalamic pituitary dysfunction. So far this defect has been illustrated by demonstration of a blunted prolactin response to TRH and failure of L-dopa to suppress prolactin levels. In the present study two powerful prolactin and growth hormone stimuli, namely iv arginine infusion and insulin hypoglycaemia were applied in a group of uraemic patients on chronic haemodialysis and in age matched control subjects. The prolactin increments to arginine infusion (4.4 +/- 1.2 ng/ml vs 17.6 +/- 4.6 ng/ml, mean +/- SE) and to insulin hypoglycaemia (7.9 +/- 1.7 ng/ml vs 31.5 +/- 5.4 ng/ml) were significantly suppressed in the uraemic patients compared to the controls (P less than 0.05). In contradistinction the growth hormone rise provoked by the tests were similar in the two groups. Our results provide further insight into the hypothalamic pituitary derangement in uraemic patients and confirm the presumption of an insensitivity of the lactotrophs to stimulation in uraemic patients.

Schmitz O; Møller J

1983-04-01

156

Pavlovian conditioned approach, extinction, and spontaneous recovery to an audiovisual cue paired with an intravenous heroin infusion.  

UK PubMed Central (United Kingdom)

RATIONALE: Novel stimuli paired with exposure to addictive drugs can elicit approach through Pavlovian learning. While such approach behavior, or sign tracking, has been documented for cocaine and alcohol, it has not been shown to occur with opiate drugs like heroin. Most Pavlovian conditioned approach paradigms use an operandum as the sign, so that sign tracking can be easily automated. OBJECTIVES: We were interested in assessing whether approach behavior occurs to an audiovisual cue paired with an intravenous heroin infusion. If so, would this behavior exhibit characteristics of other Pavlovian conditioned behaviors, such as extinction and spontaneous recovery? METHODS: Rats were repeatedly exposed to an audiovisual cue, similar to that used in standard self-administration models, along with an intravenous heroin infusion. Sign tracking was measured in an automated fashion by analyzing motion pixels within the cue zone during each cue presentation. RESULTS: We were able to observe significant sign tracking after only five pairings of the conditioned stimulus (CS) with the unconditioned stimulus (US). This behavior rapidly extinguished over 2 days, but exhibited pronounced spontaneous recovery 3 weeks later. CONCLUSIONS: We conclude that sign tracking measured by these methods exhibits all the characteristics of a classically conditioned behavior. This model can be used to examine the Pavlovian component of drug memories, alone, or in combination with self-administration methods.

Peters J; De Vries TJ

2013-09-01

157

Evidence-based guideline for neuropathic pain interventional treatments: spinal cord stimulation, intravenous infusions, epidural injections and nerve blocks.  

UK PubMed Central (United Kingdom)

BACKGROUND: The Special Interest Group of the Canadian Pain Society has produced consensus-based guidelines for the pharmacological management of neuropathic pain. The society aimed to generate an additional guideline for other forms of neuropathic pain treatments. OBJECTIVE: To develop evidence-based recommendations for neuropathic pain interventional treatments. METHODS: A task force was created and engaged the Institute of Health Economics in Edmonton, Alberta, to survey the literature pertaining to multiple treatments. Sufficient literature existed on four interventions only: spinal cord stimulation; epidural injections; intravenous infusions; and nerve blocks. A comprehensive search was conducted for systematic reviews, randomized controlled trials and evidence-based clinical practice guidelines; a critical review was generated on each topic. A modified United States Preventive Services Task Force tool was used for quality rating and grading of recommendations. RESULTS: Investigators reviewed four studies of spinal cord stimulation, 19 studies of intravenous infusions, 14 studies of epidural injections and 16 studies of nerve blocks that met the inclusion criteria. The task force chairs rated the quality of evidence and graded the recommendations. Feedback was solicited from the members of the task force. CONCLUSION: There is sufficient evidence to support recommendations for some of these interventions for selected neuropathic pain conditions. This evidence is, at best, moderate and is often limited or conflicting. Pain practitioners are encouraged to explore evidence-based treatment options before considering unproven treatments. Full disclosure of risks and benefits of the available options is necessary for shared decision making and informed consent.

Mailis A; Taenzer P

2012-05-01

158

Pharmacokinetics and postprandial glycemic excursions following insulin lispro delivered by intradermal microneedle or subcutaneous infusion.  

UK PubMed Central (United Kingdom)

BACKGROUND: Intradermal (ID) delivery has been shown to accelerate insulin pharmacokinetics (PK). We compared the PK and pharmacodynamic (PD) effects of insulin lispro administered before two daily standardized solid mixed meals (breakfast and lunch), using microneedle-based ID or traditional subcutaneous (SC) delivery. METHOD: The study included 22 subjects with type 1 diabetes in an eight-arm full crossover block design. One arm established each subject's optimal meal dose. In six additional arms, the optimal, higher, and lower doses (+30%, -30%) were each given ID and SC delivery, in random order. The final arm assessed earlier timing for the ID optimal dose (-12 versus -2 min). The PK/PD data were collected for 6 h following meals. Intravenous basal regular insulin was given throughout, and premeal blood glucose (BG) adjusted to 115 mg/dl. RESULTS: The primary end point, postprandial time in range (70-180 mg/dl), showed no route-based differences with a high level of overall BG control for both SC and ID delivery. Secondary insulin PK end points showed more rapid ID availability versus SC across doses and meals (?Tmax -16 min, ?T50rising -7 min, ?T50falling -30 min, all p < .05). Both intrasubject and intersubject variability for ID Tmax were significantly lower. Intradermal delivery showed modest, statistically significant secondary PD differences across doses and meals, generally within 90-120 min postprandially (?12 mg/dl BG at 90 min, ?7 mg/dl BGmax, ?7 mg/dl mean BG 0-2 h, all p < .05). CONCLUSIONS: This study indicates that ID insulin delivery is superior to SC delivery in speed of systemic availability and PK consistency and may improve postprandial glucose control.

McVey E; Hirsch L; Sutter DE; Kapitza C; Dellweg S; Clair J; Rebrin K; Judge K; Pettis RJ

2012-07-01

159

Short-lasting systemic and regional benefits of early crystalloid infusion after intravenous inoculation of dogs with live Escherichia coli  

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Full Text Available We investigated the systemic and regional hemodynamic effects of early crystalloid infusion in an experimental model of septic shock induced by intravenous inoculation with live Escherichia coli. Anesthetized dogs received an intravenous infusion of 1.2 x 10(10) cfu/kg live E. coli in 30 min. After 30 min of observation, they were randomized to controls (no fluids; N = 7), or fluid resuscitation with lactated Ringer's solution, 16 ml/kg (N = 7) or 32 ml/kg (N = 7) over 30 min and followed for 120 min. Cardiac index, portal blood flow, mean arterial pressure, systemic and regional oxygen-derived variables, blood lactate, and gastric PCO2 were assessed. Rapid and progressive cardiovascular deterioration with reduction in cardiac output, mean arterial pressure and portal blood flow (~50, ~25 and ~70%, respectively) was induced by the live bacteria challenge. Systemic and regional territories showed significant increases in oxygen extraction and in lactate levels. Significant increases in venous-arterial (~9.6 mmHg), portal-arterial (~12.1 mmHg) and gastric mucosal-arterial (~18.4 mmHg) PCO2 gradients were also observed. Early fluid replacement, especially with 32 ml/kg volumes of crystalloids, promoted only partial and transient benefits such as increases of ~76% in cardiac index, of ~50% in portal vein blood flow and decreases in venous-arterial, portal-arterial, gastric mucosal-arterial PCO2 gradients (7.2 ± 1.0, 7.2 ± 1.3 and 9.7 ± 2.5 mmHg, respectively). The fluid infusion promoted only modest and transient benefits, unable to restore the systemic and regional perfusional and metabolic changes in this hypodynamic septic shock model.

A.G. Garrido; L.F. Poli de Figueiredo; R.J. Cruz Jr.; E. Silva; M. Rocha e Silva

2005-01-01

160

Short-lasting systemic and regional benefits of early crystalloid infusion after intravenous inoculation of dogs with live Escherichia coli  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english We investigated the systemic and regional hemodynamic effects of early crystalloid infusion in an experimental model of septic shock induced by intravenous inoculation with live Escherichia coli. Anesthetized dogs received an intravenous infusion of 1.2 x 10(10) cfu/kg live E. coli in 30 min. After 30 min of observation, they were randomized to controls (no fluids; N = 7), or fluid resuscitation with lactated Ringer's solution, 16 ml/kg (N = 7) or 32 ml/kg (N = 7) over 30 (more) min and followed for 120 min. Cardiac index, portal blood flow, mean arterial pressure, systemic and regional oxygen-derived variables, blood lactate, and gastric PCO2 were assessed. Rapid and progressive cardiovascular deterioration with reduction in cardiac output, mean arterial pressure and portal blood flow (~50, ~25 and ~70%, respectively) was induced by the live bacteria challenge. Systemic and regional territories showed significant increases in oxygen extraction and in lactate levels. Significant increases in venous-arterial (~9.6 mmHg), portal-arterial (~12.1 mmHg) and gastric mucosal-arterial (~18.4 mmHg) PCO2 gradients were also observed. Early fluid replacement, especially with 32 ml/kg volumes of crystalloids, promoted only partial and transient benefits such as increases of ~76% in cardiac index, of ~50% in portal vein blood flow and decreases in venous-arterial, portal-arterial, gastric mucosal-arterial PCO2 gradients (7.2 ± 1.0, 7.2 ± 1.3 and 9.7 ± 2.5 mmHg, respectively). The fluid infusion promoted only modest and transient benefits, unable to restore the systemic and regional perfusional and metabolic changes in this hypodynamic septic shock model.

Garrido, A.G.; Poli de Figueiredo, L.F.; Cruz Jr., R.J.; Silva, E.; Rocha e Silva, M.

2005-06-01

 
 
 
 
161

Effects of equine metabolic syndrome on inflammatory responses of horses to intravenous lipopolysaccharide infusion.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To test the hypothesis that inflammatory responses to endotoxemia differ between healthy horses and horses with equine metabolic syndrome (EMS). Animals-6 healthy horses and 6 horses with EMS. PROCEDURES: Each horse randomly received an IV infusion of lipopolysaccharide (20 ng/kg [in 60 mL of sterile saline {0.9% NaCl} solution]) or saline solution, followed by the other treatment after a 7-day washout period. Baseline data were obtained 30 minutes before each infusion. After infusion, a physical examination was performed hourly for 9 hours and at 15 and 21 hours; a whole blood sample was collected at 30, 60, 90, 120, 180, and 240 minutes for assessment of inflammatory cytokine gene expression. Liver biopsy was performed between 240 and 360 minutes after infusion. Results-Following lipopolysaccharide infusion in healthy horses and horses with EMS, mean rectal temperature, heart rate, and respiratory rate increased, compared with baseline findings, as did whole blood gene expression of interleukin (IL)-1?, IL-6, IL-8, IL-10, and tumor necrosis factor-?. The magnitude of blood cytokine responses did not differ between groups, but increased expression of IL-6, IL-8, IL-10, and tumor necrosis factor-? persisted for longer periods in EMS-affected horses. Lipopolysaccharide infusion increased liver tissue gene expressions of IL-6 in healthy horses and IL-8 in both healthy and EMS-affected horses, but these gene expressions did not differ between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results supported the hypothesis that EMS affects horses' inflammatory responses to endotoxin by prolonging cytokine expression in circulating leukocytes. These findings are relevant to the association between obesity and laminitis in horses with EMS.

Tadros EM; Frank N; Donnell RL

2013-07-01

162

Evaluation of the Effect of Intravenous Lidocaein Infusion on Postoperative Analgesia after Cesarean Section under Spinal Anesthesia  

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Full Text Available Introduction & Objective: Many surgical patients still experience moderate to severe pain after surgery despite efforts to administer new drugs and techniques. Postoperative analgesia clearly enhances patient’s satisfaction and facilitates earlier mobilization and rehabilitation. lidocaein has been introduced as part of post operative pain management and clinical studies revealed analgesic actions in patients with chronic neuropathic pain. Our goal in this study was to determine the effect of intravenous lidocaein on post operative pain of women under-going cesarean section under spinal anesthesia. Materials & Methods: In this double blinded clinical trial study, 72 patients candidate for Ce-sarean section under spinal anesthesia were randomly selected and divided in two groups. In the case group, infusion of1.5 mg/kg lidocaein and in the control group infusion of the same volume normal saline started 15 minutes before the beginning of operation. After spinal anes-thesia with definite technique in both groups, infusion of 1.5 mg/kg/h lidocaein in case group and the same volume normal saline in the control group was administered and continued till 0.5 hour after finishing the operation. Data including systolic and diastolic blood pressure, heart rate, analgesic score according VAS and using of analgesic drugs were recorded during 24 hours after the operation. Results: Pain intensity according to VAS score in the time 2,6,12 hours post operation were significantly lower in the case group ( P2= 0.05, P6 = 0.01, P12= 0.05) .Analgesic consumption in form of suppository & IV,24 hours after surgery, was significantly lower in the case group.(P=0.001). Conclusion: Lidocaein infusion can decrease pain intensity & analgesic consumption after ce-sarean section under spinal anesthesia. (Sci J Hamadan Univ Med Sci 2013; 20 (1):9-14)

M. H. Bakhshaei; M. Davoudi; A. Amini

2013-01-01

163

A simple intravenous glucose tolerance test for assessment of insulin sensitivity  

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Full Text Available Abstract Background The aim of the study was to find a simple intravenous glucose tolerance test (IVGTT) that can be used to estimate insulin sensitivity. Methods In 20 healthy volunteers aged between 18 and 51 years (mean, 28) comparisons were made between kinetic parameters derived from a 12-sample, 75-min IVGTT and the Mbw (glucose uptake) obtained during a hyperinsulinemic euglycemic glucose clamp. Plasma glucose was used to calculate the volume of distribution (Vd) and the clearance (CL) of the injected glucose bolus. The plasma insulin response was quantified by the area under the curve (AUCins). Uptake of glucose during the clamp was corrected for body weight (Mbw). Results There was a 7-fold variation in Mbw. Algorithms based on the slope of the glucose-elimination curve (CL/Vd) in combination with AUCins obtained during the IVGTT showed statistically significant correlations with Mbw, the linearity being r2 = 0.63-0.83. The best algorithms were associated with a 25-75th prediction error ranging from -10% to +10%. Sampling could be shortened to 30-40 min without loss of linearity or precision. Conclusion Simple measures of glucose and insulin kinetics during an IVGTT can predict between 2/3 and 4/5 of the insulin sensitivity.

Hahn Robert G; Ljunggren Stefan; Larsen Filip; Nyström Thomas

2011-01-01

164

Early detection of liver steatosis by magnetic resonance imaging in rats infused with glucose and Intralipid solutions and correlation to insulin levels.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Magnetic resonance (MR) techniques allow noninvasive fat quantification. We aimed to investigate the accuracy of MR imaging (MRI), MR spectroscopy (MRS) and histological techniques to detect early-onset liver steatosis in three rat phenotypes assigned to an experimental glucolipotoxic model or a control group. MATERIALS AND METHODS: This study was approved by the institutional committee for the protection of animals. Thirty-two rats (13 young Wistar, 6 old Wistar and 13 diabetic Goto-Kakizaki rats) fed a standard diet were assigned to a 72h intravenous infusion of glucose and Intralipid fat emulsion or a saline infusion. Plasma insulin levels were measured. Steatosis was quantified in ex vivo livers with gradient-recalled multi-echo MRI, MRS and histology as fat fractions (FF). RESULTS: A significant correlation was found between multi-echo MRI-FF and MRS-FF (r=0.81, p<0.01) and a weaker correlation was found between histology and MRS-FF (r=0.60, p<0.01). MRS and MRI accurately distinguished young Wistar and Goto-Kakizaki rats receiving the glucose+Intralipid infusion from those receiving the saline control whereas histology did not. Significant correlations were found between MRI or MRS and insulin plasma level (r=0.63, p<0.01; r=0.57, p<0.01), and between MRI or MRS and C-peptide concentration (r=0.54, p<0.01; r=0.44, p<0.02). CONCLUSIONS: Multi-echo MRI and MRS may be more sensitive to measure early-onset liver steatosis than histology in an experimental glucolipotoxic rat model.

d'Assignies G; Fontés G; Kauffmann C; Latour M; Gaboury L; Boulanger Y; Van Beers BE; Soulez G; Poitout V; Tang A

2013-09-01

165

Comparison of the pharmacokinetics of three concentrations of insulin aspart during continuous subcutaneous insulin infusion (CSII) in a pig model.  

UK PubMed Central (United Kingdom)

OBJECTIVES: The aim of the study was to investigate the pharmacokinetic properties of insulin aspart (IAsp) in three different concentrations given as a continuous subcutaneous insulin infusion (CSII). METHODS: A randomized cross-over study was performed in pigs, where IAsp U200, U100 or U20 was given for 8?h with the same total dose. Six pigs were included and blood was sampled during the CSII and 3?h after. KEY FINDINGS: The half-life (t(1/2) ) was 24.3 (range 17.3-41.3), 28.8 (range 19.6-54.3) and 23.6 (range 17.4-36.8)?min for U200, U100 and U20, respectively. The area under the curve per dose (AUC/D) was determined to be 51.2?±?19.5, 52.3?±?12.5 and 51.6?±?6.7?pm?×?min/kg for U200, U100 and U20, respectively. The steady state plasma concentration (C(ss) ) was 57.5?±?27.1, 54.3?±?10.3 and 55.1?±?8.0?pm (mean?±?SD) for U200, U100 and U20, respectively. Time to steady state (T(ss) ) was 110?±?36, 98?±?48 and 90?±?27?min for U200, U100 and U20, respectively. CONCLUSIONS: In conclusion, no significant difference was found in t(1/2) , AUC/D, C(ss) or T(ss) between the three IAsp concentrations when given at a basal rate in CSII.

Petersen SB; Nielsen FS; Ribel U; Sturis J; Skyggebjerg O

2013-02-01

166

Alfaxalone and medetomidine intravenous infusion to maintain anaesthesia in colts undergoing field castration.  

UK PubMed Central (United Kingdom)

REASONS FOR PERFORMING THE STUDY: The use of alfaxalone and medetomidine administered as an i.v. infusion to maintain anaesthesia has not previously been reported in the horse. OBJECTIVES: To investigate the use of alfaxalone in hydroxpropyl-beta-cyclodextrin (Alfaxan) and medetomidine infusion as a field anaesthetic for short-term surgical procedures in the horse. HYPOTHESIS: Alfaxalone-medetomidine anaesthesia is suitable for short-term field anaesthesia in horses. METHODS: Eleven healthy colts underwent 45?min of anaesthesia with an i.v. infusion of alfaxalone (2?mg/kg bwt/h) and medetomidine (5??g/kg bwt/h) for routine field castration. Horses were premedicated with i.v. acepromazine (0.03?mg/kg bwt), medetomidine (7??g/kg bwt) and guaiphenesin (35?mg/kg bwt) before i.v. induction with alfaxalone (1?mg/kg bwt). Colts were intubated with an endotracheal tube and 100% oxygen insufflated at 10?l/min. The physiological variables monitored included pulse rate, respiratory rate, direct arterial blood pressure, arterial blood gases and the quality of the inductions and recoveries were scored. RESULTS: Overall, the anaesthetic period and surgical conditions were acceptable and the quality of the anaesthetic inductions and recoveries was good to excellent. All colts stood on their first attempt (mean ± s.d.) 37 ± 13.5?min after the infusion was stopped. During anaesthesia, cardiopulmonary data, presented as range of mean values at each time point were: heart rate: 45-47 beats/min; mean blood pressure: 104-112?mmHg; respiratory rate: 8 breaths/min; PaO2 : 117-172?mmHg; PaCO2 : 50-56?mmHg and pH?7.34-7.37. CONCLUSIONS AND POTENTIAL RELEVANCE: The co-administration of alfaxalone and medetomidine as an i.v. infusion after anaesthetic induction with alfaxalone was suitable for short-term field anaesthesia in the horse.

Goodwin WA; Keates HL; Pearson M; Pasloske K

2013-05-01

167

Effect of perioperative insulin infusion on surgical morbidity and mortality: systematic review and meta-analysis of randomized trials.7  

DEFF Research Database (Denmark)

OBJECTIVE: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of perioperative insulin infusion on outcomes important to patients. PATIENTS AND METHODS: We used 6 search strategies including an electronic database search of MEDLINE, EMBASE, and Cochrane CENTRAL, from their inception up to May 1, 2006, and included RCTs of perioperative insulin infusion (with or without glucose targets) measuring outcomes in patients undergoing any surgery. Pairs of reviewers working independently assessed the methodological quality and characteristics of included trials and abstracted data on perioperative outcomes (ie, outcomes that occurred during hospitalization or within 30 days of surgery). RESULTS: We identified 34 eligible trials. In the 14 trials that assessed mortality, there were 68 deaths among 2192 patients randomized to insulin infusion compared with 98 deaths among 2163 patients randomized to control therapy (random-effects pooled relative risk, 0.69; 95% confidence interval [CI], 0.51-0.94; 99% CI, 0.46-1.04; I2, 0%; 95% CI, 0.0%-47.4%). Hypoglycemia increased in the intensively treated group (20 trials, 119/1470 patients in insulin infusion vs 48/1476 patients in control group; relative risk, 2.07; 95% CI, 1.29-3.32; 99% CI, 1.09-3.88; I2, 31.5%; 95% CI, 0.0%-59.0%). No significant effect was seen in any other outcomes. The available mortality data represent only 40% of the optimal information size required to reliably detect a plausible treatment effect; potential methodological and reporting biases weaken inferences. CONCLUSION: Perioperative insulin infusion may reduce mortality but increases hypoglycemia in patients who are undergoing surgery; however, mortality results require confirmation in large and rigorous RCTs Udgivelsesdato: 2008/4

Gandhi, G.Y.; Murad, M.H.

2008-01-01

168

Effect of intravenous drip infusion of cyclophosphamide with high-dose Astragalus injection in treating lupus nephritis  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: To observe the effect of high-dose Astragalus injection and cyclophosphamide (CTX) on infection, urine protein and immune function of the patients with lupus nephritis.Methods: Forty-three patients diagnosed as systemic lupus erythematosus (SLE) complicated by kidney damage and qi-deficiency syndrome were randomly divided into trial group (n=23) and control group (n=20). Patients in both groups were treated for 3 months. Intravenous drip infusion of 0.8 g CTX was administered to all patients once a month, while intravenous drip infusion of 20 ml Astragalus injection was only administered to patients in the trial group every day for 12 days in each month.Results: The decrease of active clinical symptom score after the treatment in the trial group was greater than that in the control group (P<0.05). The infection rates of the trial group and the control group were 4.35% and 25% respectively. The decrease of 24-hour urine protein and CD8, and the increase of red blood cell count and serum albumin in the trial group were greater than those in the control group, and there were significant differences between the two groups (P<0.05). White blood cell count in the trial group was decreased less than that in the control group after the treatment (P<0.05).Conclusion: High-dose Astragalus injection used together with CTX is more effective than CTX alone in decreasing infection rate and urine protein and improving immune function for patients with lupus nephritis.

Li SU

2007-01-01

169

Economic benefits of subcutaneous rapid push versus intravenous immunoglobulin infusion therapy in adult patients with primary immune deficiency.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The objective of this study is to evaluate the economic benefits of immunoglobulin replacement therapy achieved subcutaneously (subcutaneous immunoglobulin, SCIG) by the rapid push method compared to intravenous infusion therapy (intravenous immunoglobulin, IVIG) in primary immune deficiency (PID) patients from the healthcare system perspective in the context of the adult SCIG home infusion program based at St Paul's Hospital, Vancouver, Canada. MATERIALS AND METHODS: SCIG and IVIG options were compared in cost-minimisation and budget impact models (BIMs) over 3?years. Sensitivity analyses were performed for both models to evaluate the impact of varying modality of IVIG treatments and proportion of patients switching from IVIG to SCIG. RESULTS: The cost-minimisation model estimated that SCIG treatment reduced cost to the healthcare system per patient of $5736 over 3?years, principally because of less use of hospital personnel. This figure varied between $5035 and $8739 depending on modality of IVIG therapy. Assuming 50% of patients receiving IVIG switched to SCIG, the BIM estimated cost savings for the first 3?years at $1·308 million or 37% of the personnel and supply budget. These figures varied between $1·148 million and $2·454 million (36 and 42%) with varying modalities of IVIG therapy. If 75% of patients switched to SCIG, the reduced costs reached $1·962 million or 56% of total budget. CONCLUSION: This study demonstrated that from the health system perspective, rapid push home-based SCIG was less costly than hospital-based IVIG for immunoglobulin replacement therapy in adult PID patients in the Canadian context.

Martin A; Lavoie L; Goetghebeur M; Schellenberg R

2013-02-01

170

Intravenous salbutamol bolus compared with an aminophylline infusion in children with severe asthma: a randomised controlled trial.  

UK PubMed Central (United Kingdom)

BACKGROUND: The relative efficacies of aminophylline and salbutamol in severe acute childhood asthma are currently unclear. A single bolus of salbutamol was compared with a continuous aminophylline infusion in children with severe asthma in a randomised double blind study. METHODS: Children aged 1-16 years with acute severe asthma were enrolled if they showed little improvement with three nebulisers (combined salbutamol and ipratropium) administered over an hour and systemic steroids. Subjects were randomised to receive either a short intravenous bolus of salbutamol (15 micro g/kg over 20 minutes) followed by a saline infusion or an aminophylline infusion (5 mg/kg over 20 minutes) followed by 0.9 mg/kg/h. RESULTS: Forty four subjects were enrolled, with 18 randomly allocated to receive salbutamol and 26 to receive aminophylline. The groups were well matched at baseline. An intention to treat analysis showed that there was no statistically significant difference in the asthma severity score (ASS) at 2 hours between the two groups (median (IQR) 6 (6, 8) and 6.5 (5, 8) for salbutamol and aminophylline respectively, p=0.93). A similar improvement in ASS to 2 hours was seen in the two groups (mean difference -0.08, 95% CI -0.97 to 0.80), there was a trend (p=0.07) towards a longer duration of oxygen therapy in the salbutamol group (17.8 hours (95% CI 8.5 to 37.5) v 7.0 hours (95% CI 3.4 to 14.2)), and a significantly (p=0.02) longer length of hospital stay in the salbutamol group (85.4 (95% CI 66.1 to 110.2) hours v 57.3 hours (95% CI 45.6 to 72.0)). There was no significant difference in adverse events between the two groups. CONCLUSIONS: This study suggests that, in severe childhood asthma, there is no significant difference in the effectiveness of a bolus of salbutamol and an aminophylline infusion in the first 2 hours of treatment. Overall, the aminophylline infusion was superior as it significantly reduced the length of stay in hospital.

Roberts G; Newsom D; Gomez K; Raffles A; Saglani S; Begent J; Lachman P; Sloper K; Buchdahl R; Habel A

2003-04-01

171

Long-term metabolic effects of continuous subcutaneous insulin infusion therapy in type 1 diabetes.  

UK PubMed Central (United Kingdom)

BACKGROUND: Continuous subcutaneous insulin infusion (CSII) and intensive multiple daily insulin injections (iMDI) program are treatment options in patients with type 1 diabetes not achieving optimal glycemic control. The long-term effects of CSII in patients with type 1 diabetes in comparison with those educated for iMDI are poorly documented. RESEARCH DESIGN AND METHODS: Medical records for patients commenced on CSII or undertaking an iMDI program between 2000 and 2011 were extracted. Change in hemoglobin A1c (HbA1c), hypoglycemia, and weight were analyzed. Prior to CSII or iMDI commencement, all patients were on basal bolus analog insulin. Data from blood glucose meter downloads before and 6 months after CSII and iMDI were also analyzed. RESULTS: One hundred twenty-six CSII and 121 iMDI patients were studied, with mean (±SD) follow-up of 39±26 and 48±26 months, respectively. For CSII, HbA1c was significantly lower than baseline at every time period up to 36 months. Peak HbA1c reduction was 0.64% at 6 months, following which the HbA1c change declined. For iMDI, HbA1c was significantly reduced only at 6 months, by 0.15%. Glucose meter data were available for 119 patients. CSII-treated patients had a significant decrease in mean glucose and glucose SD with no change hypoglycemia at 6 months compared with baseline; no differences were observed for iMDI-treated patients. CONCLUSIONS: CSII in type 1 diabetes is associated with improved glycemic control with no increase in hypoglycemia. HbA1c improvement declined over time, suggesting a need for re-education after CSII commencement. The iMDI program did not have significant glycemic benefits.

Cohen ND; Hong ES; Van Drie C; Balkau B; Shaw J

2013-07-01

172

Intraoperative glycemic control without insulin infusion during pediatric cardiac surgery for congenital heart disease.  

UK PubMed Central (United Kingdom)

BACKGROUND: Many studies are reporting that the occurrence of hyperglycemia in the postoperative period is associated with increased morbidity and mortality rates in children after cardiac surgery for congenital heart disease. This study sought to determine blood glucose levels in standard pediatric cardiac anesthesiological management without insulin infusions. METHODS: The study population consisted of 204 consecutive pediatric patients aged from 3 days to 15.4 years undergoing open cardiac surgery for congenital heart disease between June 2007 and January 2009. Glucose-containing fluids were not administrated intraoperatively, and all patients received high dose of opioids (sufentanil 10 mcg·kg(-1) ) and steroids (30 mg·kg(-1) methylprednisolone) iv. Glucose levels were measured before CPB, 10 min after initiation of CPB, every hour on CPB, post-CPB, and on arrival at intensive care unit (ICU). RESULTS: Intraoperatively, only one patient had a glucose level <50 mg·dl(-1) (=34.2 mg·dl(-1) ), 57/204 patients (27.9%) had at least one intraoperative glucose >180 mg·dl(-1) , but only 12 patients (5.8%) had a glucose level >180 mg·dl(-1) at ICU arrival. Thirty-day mortality was 1.5% (3/204). Younger age, lower body weight, and lower CPB temperature were associated with hyperglycemia at ICU arrival, as were higher RACHS and Aristotle severity scores. CONCLUSION: A conventional (no insulin, no glucose) anesthetic management seems sufficient in the vast majority of patients (96.5%). Special attention should be paid to small neonates with complex congenital heart surgery, in whom insulin treatment may be contemplated.

Scohy TV; Golab HD; Egal M; Takkenberg JJ; Bogers AJ

2011-08-01

173

Radiochemical purity, at expiry, and radiochemical stability of iodine-131 labelled meta-iodobenzylguanidine concentrates for intravenous infusion  

International Nuclear Information System (INIS)

The determination of the amount of free [131I]iodide in [131I]metaiodobenzylguanidine ([131I]MIBG) concentrates for intravenous infusion under different storage conditions derived from daily practice. The percentage of free [131I]iodide was determined in [131I]MIBG concentrates (1.6-3.9 GBq in 7.5 ml), kept on dry ice (up to expiry, 3 days after production) or, after thawing, at room temperature (up to 24 h). A validated solid phase extraction (SPE) assay was used. Free [131I]iodide increased from 1.9%±0.34% at production to 4.4%±0.67% (mean±SD; n=5) at expiry in 3.7 GBq per 7.5 ml [131I]MIBG infusion concentrates stored on dry ice (-78 C). At room temperature, formation of free [131I]iodide was found to be dependent on the radioactive concentration of the fluid. [131I]iodide levels increased from 3.1%, immediately after thawing, to 6.6% and 16.6% at t=5 and 24 h, respectively, for a 3.9 GBq per 7.5 ml concentrate. The investigated formulation of [131I]MIBG concentrates, stored in its original packing containing dry ice, can generally be used up to expiry. After thawing, the undiluted concentrates should be administered to a patient within 3.5 h. (orig.).

1996-01-01

174

Effects of chronic intravenous infusions of dopexamine and isoprenaline to rats on D1-, beta 1- and beta 2-receptor-mediated responses.  

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1. Rats received intravenous infusions of dopexamine, an agonist with selectivity for D1-dopamine receptors and beta 2-adrenoceptors (240 micrograms kg-1 h-1), isoprenaline, a beta 1- and beta 2-adrenoceptor agonist (40 micrograms kg-1 h-1) or vehicle (isotonic saline at pH 2.5) for 7 days via subcu...

Martin, S. W.; Broadley, K. J.

175

Blood glucose control in healthy subject and patients receiving intravenous glucose infusion or total parenteral nutrition using glucagon-like peptide 1  

DEFF Research Database (Denmark)

It was the aim of the study to examine whether the insulinotropic gut hormone GLP-1 is able to control or even normalise glycaemia in healthy subjects receiving intravenous glucose infusions and in severely ill patients hyperglycaemic during total parenteral nutrition.

Nauck, Michael A; Walberg, Jörg

2004-01-01

176

In silico evaluation of a control system and algorithm for automated insulin infusion in the ICU setting.  

UK PubMed Central (United Kingdom)

BACKGROUND: It is known that tight control of glucose in the Intensive Care Unit reduces morbidity and mortality not only in diabetic patients but also in those non-diabetics who become transiently hyperglycemic. Taking advantage of a recently marketed subcutaneous glucose sensor we designed an Automatic Insulin Infusion System (AIIS) for inpatient treatment, and tested its stability under simulated clinical conditions. METHODS: The system included: reference glucose, glucose sensor, insulin and glucose infusion controllers and emergency infusion logic. We carried out computer simulations using Matlab/Simulink, in both common and worst-case conditions. RESULTS: The system was capable of controlling glucose levels without entering in a phase of catastrophic instability, even under severe simulated challenges. Care was taken to include in all simulations the 5-10 minute delay of the subcutaneous glucose signal when compared to the real-time serum glucose signal, a well-known characteristic of all subcutaneous glucose sensors. CONCLUSIONS: When tested in-Silico, a commercially available subcutaneous glucose sensor allowed the stable functioning of a proportional-derivative Automatic Insulin Infusion System, which was able to maintain glucose within acceptable limits when using a well-established glucose response model simulating a patient. Testing of the system in vivo using animal models is now warranted.

Ortiz JL; Guarini MW; Borzone GR; Olmos PR

2010-01-01

177

Regional myocardial lidocaine concentration following continuous intravenous infusion early and later after myocardial infarction  

International Nuclear Information System (INIS)

The regional concentration of lidocaine using a double constant infusion technique (250 micrograms/kg/min x 15 minutes followed by 35 micrograms/kg/mg/min x 120 minutes) was studied immediately (2 hours) in seven dogs and 24 hours (six dogs) after myocardial infarction. Tissue levels were determined by gas chromatography and related to regional myocardial blood flow as determined by the radioactive microsphere technique in multiple samples. At 2 hours after infarction a significantly higher lidocaine concentration (4.1 +/- 0.42 micrograms/g) was found in zones with greatly reduced blood flow (regional myocardial blood flow less than 0.2 ml/min per g) when compared with that (2.6 +/- 0.19 micrograms/g) in zones with normal blood flow (regional myocardial blood flow greater than 0.8 ml/min per g) (p less than 0.01). In contrast, in the 24 hour model the opposite situation was observed. Although the concentration of lidocaine in the infarct zone was substantial, a significant decline in lidocaine tissue concentration was found in the zones of lowest blood flow (regional myocardial blood flow less than 0.2 ml/min per g) when compared with that in normal zones (1.76 +/- 0.21 versus 3.38 +/- 0.21 micrograms/g, p less than 0.001). In addition, no significant differences in lidocaine concentrations were found between endocardium and epicardium in any of the groups other than those related to regional myocardial blood flow. Thus, with the double constant infusion technique, lidocaine reached normal and ischemic myocardium in concentrations equivalent to therapeutic plasma concentrations, even in lower infarct blood flow zones, with no significant differences between endocardium and epicardium. Of perhaps greater significance, the age of the ischemic insult is an important determinant of lidocaine tissue distribution in infarcted myocardium.

1982-01-01

178

Regional myocardial lidocaine concentration following continuous intravenous infusion early and later after myocardial infarction  

Energy Technology Data Exchange (ETDEWEB)

The regional concentration of lidocaine using a double constant infusion technique (250 micrograms/kg/min x 15 minutes followed by 35 micrograms/kg/mg/min x 120 minutes) was studied immediately (2 hours) in seven dogs and 24 hours (six dogs) after myocardial infarction. Tissue levels were determined by gas chromatography and related to regional myocardial blood flow as determined by the radioactive microsphere technique in multiple samples. At 2 hours after infarction a significantly higher lidocaine concentration (4.1 +/- 0.42 micrograms/g) was found in zones with greatly reduced blood flow (regional myocardial blood flow less than 0.2 ml/min per g) when compared with that (2.6 +/- 0.19 micrograms/g) in zones with normal blood flow (regional myocardial blood flow greater than 0.8 ml/min per g) (p less than 0.01). In contrast, in the 24 hour model the opposite situation was observed. Although the concentration of lidocaine in the infarct zone was substantial, a significant decline in lidocaine tissue concentration was found in the zones of lowest blood flow (regional myocardial blood flow less than 0.2 ml/min per g) when compared with that in normal zones (1.76 +/- 0.21 versus 3.38 +/- 0.21 micrograms/g, p less than 0.001). In addition, no significant differences in lidocaine concentrations were found between endocardium and epicardium in any of the groups other than those related to regional myocardial blood flow. Thus, with the double constant infusion technique, lidocaine reached normal and ischemic myocardium in concentrations equivalent to therapeutic plasma concentrations, even in lower infarct blood flow zones, with no significant differences between endocardium and epicardium. Of perhaps greater significance, the age of the ischemic insult is an important determinant of lidocaine tissue distribution in infarcted myocardium.

Zito, R.A.; Caride, V.J.; Holford, T.; Zaret, B.L.

1982-09-01

179

Local infusion of bupivacaine combined with intravenous patient-controlled analgesia provides better pain relief than intravenous patient-controlled analgesia alone in patients undergoing minimally invasive cardiac surgery.  

UK PubMed Central (United Kingdom)

OBJECTIVE: This prospective randomized double-blind study examined the effect of local wound infusion of anesthetics on pain control in the thoracotomy wound of patients undergoing minimally invasive cardiac surgery. METHODS: Patients who underwent coronary artery bypass grafting or cardiac valvular procedures via a minimally invasive thoracotomy were studied. Patients were enrolled and randomly allocated to two groups with different modalities of postoperative analgesia. The thoracotomy wound infusion group received 0.15% bupivacaine infused continuously at 2 mL/h through a catheter embedded in the wound, as well as intravenous patient-controlled analgesia. The control group had patient-controlled analgesia alone with a sham thoracotomy wound infusion of normal saline. Verbal analog pain scores (0-10 points) and recovery profiles were investigated. RESULTS: There were 19 patients in each group for complete data analysis. On the first day after the operation, infusion of local anesthetics significantly reduced the verbal analog pain scores both at rest and during motion (thoracotomy wound infusion vs control). The improved pain relief with thoracotomy wound infusion persisted at day 3 and even at 3 months after the operation. No difference was noted about time to extubation, length of intensive care unit stay, or hospital stay. CONCLUSION: In this controlled double-blind study, thoracotomy wound infusion and patient-controlled analgesia were superior to patient-controlled analgesia alone in reducing pain at 1, 3, and 90 days after minimally invasive cardiac surgery.

Chiu KM; Wu CC; Wang MJ; Lu CW; Shieh JS; Lin TY; Chu SH

2008-06-01

180

Differential effects of ketoconazole on exposure to temsirolimus following intravenous infusion of temsirolimus  

Science.gov (United States)

Intravenous (i.v.) temsirolimus, a novel inhibitor of mammalian target of rapamycin, is approved for the treatment of advanced renal cell carcinoma and is being studied in patients with mantle cell lymphoma. Because temsirolimus and its primary metabolite, sirolimus, are metabolised by the cytochrome P450 3A4 pathway (CYP3A4), the potential exists for pharmacokinetic (PK) drug interactions with the numerous agents that modulate CYP3A4 isozyme activity. We investigated the effects of ketoconazole, a potent CYP3A4 inhibitor, on the PK profile of i.v. temsirolimus in healthy adults. Coadministration of 400?mg oral ketoconazole with 5?mg i.v. temsirolimus had no significant effect on temsirolimus maximum concentration (Cmax) or area under the concentration curve (AUC). However, mean AUC increased 3.1-fold and AUCsum (sum of temsirolimus plus sirolimus AUCs) increased 2.3-fold compared with temsirolimus alone. A single 5-mg dose of temsirolimus with ketoconazole was well tolerated, and there were no unexpected safety results. Therefore, in cancer patients receiving 25?mg i.v. temsirolimus, concomitant treatment with agents that have strong CYP3A4 inhibition potential should be avoided. If a concomitant strong CYP3A4 inhibitor is necessary, a temsirolimus dose reduction to 12.5?mg weekly should be considered.

Boni, J P; Leister, C; Burns, J; Hug, B

2008-01-01

 
 
 
 
181

Pontine ?-opioid receptors mediate bradypnea caused by intravenous remifentanil infusions at clinically relevant concentrations in dogs.  

Science.gov (United States)

Life-threatening side effects such as profound bradypnea or apnea and variable upper airway obstruction limit the use of opioids for analgesia. It is yet unclear which sites containing ?-opioid receptors (?ORs) within the intact in vivo mammalian respiratory control network are responsible. The purpose of this study was 1) to define the pontine region in which ?OR agonists produce bradypnea and 2) to determine whether antagonism of those ?ORs reverses bradypnea produced by intravenous remifentanil (remi; 0.1-1.0 ?g·kg(-1)·min(-1)). The effects of microinjections of agonist [D-Ala(2),N-Me-Phe(4),Gly-ol(5)]-enkephalin (DAMGO; 100 ?M) and antagonist naloxone (NAL; 100 ?M) into the dorsal rostral pons on the phrenic neurogram were studied in a decerebrate, vagotomized, ventilated, paralyzed canine preparation during hyperoxia. A 1-mm grid pattern of microinjections was used. The DAMGO-sensitive region extended from 5 to 7 mm lateral of midline and from 0 to 2 mm caudal of the inferior colliculus at a depth of 3-4 mm. During remi-induced bradypnea (~72% reduction in fictive breathing rate) NAL microinjections (~500 nl each) within the region defined by the DAMGO protocol were able to reverse bradypnea by 47% (SD 48.0%) per microinjection, with 13 of 84 microinjections producing complete reversal. Histological examination of fluorescent microsphere injections shows that the sensitive region corresponds to the parabrachial/Kölliker-Fuse complex. PMID:22875901

Prkic, Ivana; Mustapic, Sanda; Radocaj, Tomislav; Stucke, Astrid G; Stuth, Eckehard A E; Hopp, Francis A; Dean, Caron; Zuperku, Edward J

2012-08-08

182

Pontine ?-opioid receptors mediate bradypnea caused by intravenous remifentanil infusions at clinically relevant concentrations in dogs.  

UK PubMed Central (United Kingdom)

Life-threatening side effects such as profound bradypnea or apnea and variable upper airway obstruction limit the use of opioids for analgesia. It is yet unclear which sites containing ?-opioid receptors (?ORs) within the intact in vivo mammalian respiratory control network are responsible. The purpose of this study was 1) to define the pontine region in which ?OR agonists produce bradypnea and 2) to determine whether antagonism of those ?ORs reverses bradypnea produced by intravenous remifentanil (remi; 0.1-1.0 ?g·kg(-1)·min(-1)). The effects of microinjections of agonist [D-Ala(2),N-Me-Phe(4),Gly-ol(5)]-enkephalin (DAMGO; 100 ?M) and antagonist naloxone (NAL; 100 ?M) into the dorsal rostral pons on the phrenic neurogram were studied in a decerebrate, vagotomized, ventilated, paralyzed canine preparation during hyperoxia. A 1-mm grid pattern of microinjections was used. The DAMGO-sensitive region extended from 5 to 7 mm lateral of midline and from 0 to 2 mm caudal of the inferior colliculus at a depth of 3-4 mm. During remi-induced bradypnea (~72% reduction in fictive breathing rate) NAL microinjections (~500 nl each) within the region defined by the DAMGO protocol were able to reverse bradypnea by 47% (SD 48.0%) per microinjection, with 13 of 84 microinjections producing complete reversal. Histological examination of fluorescent microsphere injections shows that the sensitive region corresponds to the parabrachial/Kölliker-Fuse complex.

Prkic I; Mustapic S; Radocaj T; Stucke AG; Stuth EA; Hopp FA; Dean C; Zuperku EJ

2012-11-01

183

Reduction of glycosylated hemoglobin following 6 months of continuous subcutaneous insulin infusion in an Indian population with type 2 diabetes.  

UK PubMed Central (United Kingdom)

BACKGROUND: The standard treatment regimen for insulin-dependent type 2 diabetes is multiple daily injections (MDI) of insulin, but continuous subcutaneous insulin infusion (CSII) with an insulin pump offers more flexibility and the possibility of a reduced total daily insulin dose. Few studies have investigated CSII for type 2 diabetes, and none has focused on an Asian Indian population. METHODS: Subjects with type 2 diabetes who were previously using MDI were switched to CSII. Glycosylated hemoglobin (HbA1c), body weight, and total daily insulin dose were recorded at baseline (MDI) and after 6 months of CSII. Subjects were also asked to rate their satisfaction with CSII and the treatment's interference in their daily activities after 6 months. RESULTS: A total of 46 subjects received CSII. Mean HbA1c was reduced by 0.5% after 6 months. This outcome was statistically significant (P < 0.0063; 95% confidence interval, 0.161-0.921%). There was no statistically significant change in body weight or total insulin daily dose. Subjects reported high satisfaction with CSII and low interference with daily activities. CONCLUSIONS: Six months of CSII in Asian Indian subjects with type 2 diabetes resulted in a statistically and clinically significant change in HbA1c.

Kesavadev J; Balakrishnan S; Ahammed S; Jothydev S

2009-08-01

184

Surgical aspects and complications of continuous intraperitoneal insulin infusion with an implantable pump.  

UK PubMed Central (United Kingdom)

PURPOSE: Continuous intraperitoneal insulin infusion (CIPII) with an implantable pump is safe and effective in selected subjects with diabetes. Our aim was to assess surgical experience and complications with CIPII. METHODS: We performed a retrospective longitudinal observational cohort study of patients that started with CIPII from 1990 to 2006. Operation free period and complication rate were compared between patients initiating CIPII before 2000 and from 2000 onwards. RESULTS: In 63 patients, 166 re-operations were performed during 381 patient-years. Re-operations were pump replacement due to end-of-battery life (47%), laparoscopic catheter-related procedures (29%) and other interventions (24%). Median operation free period increased from 21 to 78 months from 2000 onwards (p = 0.039). Nineteen percent of patients developed complications. No operation-related mortality was reported. CONCLUSIONS: Increased experience together with technical improvements has led to an increase of the operation free period. The absence of procedure-related mortality and a low complication rate makes CIPII feasible for selected patients with diabetes.

Haveman JW; Logtenberg SJ; Kleefstra N; Groenier KH; Bilo HJ; Blomme AM

2010-01-01

185

Effects of intravenous magnesium infusion on in vivo release of acetylcholine and catecholamine in rat adrenal medulla.  

UK PubMed Central (United Kingdom)

We applied microdialysis technique to the left adrenal medulla of anesthetized rats and examined the effects of intravenous Mg(2+) infusion on presynaptic acetylcholine (ACh) release and postsynaptic catecholamine release induced by electrical stimulation of splanchnic nerves. The dialysis probes were perfused with Ringer's solution containing neostigmine. Low-dose MgSO4 (25?mol/kg/min for 30min i.v.) increased mean plasma Mg(2+) concentration to 2.5mM; the administration suppressed norepinephrine (NE) release by approximately 30% and epinephrine (Epi) release by approximately 20%, but did not affect ACh release. High-dose MgSO4 (50?mol/kg/min for 30min i.v.) increased mean plasma Mg(2+) concentration to 3.8mM; the administration suppressed ACh release by approximately 25%, NE release by approximately 60% and Epi release by approximately 45%. Administration of Na2SO4 (50?mol/kg/min for 30min i.v.) did not change the release of ACh, NE or Epi. Local administration of nifedipine (200?M) suppressed NE release by approximately 40% and Epi release by approximately 30%, but did not affect ACh release. In the presence of nifedipine, low-dose MgSO4 did not suppress the release of ACh, or further suppress NE or Epi compared to nifedipine alone, but high-dose MgSO4 suppressed ACh release by approximately 25% and further suppressed NE release by approximately 60% and Epi release by approximately 50% compared to nifedipine alone. In conclusion, intravenous administration of Mg(2+) inhibits both presynaptic ACh release and postsynaptic catecholamine release in the adrenal medulla, but L-type Ca(2+) channel-controlled catecholamine release may be more sensitive to Mg(2+) than non-L-type Ca(2+) channel-controlled ACh release.

Komaki F; Akiyama T; Yamazaki T; Kitagawa H; Nosaka S; Shirai M

2013-10-01

186

Effects of intravenous magnesium infusion on in vivo release of acetylcholine and catecholamine in rat adrenal medulla.  

Science.gov (United States)

We applied microdialysis technique to the left adrenal medulla of anesthetized rats and examined the effects of intravenous Mg(2+) infusion on presynaptic acetylcholine (ACh) release and postsynaptic catecholamine release induced by electrical stimulation of splanchnic nerves. The dialysis probes were perfused with Ringer's solution containing neostigmine. Low-dose MgSO4 (25 ?mol/kg/min for 30 min i.v.) increased mean plasma Mg(2+) concentration to 2.5mM; the administration suppressed norepinephrine (NE) release by approximately 30% and epinephrine (Epi) release by approximately 20%, but did not affect ACh release. High-dose MgSO4 (50 ?mol/kg/min for 30 min i.v.) increased mean plasma Mg(2+) concentration to 3.8mM; the administration suppressed ACh release by approximately 25%, NE release by approximately 60% and Epi release by approximately 45%. Administration of Na2SO4 (50 ?mol/kg/min for 30 min i.v.) did not change the release of ACh, NE or Epi. Local administration of nifedipine (200 ?M) suppressed NE release by approximately 40% and Epi release by approximately 30%, but did not affect ACh release. In the presence of nifedipine, low-dose MgSO4 did not suppress the release of ACh, or further suppress NE or Epi compared to nifedipine alone, but high-dose MgSO4 suppressed ACh release by approximately 25% and further suppressed NE release by approximately 60% and Epi release by approximately 50% compared to nifedipine alone. In conclusion, intravenous administration of Mg(2+) inhibits both presynaptic ACh release and postsynaptic catecholamine release in the adrenal medulla, but L-type Ca(2+) channel-controlled catecholamine release may be more sensitive to Mg(2+) than non-L-type Ca(2+) channel-controlled ACh release. PMID:23562142

Komaki, Fumiaki; Akiyama, Tsuyoshi; Yamazaki, Toji; Kitagawa, Hirotoshi; Nosaka, Syuichi; Shirai, Mikiyasu

2013-04-03

187

Usefulness of Intravenous Anesthesia Using a Target-controlled Infusion System with Local Anesthesia in Submuscular Breast Augmentation Surgery  

Directory of Open Access Journals (Sweden)

Full Text Available Background Patients have anxiety and fear of complications due to general anesthesia.Through new instruments and local anesthetic drugs, a variety of anesthetic methods havebeen introduced. These methods keep hospital costs down and save time for patients. Inparticular, the target-controlled infusion (TCI) system maintains a relatively accurate level ofplasma concentration, so the depth of anesthesia can be adjusted more easily. We conductedthis study to examine whether intravenous anesthesia using the TCI system with propofol andremifentanil would be an effective method of anesthesia in breast augmentation.Methods This study recruited 100 patients who underwent breast augmentation surgeryfrom February to August 2011. Intravenous anesthesia was performed with 10 mg/mLpropofol and 50 ?g/mL remifentanil simultaneously administered using two separate modulesof a continuous computer-assisted TCI system. The average target concentration was set at2 ?g/mL and 2 ng/mL for propofol and remifentanil, respectively, and titrated against clinicaleffect and vital signs. Oxygen saturation, electrocardiography, and respiratory status werecontinuously measured during surgery. Blood pressure was measured at 5-minute intervals.Information collected includes total duration of surgery, dose of drugs administered duringsurgery, memory about surgery, and side effects.Results Intraoperatively, there was transient hypotension in two cases and hypoxia in threecases. However, there were no serious complications due to anesthesia such as respiratorydifficulty, deep vein thrombosis, or malignant hypertension, for which an endotrachealintubation or reversal agent would have been needed. All the patients were discharged on theday of surgery and able to ambulate normally.Conclusions Our results indicate that anesthetic methods, where the TCI of propofol andremifentanil is used, might replace general anesthesia with endotracheal intubation in breastaugmentation surgery.

Kyu-Jin Chung; Kyu-Ho Cha; Jun-Ho Lee1; Yong-Ha Kim; Tae-Gon Kim; Il-Guk Kim

2012-01-01

188

A holstein cow-calf model for the transfer of ciprofloxacin through milk after a long-term intravenous infusion.  

Science.gov (United States)

This study is part of an ongoing effort to develop animal models that provide milk and sufficient infant (offspring) plasma samples to fully describe a drug's pharmacokinetics to quantitate the risk to the nursing infant. Ciprofloxacin was administered to six healthy Holstein cows as a constant rate intravenous infusion (flow rate was weight adjusted) to achieve a steady-state concentration of approximately 300 ng/mL for 7 days. Plasma and milk samples were collected from the cow at regular intervals over the course of the 7 days. The plasma and milk samples were analyzed for ciprofloxacin by high-performance liquid chromatography. The milk was fed to calves, and calf plasma samples were analyzed to study the lactational transfer of ciprofloxacin from dam to nursing neonate. Remarkably, concentrations of ciprofloxacin in milk were 45 times higher than plasma drug concentrations in the dam. Approximately 6% of the administered dose was transferred to the milk, resulting in an average oral dose of 0.5 mg/kg to the calves with every feeding. The drug did not accumulate in the calves, and plasma concentrations were between one-tenth and one-fifth the plasma concentrations of the dam. PMID:23030707

Chiesa, O A; Idowu, O R; Heller, D; Smith, M; Nochetto, C; Chamberlain, P L; Gehring, R; von Bredow, J

2012-10-03

189

[A case of RSD with complete disappearance of symptoms following intravenous ketamine infusion combined with stellate ganglion block and continuous epidural block  

UK PubMed Central (United Kingdom)

A 74 year-old woman with a 6-month history of RSD following herpes zoster on her right arm was treated with stellate ganglion blocks (SGB), continuous epidural block (CEB) and continuous intravenous infusion of ketamine known as one of the NMDA receptor blockers. Of the symptoms of RSD, burning pain and hyperperspiration but allodynia disappeared after the treatment with SGB 8 times and CEB for 4 days. Allodynia disappeared completely after ketamine treatment, where ketamine was infused once using a subanesthetic dose for 2 hours. It is considered that ketamine is one of the useful drugs for the treatment of neuropathic pain with allodynia.

Kishimoto N; Kato J; Suzuki T; Arakawa H; Ogawa S; Suzuki H

1995-12-01

190

Economic evaluation of continuous subcutaneous insulin infusion for children with diabetes - a pilot study: CSII application for children -- economic evaluation.  

UK PubMed Central (United Kingdom)

BACKGROUND: The objective of this study is to assess the cost of using continuous subcutaneous insulin infusion to treat children with type-1diabetes in Bulgaria, considering changes in body mass index (BMI) and the glycated hemoglobin. The study was performed from the perspective of the Bulgarian National Health Insurance Fund (NHIF) and patients. METHODS: A total of 34 pediatric type-1-diabetes patients were observed for 7 months, divided into 2 groups -- on pumps and on insulin analogue therapy. Patient demographic data, BMI and glycated hemoglobin level were obtained and recorded. The cost of insulin, pumps, and consumables were calculated and compared with changes in glycated hemoglobin level. The incremental cost-effectiveness ratio was below the threshold value of gross domestic product per capita. RESULTS: The results were sensitive to changes in glycated hemoglobin level. Improvements associated with glycemic control led to a reduced glycated hemoglobin level that could ensure good diabetes management, but its influence on BMI in growing children remains unclear. CONCLUSION: Continuous subcutaneous insulin infusion appears to be more cost-effective for the Bulgarian pediatric population and health care system.

Petkova E; Petkova V; Konstantinova M; Petrova G

2013-10-01

191

Evaluation of the efficacy and safety of Griflow(®) Dual, a pre-set two-flow infusion device for intravenous immunoglobulin (Flebogamma(®) 5%) administration.  

UK PubMed Central (United Kingdom)

PURPOSE: A single center, prospective study was performed to assess the efficacy and safety of Griflow(®) Dual a gravity-fed device for intravenous delivery of human immunoglobulin Flebogamma(®). METHODS: A total of 2 infusions in 2 visits per patient were assessed using G2 and G3 Griflow(®) Dual models that provide different flow rates adjusted to the patient's weight. To follow the most common method of intravenous immunoglobulin administration, infusion through the two-way device commenced with the low flow rate capillary (clamp closed) for 30 minutes and continued with the high flow rate, opening both ways. Reliability of flow delivery (average flow rates), adverse events, as well as functionality in daily practice (questionnaire to nurses) were assessed. RESULTS: twenty-five valid infusions were evaluated on 13 subjects. Except for the G2 model with closed clamp in which 14.5% deviation was observed, actual average flow rate values fell well into the maximum 10% deviation permitted with respect to expected charted values (G2: 55 and 142 mL/h; G3: 76 and 189 mL/h). Discrepancies could be explained by patient's arm movements or posture change during infusion. No adverse events related to the study device occurred. In the functionality questionnaires, nurse's comfort and safety of infusion with Griflow(®) Dual were rated higher than without Griflow(®) Dual but lower than with infusion pumps. CONCLUSIONS: Although it may not be as precise as an infusion pump, Griflow(®) Dual proved to be a reliable and suitable device to administer Flebogamma(®) 5%. Correct safety should be confirmed in a larger sample.

Sánchez A; Álvarez M; Bustillo MA; García MC; Muñoz M; Pacios C; Pizarroso L; Rubio MI; Rodríguez N

2012-01-01

192

Nutrient infusion bypassing duodenum-jejunum improves insulin sensitivity in glucose-tolerant and diabetic obese subjects.  

UK PubMed Central (United Kingdom)

The mechanisms of type 2 diabetes remission after bariatric surgery is still not fully elucidated. In the present study, we tried to simulate the Roux-en-Y gastric bypass with a canonical or longer biliary limb by infusing a liquid formula diet into different intestinal sections. Nutrients (Nutrison Energy) were infused into mid- or proximal jejunum and duodenum during three successive days in 10 diabetic and 10 normal glucose-tolerant subjects. Plasma glucose, insulin, C-peptide, glucagon, incretins, and nonesterified fatty acids (NEFA) were measured before and up to 360 min following. Glucose rate of appearance (Ra) and insulin sensitivity (SI), secretion rate (ISR), and clearance were assessed by mathematical models. SI increased when nutrients were delivered in mid-jejunum vs. duodenum (SI × 10? min?¹·pM?¹: 1.11 ± 0.44 vs. 0.62 ± 0.22, P < 0.015, in controls and 0.79 ± 0.34 vs. 0.40 ± 0.20, P < 0.05, in diabetic subjects), whereas glucose Ra was not affected. In controls, Sensitivity of NEFA production was doubled in mid-jejunum vs. duodenum (2.80 ± 1.36 vs. 1.13 ± 0.78 × 10?, P < 0.005) and insulin clearance increased in mid-jejunum vs. duodenum (2.05 ± 1.05 vs. 1.09 ± 0.38 l/min, P < 0.03). Bypass of duodenum and proximal jejunum by nutrients enhances insulin sensitivity, inhibits lipolysis, and increases insulin clearance. These results may further our knowledge of the effects of bariatric surgery on both insulin resistance and diabetes.

Salinari S; Carr RD; Guidone C; Bertuzzi A; Cercone S; Riccioni ME; Manto A; Ghirlanda G; Mingrone G

2013-07-01

193

Treatment Efficacy of Subcutaneous Insulin Infusion Therapy In Type 1 Diabetic Patients - Orijinal Article  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: Current goals of treatment of diabetes are to achieve near-normal glycemia, minimize the risk of severe hypoglycemia, limit excessive weight gain, and to improve quality of life. Insulin pump or continuous subcutaneous insulin infusion (CSII) therapy provides a treatment option to aid in achieving all of these goals. CSII is a viable alternative to multiple daily injections (MDI) therapy for patients with diabetes who are capable and motivated. In this study, we aimed to compare the diabetic control and treatment satisfaction in our patients using CSII and MDI. Materials and Methods: Fifty patients with type 1 diabetes, who had been followed between 2005-2008, were enrolled in the study. Changes in biomedical outcomes (glycated haemoglobin; HbA1c), hypoglycaemia, and weigth gain pre-CSII, during the last year and at the end of the study were analyzed retrospectively. For treatment satisfaction and compliance, we used a questionnaire containing 12 questions. The patients were divided into two groups according to MDI or CSII therapy use for least one year: Group 1 using CSII (n:27) and Group 2 using MDI (n:23). Results: There was no significant difference between the last HbA1c levels in both groups. In CSII group, decrease in HbA1c was 0.79% for average follow-up of 1.66 years ( 9.19%±2.23; 8.40%±1.17). When the two groups were compared in terms of hypoglycemia rates and weight gain over the last year, no statistically significant difference was found, but in CSII group, hypoglycemia rates were lower. Finally, CSII group demonstrated a higher treatment satisfaction rate and higher compliance, while a negative correlation was detected between frequency of home blood glucose monitoring and HbA1c levels in all patients. Conclusion: CSII therapy is effective in improving glycemic control with higher treatment satisfaction when compared with MDI therapy in selected type 1 diabetic patients. Turk Jem 2010; 14: 80-4

Soner; Sinem; Adem; Özen; O?uz Kaan; Mustafa; Ercan; ?azi

2010-01-01

194

Practical closed-loop insulin delivery. A system for the maintenance of overnight euglycemia and the calculation of basal insulin requirements in insulin-dependent diabetics.  

Science.gov (United States)

We evaluated a practical closed-loop system of insulin delivery consisting of hourly blood glucose determinations using glucose oxidase reagent strips and an intravenous infusion of insulin controlled by a commonly available controller. In 25 insulin-dependent diabetic subjects, this system was successful in achieving and maintaining near euglycemia (blood glucose, 101 +/- 2 mg/dL, mean +/- SE) in the fasting state between 0200 and 0800 hours. This system may be useful in the management of insulin-dependent diabetic patients in various hospital settings. Also, in 10 subjects treated subsequently using a continuous subcutaneous insulin infusion, the mean hourly insulin infusion rate using the described system correlated well (r = 0.92) with the optimal overnight basal rate needed during continous subcutaneous insulin infusion therapy. PMID:7103278

White, N H; Skor, D; Santiago, J V

1982-08-01

195

Practical closed-loop insulin delivery. A system for the maintenance of overnight euglycemia and the calculation of basal insulin requirements in insulin-dependent diabetics.  

UK PubMed Central (United Kingdom)

We evaluated a practical closed-loop system of insulin delivery consisting of hourly blood glucose determinations using glucose oxidase reagent strips and an intravenous infusion of insulin controlled by a commonly available controller. In 25 insulin-dependent diabetic subjects, this system was successful in achieving and maintaining near euglycemia (blood glucose, 101 +/- 2 mg/dL, mean +/- SE) in the fasting state between 0200 and 0800 hours. This system may be useful in the management of insulin-dependent diabetic patients in various hospital settings. Also, in 10 subjects treated subsequently using a continuous subcutaneous insulin infusion, the mean hourly insulin infusion rate using the described system correlated well (r = 0.92) with the optimal overnight basal rate needed during continous subcutaneous insulin infusion therapy.

White NH; Skor D; Santiago JV

1982-08-01

196

Serum fibroblast growth factor 21 in human obesity: regulation by insulin infusion and relationship with glucose and lipid oxidation.  

Science.gov (United States)

Objective:Fibroblast growth factor 21 (FGF21) reduces plasma glucose and triglycerides, and increases free fatty acid oxidation in animal models of diabetes. The aim of the present study was to assess the relationships of serum FGF21 with glucose oxidation (GOx) and lipid oxidation (LOx) in the baseline and insulin-stimulated conditions in lean and obese subjects.Design:Cross-sectional study.Subjects:Eighty-four subjects with normal glucose tolerance, 42 lean (body mass index (BMI) <25?kg?m(-2)) and 42 overweight or obese (BMI between 25 and 40?kg?m(-2)).Measurements:Euglycemic hyperinsulinemic clamp and indirect calorimetry in the baseline state and during last 30?min of the clamp. The change in respiratory quotient (?RQ) in response to insulin was used as a measure of metabolic flexibility. Serum FGF21 was determined in the baseline state and after the clamp.Results:Obese subjects had higher LOx in the baseline and insulin-stimulated conditions, lower insulin-stimulated GOx and ?RQ (all P<0.05). Fasting serum FGF21 did not differ between the groups. Insulin infusion resulted in an increase in serum FGF21 in the obese (P=0.0001), but not in the lean group (P=0.76). Postclamp serum FGF21 was higher in the obese subjects (P=0.0007). In this group, postclamp FGF21 was related to LOx during the clamp (r=0.32, P=0.044), change in GOx and LOx in response to insulin (r=-0.44, P=0.005; r=0.47, P=0.002; respectively) and ?RQ (r=-0.50, P=0.001).Conclusions:An increase in serum FGF21 in response to insulin in obese subjects might represent inappropriate response, possibly associated with metabolic inflexibility in obesity and insulin resistance. PMID:23419601

Str?czkowski, M; Karczewska-Kupczewska, M; Adamska, A; Otziomek, E; Kowalska, I; Niko?ajuk, A

2013-02-19

197

Serum fibroblast growth factor 21 in human obesity: regulation by insulin infusion and relationship with glucose and lipid oxidation.  

UK PubMed Central (United Kingdom)

Objective:Fibroblast growth factor 21 (FGF21) reduces plasma glucose and triglycerides, and increases free fatty acid oxidation in animal models of diabetes. The aim of the present study was to assess the relationships of serum FGF21 with glucose oxidation (GOx) and lipid oxidation (LOx) in the baseline and insulin-stimulated conditions in lean and obese subjects.Design:Cross-sectional study.Subjects:Eighty-four subjects with normal glucose tolerance, 42 lean (body mass index (BMI) <25?kg?m(-2)) and 42 overweight or obese (BMI between 25 and 40?kg?m(-2)).Measurements:Euglycemic hyperinsulinemic clamp and indirect calorimetry in the baseline state and during last 30?min of the clamp. The change in respiratory quotient (?RQ) in response to insulin was used as a measure of metabolic flexibility. Serum FGF21 was determined in the baseline state and after the clamp.Results:Obese subjects had higher LOx in the baseline and insulin-stimulated conditions, lower insulin-stimulated GOx and ?RQ (all P<0.05). Fasting serum FGF21 did not differ between the groups. Insulin infusion resulted in an increase in serum FGF21 in the obese (P=0.0001), but not in the lean group (P=0.76). Postclamp serum FGF21 was higher in the obese subjects (P=0.0007). In this group, postclamp FGF21 was related to LOx during the clamp (r=0.32, P=0.044), change in GOx and LOx in response to insulin (r=-0.44, P=0.005; r=0.47, P=0.002; respectively) and ?RQ (r=-0.50, P=0.001).Conclusions:An increase in serum FGF21 in response to insulin in obese subjects might represent inappropriate response, possibly associated with metabolic inflexibility in obesity and insulin resistance.International Journal of Obesity advance online publication, 19 February 2013; doi:10.1038/ijo.2013.10.

Str?czkowski M; Karczewska-Kupczewska M; Adamska A; Otziomek E; Kowalska I; Niko?ajuk A

2013-02-01

198

Comparative study of toxic reactions and pharmacological dynamics of DDP administrated by trans-arterial injection and intravenous infusion in patients with NSCLC  

International Nuclear Information System (INIS)

Objective: Through a comparative analysis serum concentration of DDP administrated by intra-arterial injection and intravenous infusion in patients with non-small cell lung cancer (NSCLC), the whole body toxic reactions and the pharmacological mechanism of chemotherapy agents administrated by bronchial artery infusion (BAI) was studied. Methods: In total 60 patients with advanced NSCLC confirmed by pathology were randomly enrolled into two groups in this study. The 30 patients in group A were treated by BAI chemotherapy with DDP at the dose of 80 mg/m2 within 30 min, while MMC at the dose of 10 mg/m2 and VDS at the dose of 3 mg/m2 were given intravenously. Patients in group B was given intravenous chemotherapy of the same components as that given in group A. Blood samples was collected at 5 min, 15 min, 30 min, 1h, 2h, 4h, 8h, 24h and 48h from the beginning of DDP infusion. High performance liquid chromatography (HPLC) was used to measure DDP concentration in blood samples and a time-concentrate curve was drawn. During chemotherapy, the side-effects were investigated. Results: (1) Both group A and B reached a peak concentration at 30 min. Peak concentration value of group B is higher than that of group A. There was a statistical difference of peak concentration between group A and B (P

2003-01-01

199

The importance of active learning and practice on the students' mastery of pharmacokinetic calculations for the intermittent intravenous infusion dosing of antibiotics  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Estimation of pharmacokinetic parameters after intermittent intravenous infusion (III) of antibiotics, such as aminoglycosides or vancomycin, has traditionally been a difficult subject for students in clinical pharmacology or pharmacokinetic courses. Additionally, samples taken at different intervals during repeated dose therapy require manipulation of sampling times before accurate calculation of the patient-specific pharmacokinetic parameters. The main goal of this study was to evaluate the effectiveness of active learning tools and practice opportunities on the ability of students to estimate pharmacokinetic parameters from the plasma samples obtained at different intervals following intermittent intravenous infusion. Methods An extensive reading note, with examples, and a problem case, based on a patient’s chart data, were created and made available to students before the class session. Students were required to work through the case before attending the class. The class session was devoted to the discussion of the case requiring active participation of the students using a random participation program. After the class, students were given additional opportunities to practice the calculations, using online modules developed by the instructor, before submitting an online assignment. Results The performance of students significantly (P?P? Conclusions Despite being a difficult subject, students achieve mastery of pharmacokinetic calculations for the topic of intermittent intravenous infusion when appropriate active learning strategies and practice opportunities are employed.

Mehvar Reza

2012-01-01

200

Safety and feasibility of thallium-201 myocardial SPECT with intravenous infusion of disodium adenosine triphosphate (ATP) in the diagnosis of coronary artery disease  

International Nuclear Information System (INIS)

ATP (adenosine triphosphate) is a potent coronary vasodilator with a rapid onset of action and a very short half-life. Myocardial perfusion scintigraphy with intravenous ATP has not yet bee sufficiently proven in the diagnosis, follow-up, and risk stratification of coronary artery disease. The purpose of this study was to evaluate the safety, feasibility and diagnostic accuracy of pharmacologic stress thallium-102 myocardial SPECT using an intravenous ATP infusion in patients with suspected coronary artery disease. Thallium-201 myocardial SPECT in 319 patients with suspected coronary artery disease were performed after the infusion of ATP (0.08 mg/min for 6 min). The adverse effects were carefully monitored. Coronary angiography was also performed within 3 weeks. Although 76.5% of he patients had some adverse effects, they were transient, mild, and well tolerated. In all patients, the ATP infusion protocol was completed and only 2 patients required aminophylline. The adverse effects were dyspnea in 63%, headache in 31%, flushing in 21%, chest pain in 14% and abdominal discomfort in 5% of the patients. The sensitivity and specificity were 80% and 90% respectively. Thallium-201 myocardial SPECT after 6 min-infusion of ATP at a rate of 0.08 mg/kg/min is safe and has a diagnostic value in detecting coronary artery disease

1998-01-01

 
 
 
 
201

Effects of Everyday Life Events on Glucose, Insulin, and Glucagon Dynamics in Continuous Subcutaneous Insulin Infusion–Treated Type 1 Diabetes: Collection of Clinical Data for Glucose Modeling  

DEFF Research Database (Denmark)

Background: In the development of glucose control algorithms, mathematical models of glucose metabolism are useful for conducting simulation studies and making real-time predictions upon which control calculations can be based. To obtain type 1 diabetes (T1D) data for the modeling of glucose metabolism, we designed and conducted a clinical study.Methods: Patients with insulin pump–treated T1D were recruited to perform everyday life events on two separate days. During the study, patients wore their insulin pumps and, in addition, a continuous glucose monitor and an activity monitor to estimate energy expenditure. The sequence of everyday life events was predetermined and included carbohydrate intake, insulin boluses, and bouts of exercise; the events were introduced, temporally separated, in different orders and in different quantities. Throughout the study day, 10-min plasma glucose measurements were taken, and samples for plasma insulin and glucagon analyses were obtained every 10 min for the first 30 min after an event and subsequently every 30 min.Results: We included 12 patients with T1D (75% female, 34.3±9.1 years old [mean±SD], hemoglobin A1c 6.7±0.4%). During the 24 study days we collected information-rich, high-quality data during fast and slow changes in plasma glucose following carbohydrate intake, exercise, and insulin boluses.Conclusions: This study has generated T1D data suitable for glucose modeling, which will be used in the development of glucose control strategies. Furthermore, the study has given new physiologic insight into the metabolic effects of carbohydrate intake, insulin boluses, and exercise in continuous subcutaneous insulin infusion–treated patients with T1D.

Schmidt, Signe; Finan, Daniel A.

2012-01-01

202

Effect of intravenous infusion of dexmedetomidine on perioperative haemodynamic changes and postoperative recovery: A study with entropy analysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Dexmedetomidine, an ?2 agonist, when used as an adjuvant in general anaesthesia attenuates stress response to various noxious stimuli, maintains perioperative haemodynamic stability and provides sedation without significant respiratory depression postoperatively. METHODS: Sixty patients were randomly divided into two groups of 30 each. In group A, fentanyl 2 ?g/kg and in group B dexmedetomidine were given intravenously as loading dose of 1 ?g/kg over 10 min prior to induction. After induction with thiopentone, in group B, dexmedetomidine was given as infusion at a dose of 0.2-0.8 ?g/kg. Sevoflurane was used as inhalation agent in both groups. Haemodynamic variables and entropy (response entropy and state entropy) were recorded continuously. Postoperative sedation and recovery were assessed by sedation score and modified Aldrete's score, respectively. RESULTS: Dexmedetomidine significantly attenuates stress response at intubation with lesser increase in heart rate (10% vs. 17%), systolic blood pressure (6% vs. 23%) and diastolic blood pressure (7% vs. 20%) as compared to the control group (P<0.05). Intraoperatively, an average of 8% fall in systolic blood pressure and 8.16% fall in diastolic pressure in the test group as compared to 3.6% rise in systolic and 3.3% in diastolic pressure of the control group was observed. Postoperatively, the test group showed significant sedation at 2 h as compared to the control group (P=0.00) and recovery was better in the control group for the first 2 h post extubation. CONCLUSION: Dexmedetomidine attenuates various stress responses during surgery and maintains the haemodynamic stability when used as an adjuvant in general anaesthesia. Also, the sedative action of dexmedetomidine delays recovery for the first few hours post extubation.

Patel CR; Engineer SR; Shah BJ; Madhu S

2012-11-01

203

Possible activation of auto-immune thyroiditis from continuous subcutaneous infusion of genapol-containing insulin.  

UK PubMed Central (United Kingdom)

A case of a type 1 diabetic woman with auto-immune thyroiditis is reported, in whom repeated exposure to insulin containing Genapol(R) (polyethylen-polypropylenglycol) over 3 years reproducibly parallels with an increase of serum TSH (thyroid-stimulating hormone) above the normal limit. Previously, adverse effects of Genapol(R) insulin have been related to its intraperitoneal application, and thought to be restricted to anti-insulin-immunity; activating effects on thyroid auto-immunity have been repeatedly disputed. We suggest that Genapol(R) insulin should be replaced by other insulin preparations with a better safety record.

Chantelau E

2000-09-01

204

Possible activation of auto-immune thyroiditis from continuous subcutaneous infusion of genapol-containing insulin.  

Science.gov (United States)

A case of a type 1 diabetic woman with auto-immune thyroiditis is reported, in whom repeated exposure to insulin containing Genapol(R) (polyethylen-polypropylenglycol) over 3 years reproducibly parallels with an increase of serum TSH (thyroid-stimulating hormone) above the normal limit. Previously, adverse effects of Genapol(R) insulin have been related to its intraperitoneal application, and thought to be restricted to anti-insulin-immunity; activating effects on thyroid auto-immunity have been repeatedly disputed. We suggest that Genapol(R) insulin should be replaced by other insulin preparations with a better safety record. PMID:11011223

Chantelau, E

2000-09-01

205

Effects and Safety of Allogenic Mesenchymal Stem Cells Intravenous Infusion in Active Ankylosing Spondylitis Patients Who Failed NSAIDs: A 20 Week Clinical Trial.  

Science.gov (United States)

Objective: To evaluate the feasibility, safety, and efficacy of intravenous infusion of allogenic mesenchymal stem cells (MSCs) in ankylosing spondylitis (AS) patients who are refractory to or could not tolerate the side effects of nonsteroidal anti-inflammatory drugs (NSAIDs). Method: AS patients enrolled in this study received 4 intravenous infusions (IVI) of MSCs on days 0,7,14, and 21. The percentage of ASAS20 responders (the primary endpoint) at the 4th week and the mean ASAS20 response duration (the secondary endpoint) were used to assess treatment response to MSC infusion and duration of the therapeutic effects. Ankylosing Spondylitis Disease Activity Score Containing C-reactive Protein (ASDAS-CRP) and other pre-established evaluation indices were also adopted to evaluate the clinical effects. Magnetic resonance imaging (MRI) was performed to detect changes of bone marrow edema in the spine. The safety of this treatment was also evaluated. Results: Thirty-one patients were included, and the percentage of ASAS20 responders reached 77.4% at the 4th week and the mean ASAS20 response duration was 7.1 weeks. The mean ASDAS-CRP score decreased from 3.6±0.6 to 2.4±0.5 at the 4th week, and then increased to 3.2±0.8 at the 20th week. The average total inflammation extent (TIE) detected by MRI decreased from 533,482.5 at baseline to 480,692.3 at the 4th week (p>0.05) and 400,547.2 at the 20th week (p<0.05). No adverse effects were noted. Conclusion: Intravenous infusion of MSCs is a feasible, safe, and promising treatment for patients with AS. PMID:23711393

Wang, Peng; Li, Yuxi; Huang, Lin; Yang, Jiewen; Yang, Rui; Deng, Wen; Liang, Biling; Dai, Lie; Meng, Qingqi; Gao, Liangbin; Chen, Xiaodong; Shen, Jun; Tang, Yong; Zhang, Xin; Hou, Jingyi; Ye, Jichao; Chen, Keng; Cai, Zhaopeng; Wu, Yanfeng; Shen, Huiyong

2013-05-22

206

Effects and Safety of Allogenic Mesenchymal Stem Cells Intravenous Infusion in Active Ankylosing Spondylitis Patients Who Failed NSAIDs: A 20 Week Clinical Trial.  

UK PubMed Central (United Kingdom)

Objective: To evaluate the feasibility, safety, and efficacy of intravenous infusion of allogenic mesenchymal stem cells (MSCs) in ankylosing spondylitis (AS) patients who are refractory to or could not tolerate the side effects of nonsteroidal anti-inflammatory drugs (NSAIDs). Method: AS patients enrolled in this study received 4 intravenous infusions (IVI) of MSCs on days 0,7,14, and 21. The percentage of ASAS20 responders (the primary endpoint) at the 4th week and the mean ASAS20 response duration (the secondary endpoint) were used to assess treatment response to MSC infusion and duration of the therapeutic effects. Ankylosing Spondylitis Disease Activity Score Containing C-reactive Protein (ASDAS-CRP) and other pre-established evaluation indices were also adopted to evaluate the clinical effects. Magnetic resonance imaging (MRI) was performed to detect changes of bone marrow edema in the spine. The safety of this treatment was also evaluated. Results: Thirty-one patients were included, and the percentage of ASAS20 responders reached 77.4% at the 4th week and the mean ASAS20 response duration was 7.1 weeks. The mean ASDAS-CRP score decreased from 3.6±0.6 to 2.4±0.5 at the 4th week, and then increased to 3.2±0.8 at the 20th week. The average total inflammation extent (TIE) detected by MRI decreased from 533,482.5 at baseline to 480,692.3 at the 4th week (p>0.05) and 400,547.2 at the 20th week (p<0.05). No adverse effects were noted. Conclusion: Intravenous infusion of MSCs is a feasible, safe, and promising treatment for patients with AS.

Wang P; Li Y; Huang L; Yang J; Yang R; Deng W; Liang B; Dai L; Meng Q; Gao L; Chen X; Shen J; Tang Y; Zhang X; Hou J; Ye J; Chen K; Cai Z; Wu Y; Shen H

2013-05-01

207

Intracoronary bolus-only compared with intravenous bolus plus infusion of tirofiban application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.  

UK PubMed Central (United Kingdom)

OBJECTIVES: The aim of this pilot study was to compare intracoronary bolus-only with standard intravenous bolus plus maintenance infusion of tirofiban with respect to improvement in myocardial reperfusion after primary percutaneous coronary intervention (p-PCI). BACKGROUND: Changes in clinical practice may obviate the need for a maintenance infusion of small molecule glycoprotein IIb/IIIa inhibitors in current practice. METHODS: Forty-nine patients undergoing p-PCI were randomized to either intracoronary bolus-only (n = 25) or intravenous bolus plus infusion (n = 24) of tirofiban. The primary end point was coronary hemodynamic indices of microvascular perfusion measured 4-5 days after p-PCI. The secondary end points were ST segment resolution at 90 min, the corrected TIMI frame count and myocardial blush grade. At 6 months, echocardiography and technetium-99m single-photon-emission computed tomography were performed. RESULTS: Microvascular perfusion did not differ significantly between the two treatment groups: index of microvascular resistance (27 ± 13 vs. 35 ± 15 U, P = 0.08) and coronary flow reserve (2.2 ± 0.7 vs. 1.9 ± 0.6, P = 0.25). The corrected TIMI frame counts assessed in the first (P = 0.13) and the second (P = 0.09) catheterization or the myocardial blush grades evaluated immediately (P = 0.23) and 4-5 days after MI (P = 1.00) were not significantly different between the two groups. At 6 months, there was no difference between the two groups in infarct size, left ventricular volumes, or ejection fraction. CONCLUSIONS: The standard intravenous bolus plus maintenance infusion of tirofiban in p-PCI is not superior to intracoronary bolus-only administration with respect to microvascular perfusion. Further, adequately powered randomized trials are warranted to evaluate the clinical outcomes associated with this strategy.

K?rma C; Erkol A; Pala S; Oduncu V; Dündar C; ?zgi A; Tigen K; Gibson CM

2012-01-01

208

Effect of Intravenous Infusion of Dexmedetomidine Combined with Inhalation of Isoflurane on Arterial Oxygenation and Intrapulmonary Shunt During Single-Lung Ventilation.  

UK PubMed Central (United Kingdom)

To investigate the changes in arterial oxygenation and intrapulmonary shunt during one-lung ventilation (OLV) with intravenous infusion of dexmedetomidine combined with isoflurane inhalation. ASA I-II 60 patients aged 18-70 year, undergoing OLV during elective thoracic surgery were randomly allocated to two groups: (1) isoflurane + saline (group NISO, n = 30) and (2) isoflurane + dexmedetomidine (group DISO, n = 30). After induction, anesthesia was maintained with intravenous infusion of remifentanil 0.1-0.2 ?g kg(-1) min(-1) and inhalation isoflurane (1.0-2.0 %). In addition, anesthesia was maintained with intravenous infusion of dexmedetomidine 0.7 ?g kg(-1) h(-1) in DISO group and saline 0.25 ml kg(-1) h(-1) in NISO group. Bispectral Index values were maintained within 40-60 by changing the concentration of isoflurane in all groups. Arterial blood gas samples and central venous blood gas samples were taken as follows: during two-lung ventilation before OLV and during the first 40 min of OLV. 45 Patients completed the study, with 23 patients in DISO group and 22 patients in NISO group. The two groups were comparable in terms of demographic variables, hemodynamic, PaO2, Qs/QT, end expiration isoflurane and BIS levels during the operation. Compared with patients in the group NISO, there were significant increases with PaO2, significant decrease with Qs/QT, significant decrease with end expiration isoflurane, and significant decrease with HR in the group DISO during the first 40 min of OLV (P < 0.05). Dexmedetomidine infusions decrease the requirement for isoflurane, decrease intrapulmonary shunt, and moderate the change in PaO2 and may be useful in managing OLV.

Xia R; Yin H; Xia ZY; Mao QJ; Chen GD; Xu W

2013-06-01

209

Effect of age of infusion site and type of rapid-acting analog on pharmacodynamic parameters of insulin boluses in youth with type 1 diabetes receiving insulin pump therapy.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The purpose of this study was to examine the effect of type of insulin analog and age of insertion site on the pharmacodynamic characteristics of a standard insulin bolus in youth with type 1 diabetes receiving insulin pump therapy. RESEARCH DESIGN AND METHODS: Seventeen insulin pump-treated adolescents with type 1 diabetes underwent two euglycemic clamp procedures after a 0.2 unit/kg bolus of either insulin aspart or lispro on day 1 and day 4 of insulin pump site insertion. The glucose infusion rate (GIR) required to maintain euglycemia was the primary pharmacodynamic measure. RESULTS: There were no statistically significant differences in any of the pharmacodynamic parameters between aspart and lispro during day 1 and day 4. However, when the two groups were combined, time to discontinuation of exogenous glucose infusion, and time to half-maximal onset and offset of insulin action were observed significantly earlier during day 4 compared with day 1 (P = 0.03-0.0004), but the overall area under the GIR curve was similar on day 1 and day 4. CONCLUSIONS: With both insulin aspart and lispro, there is an earlier peak and shorter duration of action with increasing duration of infusion site use, but overall insulin action is not affected.

Swan KL; Dziura JD; Steil GM; Voskanyan GR; Sikes KA; Steffen AT; Martin ML; Tamborlane WV; Weinzimer SA

2009-02-01

210

Evaluation of glucose variability when converting from insulin infusion to basal-bolus regimen in a surgical-trauma intensive care unit.  

UK PubMed Central (United Kingdom)

PURPOSE: This study aimed to identify predictive factors resulting in glucose values greater than 200 mg/dL in patients with trauma transitioned from an insulin infusion to a basal-bolus subcutaneous insulin regimen. MATERIALS AND METHODS: Thirty-nine patients with trauma on goal enteral nutrition in the intensive care unit receiving an insulin infusion for at least 48 hours and transitioned to a basal-bolus regimen were retrospectively identified. RESULTS: Ten patients had hyperglycemic events after transition. Hyperglycemia was significantly associated with increased age (42 [17] years vs 56 [13] years, P = .02), admission glucose (128 [39] mg/dL vs 214 [91] mg/dL, P = .015), and insulin drip rate 48 hours before transition (87 [38] units/d vs 127 [49] units/d, P = .012). There was no difference between groups with respect to injury severity, demographics, or physiologic parameters. Multiple regression analysis revealed that increased age (odds ratio [OR], 1.215 [1.000-1.477]; P =.05), increased admission blood glucose (OR, 1.053 [1.006-1.101]; P =.025), and higher insulin infusion rates 48 hours before transition (OR, 1.061 [1.009-1.116]; P =.020) predisposed patients to severe hyperglycemic episodes. CONCLUSIONS: Older patients with trauma and patients with higher blood glucose on admission are more likely to experience severe hyperglycemia when transitioned to basal-bolus glucose control. Higher insulin infusion rates at 48 hours before transition are also associated with severe hyperglycemia.

McKinzie BP; To L; Leon SM; Eriksson EA

2013-10-01

211

Radiochemical purity, at expiry, and radiochemical stability of iodine-131 labelled meta-iodobenzylguanidine concentrates for intravenous infusion  

Energy Technology Data Exchange (ETDEWEB)

The determination of the amount of free [{sup 131}I]iodide in [{sup 131}I]metaiodobenzylguanidine ([{sup 131}I]MIBG) concentrates for intravenous infusion under different storage conditions derived from daily practice. The percentage of free [{sup 131}I]iodide was determined in [{sup 131}I]MIBG concentrates (1.6-3.9 GBq in 7.5 ml), kept on dry ice (up to expiry, 3 days after production) or, after thawing, at room temperature (up to 24 h). A validated solid phase extraction (SPE) assay was used. Free [{sup 131}I]iodide increased from 1.9%{+-}0.34% at production to 4.4%{+-}0.67% (mean{+-}SD; n=5) at expiry in 3.7 GBq per 7.5 ml [{sup 131}I]MIBG infusion concentrates stored on dry ice (-78 C). At room temperature, formation of free [{sup 131}I]iodide was found to be dependent on the radioactive concentration of the fluid. [{sup 131}I]iodide levels increased from 3.1%, immediately after thawing, to 6.6% and 16.6% at t=5 and 24 h, respectively, for a 3.9 GBq per 7.5 ml concentrate. The investigated formulation of [{sup 131}I]MIBG concentrates, stored in its original packing containing dry ice, can generally be used up to expiry. After thawing, the undiluted concentrates should be administered to a patient within 3.5 h. (orig.) [Deutsch] Die Bestimmung der Menge freien [{sup 131}I]Jodids in [{sup 131}I]meta-Jodbenzylguanidin ([{sup 131}I]MIBG) Infusionskonzentraten, aufbewahrt unter verschiedenen Bedingungen, wurde der taeglichen Praxis entnommen. Der Prozentsatz freien [{sup 131}I]Jodids wurde in [{sup 131}I]MIBG Konzentraten (1.6-3.9 GBq in 7.5 ml) bestimmt, entweder auf Trockeneis gelagert (bis zum Verfalltag, 3 Tage nach der Produktion) oder bei Zimmertemperatur (bis 24 h nach dem Auftauen) gelagert. Ein validiertes Solid Phase-Extraction (SPE)-Verfahren wurde benutzt. Freies [{sup 131}I]Jodid stieg von 1,9%{+-}0,34% zur Produktionszeit bis 4,4%{+-}0,67% (Mittel{+-}SD; n=5) am Verfalltag in 3,7 GBq pro 7,5 ml [{sup 131}I]MIBG Infusionskonzentraten, auf Trockeneis gelagert (-78 C). Bei Zimmertemperatur zeigte sich die Bildung freien [{sup 131}I]Jodids abhaengig von der radioaktiven Konzentration der Loesung. Der Prozentsatz freien [{sup 131}I]Jodids in einem 3,9 GBq pro 7,5 ml Konzentrat stieg von 3,1% zur Zeit des Auftauens bis 6,6% bzw. 16,6% Nach 5 bzw. 24 h. Die untersuchte Formulierung des [{sup 131}I]MIBG-Infusionskonzentrates kann, gelagert in ihrer Originalpackung inklusive Trockeneis, im allgemeinen bis zum Verfalltag angewendet werden. nach dem Auftauen sollten die unverduennten Konzentrate innerhalb von 3,5 h an Patienten verabreicht werden. (orig.)

Wafelman, A.R. [Dept. of Pharmacy, Slotervaart Hospital, Amsterdam (Netherlands)]|[Dept. of Nuclear Medicine, Netherlands Cancer Inst., Amsterdam (Netherlands)]|[Dept. of Clinical Pharmacy and Toxicology, Leiden Univ. Hospital (Netherlands); Hoefnagel, C.A. [Dept. of Nuclear Medicine, Netherlands Cancer Inst., Amsterdam (Netherlands); Maes, R.A.A. [Dept. of Pharmaceutical Analysis and Toxicology, Faculty of Pharmacy, Univ. Utrecht (Netherlands); Beijnen, J.H. [Dept. of Pharmacy, Slotervaart Hospital, Amsterdam (Netherlands)]|[Dept. of Nuclear Medicine, Netherlands Cancer Inst., Amsterdam (Netherlands)]|[Dept. of Pharmaceutical Analysis and Toxicology, Faculty of Pharmacy, Univ. Utrecht (Netherlands)

1996-08-01

212

The importance of active learning and practice on the students' mastery of pharmacokinetic calculations for the intermittent intravenous infusion dosing of antibiotics.  

UK PubMed Central (United Kingdom)

BACKGROUND: Estimation of pharmacokinetic parameters after intermittent intravenous infusion (III) of antibiotics, such as aminoglycosides or vancomycin, has traditionally been a difficult subject for students in clinical pharmacology or pharmacokinetic courses. Additionally, samples taken at different intervals during repeated dose therapy require manipulation of sampling times before accurate calculation of the patient-specific pharmacokinetic parameters. The main goal of this study was to evaluate the effectiveness of active learning tools and practice opportunities on the ability of students to estimate pharmacokinetic parameters from the plasma samples obtained at different intervals following intermittent intravenous infusion. METHODS: An extensive reading note, with examples, and a problem case, based on a patient's chart data, were created and made available to students before the class session. Students were required to work through the case before attending the class. The class session was devoted to the discussion of the case requiring active participation of the students using a random participation program. After the class, students were given additional opportunities to practice the calculations, using online modules developed by the instructor, before submitting an online assignment. RESULTS: The performance of students significantly (P?intravenous infusion when appropriate active learning strategies and practice opportunities are employed.

Mehvar R

2012-01-01

213

[Ephedrine vs. phenylephrine by intravenous bolus and continuous infusion to prevent hypotension secondary to spinal anesthesia during cesarean section: a randomized comparative trial].  

UK PubMed Central (United Kingdom)

OBJECTIVE: Subarachnoid spinal anesthesia for cesarean section is associated with a high incidence of hypotension, which can require the use of vasoconstrictors. The aim of this trial was to compare ephedrine to phenylephrine for the prevention of secondary hypotension and to assess the adverse effects on both mother and newborn. MATERIAL AND METHODS: Eighty patients undergoing elective or emergency cesarean section, in the absence of uterine activity or fetal risk, were randomized to receive prophylaxis with ephedrine or phenylephrine immediately after the spinal block. Patients in the ephedrine group received an intravenous bolus of 0.1 mg/kg plus continuous infusion at a rate of 0.5 mg/kg/h; patients in the phenylephrine group received an intravenous bolus of 1.5 microg/kg plus a continuous infusion at 1.5 microg/kg/min. Infusion was maintained until umbilical cord clamping. We recorded maternal blood pressure, heart rate, nausea and vomiting, dizziness, bradycardia, hypotension, hypertension, fetal Apgar index, and umbilical cord blood parameters (pH, PCO2, and HCO3). RESULTS: The overall incidence of hypotension was 11.2%, with no significant between-group differences (ephedrine group, 11.4%; phenylephrine group, 11.1%). The incidences of hypertension and bradycardia were higher in the phenylephrine group (27.8% and 2.3%, respectively) than in the ephedrine group (25% and 0%, respectively). Umbilical cord blood parameters and Apgar scores were similar. After suspension of continuous infusion, an episode of hypotension was detected in 22.5% of the patients (72.2% of these patients were in the phenylephrine group and 27.8% were in the ephedrine group). CONCLUSIONS: At the doses of ephedrine and phenylephrine administered in this trial, the ability of these drugs to prevent hypotension during cesarean section proved to be similar. Higher incidences of adverse events (hypertension and bradycardia) were observed in the phenylephrine group. No differences were observed in neonatal effects.

Alday Muñoz E; Palacio Abizanda F; De Diego Pdel R; Gilsanz Rodríguez F

2011-08-01

214

Prevention of methionine and ammonia-induced coma by intravenous infusion of a branched chain amino acid solution to rats with liver injury.  

Directory of Open Access Journals (Sweden)

Full Text Available The prevention of hepatic encephalopathy by the intravenous infusion of a branched chain amino acid (BCAA)-enriched solution was investigated in methionine and ammonium acetate-treated rats whose liver was already injured with carbon tetrachloride. A BCAA-enriched solution protected the rats from entering a coma. The brain BCAA contents became higher, and the brain methionine and tyrosine levels and the ratio of glutamine to glutamic acid in the brain diminished after administering the BCAA-enriched solution.

Shiota,Tetsuya; Watanabe,Akiharu; Higashi,Toshihiro; Nagashima,Hideo

1984-01-01

215

Effect of intravenous injection of dopamine on the bispectral index,entropy index,and sedation score during continuous propofol infusion  

Directory of Open Access Journals (Sweden)

Full Text Available Objective To examine the effect of an intravenous injection of dopamine on the bispectral index(BIS),entropy index,and sedation score [Observer’s Assessment of Alertness/Sedation(OAAS)] during continuous propofol infusion.Methods The present study selected nine patients undergoing an operation under ASA ?-? general anesthesia.Propofol is administered for anesthesia,and plasma/effective concentration(Cp/Ce) remained unchanged when OAA/S=2.An intravenous injection of dopamine is then administrated at a single injection dosage of 3 mg to 5 mg.BIS,response entropy(RE),state entropy(SE),OAA/S score,and mean arterial pressure(MAP) are recorded 1 min before injection and 1 min to 5 min after injection.Results Cp/Ce is 1.71±0.42 when OAA/S=2.After the intravenous injection of dopamine,BIS increases remarkably in five cases(BIS > 70 in four cases).The increment primarily occurs at 3 and 4 min.The entropy index in nine cases begins to increase at 2min,with this index apparently higher than that before the injection in six cases.The difference between RE and SE increases,and the increment of BIS and the entropy index occurs later than MAP.The OAA/S score ?4 in five cases.Conclusion Intravenous injection of dopamine results in higher BIS,entropy index,and sedation score during a continuous infusion of propofol when OAA/S=2,thereby having an arousal effect.The entropy index is sensitive in terms of reflecting the arousal effect of dopamine.

Ji-xiu XUE; Guo-xun XU; Qing-hai LIU; Ke-jie WANG; Tian-long WANG; Bing LI; Li-li YANG

2011-01-01

216

Intravenous salbutamol bolus compared with an aminophylline infusion in children with severe asthma: a randomised controlled trial  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background: The relative efficacies of aminophylline and salbutamol in severe acute childhood asthma are currently unclear. A single bolus of salbutamol was compared with a continuous aminophylline infusion in children with severe asthma in a randomised double blind study.

Roberts, G; Newsom, D; Gomez, K; Raffles, A; Saglani, S; Begent, J; Lachman, P; Sloper, K; Buchdahl, R; Habel, A

217

Maintenance time of sedative effects after an intravenous infusion of diazepam: A guide for endoscopy using diazepam  

Digital Repository Infrastructure Vision for European Research (DRIVER)

AIM: To examine whether the sedative effects assessed by psychomotor tests would depend on the cytochrome P450 (CYP) 2C19 genotypes after an infusion regimen of diazepam commonly used for gastrointestinal endoscopy in Japan.

Sugimoto, Mitsushige; Furuta, Takahisa; Nakamura, Akiko; Shirai, Naohito; Ikuma, Mutsuhiro; Misaka, Shingen; Uchida, Shinya

218

Safety and efficacy of intravenous infusion of allogeneic cryopreserved mesenchymal stem cells for treatment of chronic kidney disease in cats: results of three sequential pilot studies.  

Science.gov (United States)

INTRODUCTION: Administration of mesenchymal stem cells (MSCs) has been shown to improve renal function in rodent models of chronic kidney disease (CKD), in part by reducing intrarenal inflammation and suppressing fibrosis. CKD in cats is characterized by tubulointerstitial inflammation and fibrosis, and thus treatment with MSCs might improve renal function and urinary markers of inflammation in this disease. Therefore, a series of pilot studies was conducted to assess the safety and efficacy of intravenous administration of allogeneic adipose-derived MSCs (aMSCs) in cats with naturally occurring CKD. METHODS: Cats enrolled in these studies received an intravenous infusion of allogeneic aMSCs every 2 weeks collected from healthy, young, specific pathogen-free cats. Cats in pilot study 1 (six cats) received 2 × 106 cryopreserved aMSCs per infusion, cats in pilot study 2 (five cats) received 4 × 106 cryopreserved aMSCs per infusion, and cats in pilot study 3 (five cats) received 4 × 106 aMSCs cultured from cryopreserved adipose. Serum biochemistry, complete blood count, urinalysis, urine protein, glomerular filtration rate, and urinary cytokine concentrations were monitored during the treatment period. Changes in clinical parameters were compared statistically by means of repeated measures analysis of variance (ANOVA) followed by Bonferroni's correction. RESULTS: Cats in pilot study 1 had few adverse effects from the aMSC infusions and there was a statistically significant decrease in serum creatinine concentrations during the study period, however the degree of decrease seems unlikely to be clinically relevant. Adverse effects of the aMSC infusion in cats in pilot study 2 included vomiting (2/5 cats) during infusion and increased respiratory rate and effort (4/5 cats). Cats in pilot study 3 did not experience any adverse side effects. Serum creatinine concentrations and glomerular filtration rates did not change significantly in cats in pilot studies 2 and 3. CONCLUSIONS: Administration of cryopreserved aMSCs was associated with significant adverse effects and no discernible clinically relevant improvement in renal functional parameters. Administration of aMSCs cultured from cryopreserved adipose was not associated with adverse effects, but was also not associated with improvement in renal functional parameters. PMID:23632128

Quimby, Jessica M; Webb, Tracy L; Habenicht, Lauren M; Dow, Steven W

2013-04-30

219

Insulin production following intravenous glucose, arginine, and valine: different pattern in patients with impaired glucose tolerance and non-insulin-dependent diabetes mellitus.  

UK PubMed Central (United Kingdom)

To better understand abnormal insulin production (IP) in states of carbohydrate intolerance, insulin release was quantified following equimolar (2.4 mmol/kg) infusions of glucose, arginine, and valine in healthy subjects ([HS] age, 45 +/- 3 years; body mass index [BMI, kg/m2], 26.3 +/- 2.4; means +/- SEM), obese subjects with impaired glucose tolerance ([IGT] age, 43 +/- 5 years; BMI, 35.4 +/- 2.4), and non-obese patients with chronic non-insulin-dependent diabetes mellitus ([NIDDM] age, 55 +/- 3 years; BMI, 26.4 +/- 1.4; duration of disease, 13 +/- 3 years). There were eight subjects per group. Incremental IP (metabolic clearance rate of C-peptide [MCRCP] x total incremental area under the curve of plasma C-peptide [AUCCP], pmol/kg) following substrate infusion was as follows: glucose: HS, 227 +/- 14; IGT, 1,050 +/- 184 (P < .001 v HS); NIDDM, 114 +/- 27 (P < .001 v HS); arginine: HS, 139 +/- 23; IGT, 488 +/- 106 (P < .01 v HS); NIDDM, 206 +/- 47; and valine: HS, 21 +/- 7; IGT, 32 +/- 10; NIDDM, 54 +/- 12 (P < .01 v HS). The fractional clearance rate ([FCR] k, %/min) was impaired in IGT and NIDDM for glucose (HS, 3.9 +/- 0.4; IGT, 2.3 +/- 0.3 [P < .01 v HS]; NIDDM, 1.4 +/- 0.1 [P < .001 v HS]), arginine (2.4 +/- 0.1; 1.9 +/- 0.2 [P < .01 v HS]; 1.9 +/- 0.2 [P < .01 v HS]), and valine (0.95 +/- 0.06; 0.65 +/- 0.09 [P < .05 v HS]; 0.74 +/- 0.1 [P < .05 v HS]).(ABSTRACT TRUNCATED AT 250 WORDS)

Fasching P; Ratheiser K; Nowotny P; Uurzemann S; Parzer S; Waldhäusl W

1994-03-01

220

Metabolic and hematologic changes occurring after rapid intravenous infusion of gammaglobulin in patients with antibody deficiency syndromes  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese OBJETIVO: Nós pretendemos investigar se o aumento de velocidade de infusão de gamaglobulina intravenosa (IVIG), está associada com alterações metabólicas e hematológicas em pacientes com deficiência de anticorpo. CASUÍSTICA E MÉTODO: Nós estudamos sete pacientes (2-16 anos) com deficiência primária de anticorpo que já estavam em tratamento com reposição regular de IgG, na dose de 350-600 mg/kg a cada três semanas em preparados a 3%, por períodos de seis (more) meses a quatro anos. Inicialmente a concentração dos preparados de IVIG foi aumentando para 6, 9 e 12% em infusões consecutivas numa velocidade constante 4 mg/kg/min. Subseqüentemente, na segunda fase do estudo, mantivemos a concentração a 12% e a velocidade de infusão foi aumentando para 8, 12, e 16 mg/kg/min. RESULTADOS: Clinicamente, todos os pacientes toleraram o aumento da concentração de IVIG na velocidade constante de 4 mg/kg/min. Entretanto, 3 pacientes apresentaram efeitos colaterais quando a velocidade de infusão aumentou para 8 e 16 mg/kg/min. CONCLUSÃO: Nós concluímos que alterações metabólicas e hematológicas podem ocorrer quando se administra preparados de IVIG em altas concentração e velocidade mesmo que os pacientes tolerem bem clinicamente. As vantagens de utilizar velocidades elevadas na infusão de IVIG devem ser reavaliadas. Abstract in english OBJECTIVE: We wished to investigate whether increased IgG infusion rates are associated with metabolic and hematologic changes in pediatric patients with antibody deficiency syndromes. METHODS: We studied 7 patients (2-16 years old) with primary antibody deficiencies who had been on regular IgG replacement treatment, 350-600 mg/kg/dose every 3 weeks with a 3% IVIG preparation, for periods ranging from 6 months to 4 years. Initially, the IgG concentration of IVIG preparat (more) ions was increased to 6, 9 and 12% in consecutive infusions at a constant IgG infusion rate of 4 mg/kg/min. Subsequently, the infusion rates were increased to 8, 12, and 16 mg/kg/min using the IVIG 12% preparation. RESULTS: Clinically, all patients tolerated increases in IVIG concentrations while the infusion rate was 4 mg/kg/min. However, 3 patients presented side effects when the infusion rate was increased to 8 and 16 mg/kg/min. CONCLUSION: We conclude that metabolic and hematologic sides effects occur with rapid infusion of IVIG even in patients who tolerate the increased infusion rate clinically. The advantages of using high infusion rates have to be re-evaluated.

Costa-Carvalho, Beatriz Tavares; Lin, Marisa; Solé, Dirceu; Carneiro-Sampaio, Magda Maria Sales; Sorensen, Ricardo Uhr; Naspitz, Charles Kirov

1998-09-01

 
 
 
 
221

Insulin infusion suppresses while glucose infusion induces Toll-like receptors and high-mobility group-B1 protein expression in mononuclear cells of type 1 diabetes patients.  

UK PubMed Central (United Kingdom)

The purpose of this study was to determine whether an insulin infusion exerts an anti-inflammatory effect and whether the infusion of small amounts of glucose results in oxidative and inflammatory stress in patients with type 1 diabetes. Ten patients with type 1 diabetes were infused with either 2 U/h of insulin with 100 ml 5% dextrose/h to or just dextrose (100 ml/h) or physiological saline (100 ml/h) for 4 h after an overnight fast on three separate days. Blood samples were collected at 0, 2, 4, and 6 h. Insulin with glucose infusion led to the maintenance of euglycemia and a significant suppression of reactive oxygen species (ROS) generation, p47(phox) expression, Toll-like receptor (TLR)-4, TLR-2, TLR-1, CD14, high-mobility group-B1 (HMGB1), p38 mitogen-activated protein (MAP) kinase, c-Jun NH2-terminal kinase (JNK)-1, and platelet/endothelial cell adhesion molecule expression and a fall in serum concentrations of C-reactive protein, HMGB1, and rapid upon activation T cell expressed and secreted. Glucose infusion led to an increase in plasma glucose concentration from 115 (fasting) to 215 (at 4 and 6 h) mg/dl and to an increase in ROS generation, the expression of TLR-4, TLR-2, TLR-1, HMGB1, p38 MAP kinase, and JNK-1, and plasma concentrations of HMGB1. While insulin reduces indexes of oxidative and inflammatory stress in patients with type 1 diabetes, even small amounts of glucose (20 g over 4 h) induce oxidative and inflammatory stress. These effects are reflected in TLR, p38 MAP kinase, and HMGB1 expression. The induction of significant oxidative and inflammatory stress by small amounts of glucose in patients with type 1 diabetes may have important pathophysiological and therapeutic implications.

Dandona P; Ghanim H; Green K; Sia CL; Abuaysheh S; Kuhadiya N; Batra M; Dhindsa S; Chaudhuri A

2013-04-01

222

Administration of 24-h intravenous infusions of trabectedin in ambulatory patients with mesenchymal tumors via disposable elastomeric pumps: an effective and patient-friendly palliative treatment option.  

UK PubMed Central (United Kingdom)

BACKGROUND: Patients with progressive mesenchymal tumours after standard chemotherapy have poor outcome. Trabectedin is approved in Europe as 24-h intravenous (i.v.) infusion q3w in this setting. We report the use of disposable elastomeric pumps for ambulatory treatment with trabectedin. MATERIAL AND METHODS: Pre-treated sarcoma patients were offered trabectedin 1.5 mg/m(2) as 24-h i.v. infusion via port catheter, either as inpatients using electronic pumps or as outpatients using the Baxter LV10 pump. Co-medication consisted of antiemetics including dexamethasone. RESULTS: 21/28 patients with distant metastasis and/or local relapse elected outpatient therapy and received 130 cycles (median 3, range 1-24). Dose reductions were done in 60 cycles, mainly due to laboratory adverse events (AEs). Best response (Response Evaluation Criteria in Solid Tumours (RECIST)) was 4 cases of confirmed partial remission (PR), 6 cases of stable disease (SD), and 11 cases of progressive disease (PD). Grade 3/4 (Common Toxicity Criteria (CTC)) AEs were limited to 1 case each of haemorrhage and lung embolism; other AEs were in line with published trabectedin experience. 1 port catheter contamination required replacement, 1 catheter thrombosis occurred and 1 extravasation due to needle dislocation was observed. CONCLUSIONS: Outpatient administration of trabectedin as 24-h infusion using Baxter LV10 pumps is preferred by the vast majority of patients; it is feasible, safe, effective, cost efficient, and should be considered as routine practice in this clinical setting.

Schöffski P; Cerbone L; Wolter P; De Wever I; Samson I; Dumez H; Clement P; Wildiers H; Stas M

2012-01-01

223

Longitudinal infusion of a complex of insulin-like growth factor-I and IGF-binding protein-3 in five preterm infants: pharmacokinetics and short-term safety.  

UK PubMed Central (United Kingdom)

BACKGROUND: In preterm infants, low levels of insulin-like growth factor-I (IGF-I) and IGF binding protein 3 (IGFBP-3) are associated with impaired brain growth and retinopathy of prematurity (ROP). Treatment with IGF-I/IGFBP-3 may be beneficial for brain development and may decrease the prevalence of ROP. METHODS: In a phase II pharmacokinetics and safety study, five infants (three girls) with a median (range) gestational age (GA) of 26 wk + 6 d (26 wk + 0 d to 27 wk + 2 d) and birth weight of 990 (900-1,212) g received continuous intravenous infusion of recombinant human (rh)IGF-I/rhIGFBP-3. Treatment was initiated during the first postnatal day and continued for a median (range) duration of 168 (47-168) h in dosages between 21 and 111 µg/kg/24 h. RESULTS: Treatment with rhIGF-I/rhIGFBP-3 was associated with higher serum IGF-I and IGFBP-3 concentrations (P < 0.001) than model-predicted endogenous levels. Of 74 IGF-I samples measured during study drug infusion, 37 (50%) were within the target range, 4 (5%) were above, and 33 (45%) were below. The predicted dose of rhIGF-I/rhIGFBP-3 required to establish circulating levels of IGF-I within the intrauterine range in a 1,000 g infant was 75-100 µg/kg/24 h. No hypoglycemia or other adverse effects were recorded. CONCLUSION: In this study, continuous intravenous infusion of rhIGF-I/rhIGFBP-3 was effective in increasing serum concentrations of IGF-I and IGFBP-3, and was found to be safe.

Ley D; Hansen-Pupp I; Niklasson A; Domellöf M; Friberg LE; Borg J; Löfqvist C; Hellgren G; Smith LE; Hård AL; Hellström A

2013-01-01

224

Labetalol infusion for refractory hypertension causing severe hypotension and bradycardia: an issue of patient safety  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Incremental doses of intravenous labetalol are safe and effective and, at times, such therapy may need to be augmented by a continuous infusion of labetalol to control severe hypertension. Continuous infusions of labetalol may exceed the recommended maximum daily dose of 300 mg on occasion. We report a case in which hypertension occurring after an abdominal aortic aneurysm repair, initially responsive to intermittent intravenous beta-blockade, became resistant to this therapy leading to the choice of an intravenous labetalol infusion as the therapeutic option. The labetalol infusion resulted in a profound cardiovascular compromise in this postoperative critically ill patient. While infusions of labetalol have successfully been used, prolonged administration in the intensive care unit requires vigilance and the establishment of a therapeutic rationale/policy for interventions, such as the ready availability of glucagon, ?-agonists, phosphodiesterase inhibitors, insulin, and vasopressin when severe cardiovascular depression occurs.

Fahed Samir; Grum Daniel F; Papadimos Thomas J

2008-01-01

225

Paradoxical glucose-induced hyperkalemia. Combined aldosterone-insulin deficiency.  

Science.gov (United States)

Severe hyperkalemia associated with spontaneous hyperglycemia as well as with the intravenous infusions of glucose occurred in an insulin-requiring diabetic patient in the absence of potassium administration, the use of diuretics which inhibit urinary potassium excretion or acidemia. Metabolic balance studies revealed, in addition to diabets, the presence of isolated aldosterone deficiency of the hyporeninemic type. Intravenous glucose infusions (0.5 g/kg body weight) produced significant hyperkalemia but desoxycortisone acetate (DOCA) therapy (10 mg/day) prevented the glucose-induced hyperkalemia. In this patient, the serum potassium concentration increases after the intravenous infusions of glucose because there is insufficient aldosterone and insulin to reverse the transfer of potassium to the extracellular fluid which normally occurs after hypertonic infusions of glucose. Although DOCA replacement modifies the distribution of potassium in the extracellular fluid and blunts the hyperkalemic effect of intravenous infusions of glucose, a rise in the insulin level is required for the usual hypokalemic response to intravenously administered glucose. These studies illustrate the risk of raising blood glucose levels in patients with combined aldosterone and insulin deficiency and the tendency towards hyperkalemia in diabetic patients under certain clinical conditions. PMID:1200041

Goldfarb, S; Strunk, B; Singer, I; Goldberg, M

1975-11-01

226

Paradoxical glucose-induced hyperkalemia. Combined aldosterone-insulin deficiency.  

UK PubMed Central (United Kingdom)

Severe hyperkalemia associated with spontaneous hyperglycemia as well as with the intravenous infusions of glucose occurred in an insulin-requiring diabetic patient in the absence of potassium administration, the use of diuretics which inhibit urinary potassium excretion or acidemia. Metabolic balance studies revealed, in addition to diabets, the presence of isolated aldosterone deficiency of the hyporeninemic type. Intravenous glucose infusions (0.5 g/kg body weight) produced significant hyperkalemia but desoxycortisone acetate (DOCA) therapy (10 mg/day) prevented the glucose-induced hyperkalemia. In this patient, the serum potassium concentration increases after the intravenous infusions of glucose because there is insufficient aldosterone and insulin to reverse the transfer of potassium to the extracellular fluid which normally occurs after hypertonic infusions of glucose. Although DOCA replacement modifies the distribution of potassium in the extracellular fluid and blunts the hyperkalemic effect of intravenous infusions of glucose, a rise in the insulin level is required for the usual hypokalemic response to intravenously administered glucose. These studies illustrate the risk of raising blood glucose levels in patients with combined aldosterone and insulin deficiency and the tendency towards hyperkalemia in diabetic patients under certain clinical conditions.

Goldfarb S; Strunk B; Singer I; Goldberg M

1975-11-01

227

Impaired endothelial antithrombotic activity following short-term interruption of continuous subcutaneous insulin infusion in type 1 diabetic patients.  

Science.gov (United States)

Review of literature has shown an increased rate of thrombotic complications in diabetic patients with frequent episodes of hyperketonemia. However, the mechanisms by which ketosis promotes vascular disease in diabetic patients are unclear. It was the aim of this study to investigate early changes in haemostatic parameters and oxidative stress markers during the hyperketonemic status which follows the interruption of continuous subcutaneous insulin infusion (CSII) in type I diabetic patients. Eight CSII-treated type I diabetic patients underwent a 4-hour pump arrest. Blood glucose, insulin and 3-hydroxybutirate were measured to verify the metabolic response. A vein-occlusive (VO) test was performed for the determination of tPA and PAI-1 activities and their antigen levels before and after the CSII arrest. Coagulation factor VII and VIII were evaluated by one-stage PT and PTT method, respectively. TF, vWF, tPA and PAI-1 antigens were determined by ELISA, whereas tPA and PAI-1 activities using chromogenic methods. Plasma malondialdehyde (MDA) and protein carbonyl groups (PCG) levels were determined by HPLC and spectrophotometry, respectively. After the insulin deprivation phase, post-VO tPA antigen level significantly decreased (P = 0.0391), whereas TF and post-VO PAI-1 activity and antigen levels significantly increased (P = 0.0156 and P = 0.0234, respectively). Plasma MDA and PCG levels were 1.88-fold and 1.74-fold higher than baseline values, respectively. In conclusion, the impairment of the fibrinolytic potential and the increases in TF, MDA and PCG levels may enhance the risk of both arterial and venous thrombosis during ketosis. Thus, early detection of hyperketonemia in DM patients could contribute to the prevention of life-threatening vascular events. PMID:17849053

Iorio, Alfonso; Federici, Marco Orsini; Mourvaki, Evangelia; Ferolla, Piero; Piroddi, Marta; Stabile, Anna; Timi, Alessandra; Celleno, Roberta; Benedetti, Massimo Massi

2007-09-01

228

Turnover Modeling of Non-Esterified Fatty Acids in Rats after Multiple Intravenous Infusions of Nicotinic Acid  

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The objective of this investigation was to use a pharmacokinetic (PK)/pharmacodynamic (PD) approach to describe and evaluate a PK model of nicotinic acid (NiAc) in guinea pigs and a PD feedback model of changes in non-esterified fatty acid (NEFA) concentrations in rats following multiple intravenous...

Isaksson, Christine; Gabrielsson, Johan; Wallenius, Kristina; Peletier, Lambertus A.; Toreson, Helena

229

Effect of dietary nitrogen content and intravenous urea infusion on ruminal and portal-drained visceral extraction of arterial urea in lactating Holstein cows  

DEFF Research Database (Denmark)

Urea extraction across ruminal and portal-drained visceral (PDV) tissues were investigated using 9 rumen-cannulated and multi-catheterized lactating dairy cows adapted to low-N (12.9% crude protein) and high-N (17.1% crude protein) diets in a crossover design. The interaction between adaptation to dietary treatments and blood plasma concentrations of urea was studied by dividing samplings into a 2.5-h period without urea infusion followed by a 2.5-h period with primed continuous intravenous infusion of urea (0.493 ± 0.012 mmol/kg of BW per h). Cows were sampled at 66 ± 14 and 68 ± 12 d in milk and produced 42 ± 1 and 36 ± 1 kg of milk/d with the high-N and low-N diets, respectively. The arterial blood urea concentration before urea infusion was 1.37 and 4.09 ± 0.18 mmol/L with low-N and high-N, respectively. Dietary treatment did not affect the urea infusion-induced increase in arterial urea concentration (1.91 ± 0.13 mmol/L). Arterial urea extraction across the PDV and rumen increased from 2.7 to 5.4 ± 0.5% and from 7.1 to 23.8 ± 2.1% when cows were changed from high-N to low-N, respectively. Urea infusion did not decrease urea extractions, implying that urea transport rates were proportional to arterial urea concentrations. Urea extraction increased more across the rumen wall than across the total PDV for low-N compared with high-N, which implies that a larger proportion of total PDV uptake of arterial urea is directed toward the rumen with decreasing N intake. The ruminal vein - arterial (RA) concentration difference for ammonia increased instantly (first sampling 15 min after initiation of infusion) to the primed intravenous infusion when cows were adapted to the low-N diet. The RA difference for ammonia correlated poorly to the ventral ruminal concentration of ammonia (r = 0.55). Relating the RA difference for ammonia to a function of both ruminal ammonia concentration and the RA difference for urea markedly improved the fit (r = 0.85), indicating that a large fraction of ammonia released to the ruminal veinis absorbed from an epithelial ammonia pool not in equilibrium with the ventral ruminal ammonia pool. Changing cows from high-N to low-N affected the relative blood urea clearance by kidneys and PDV. The clearance by the kidneys decreased from 41 to 27 ± 2 L/h and the clearance by the PDV increased from 52 to 105 ± 12 L/h when the diet was changed from high-N to low-N. In conclusion, urea transport across gut epithelia in cattle is adapting to N status and driven by mass action. Data are commensurable with a model for urea transport across gut epithelia based on regulated expression or activity of facilitative urea transporters.

Kristensen, Niels Bastian; Storm, Adam Christian

2010-01-01

230

A slow intravenous infusion of N-methyl-DL-aspartate as a seizure model in the mouse.  

UK PubMed Central (United Kingdom)

A seizure model involving slow i.v. infusion of the excitatory amino acid N-methyl-DL-aspartate (NMDLA) in the mouse is described. It allows determination of the threshold doses of NMDLA required to elicit clonic and tonic seizures in individual mice. The NMDA receptor antagonists MK-801, CPP, ifenprodil and 7-chlorokynurenic acid (7-CLK), and diazepam dose-dependently increased the dose of NMDLA required to elicit a tonic seizure. CPP, 7-CLK and diazepam also increased the dose of NMDLA inducing clonic seizures. In contrast, ifenprodil at doses which antagonised tonic seizures had no effect on clonic seizures. The glycine and polyamine modulatory site agonists, D-serine and spermidine respectively, dose-dependently reduced the dose of NMDLA required to induce clonic and tonic seizures. The NMDLA infusion model appears to be more sensitive than the classical bolus injection test and can detect both anticonvulsant and proconvulsant actions mediated by the NMDA receptor complex.

Singh L; Oles RJ; Vass CA; Woodruff GN

1991-05-01

231

Intravenous lipid infusion in the successful resuscitation of local anesthetic-induced cardiovascular collapse after supraclavicular brachial plexus block.  

UK PubMed Central (United Kingdom)

We describe a case of successful resuscitation with an i.v. lipid infusion of local anesthetic-induced cardiovascular toxicity after supraclavicular brachial plexus block with mepivacaine and bupivacaine. Lipid therapy was initiated after 10 min of unsuccessful resuscitation and resulted in restoration of cardiovascular activity and hemodynamic stability. This case illustrates the utility of i.v. lipid therapy in the treatment of local anesthetic toxicity.

Warren JA; Thoma RB; Georgescu A; Shah SJ

2008-05-01

232

Intravenous lipid infusion in the successful resuscitation of local anesthetic-induced cardiovascular collapse after supraclavicular brachial plexus block.  

Science.gov (United States)

We describe a case of successful resuscitation with an i.v. lipid infusion of local anesthetic-induced cardiovascular toxicity after supraclavicular brachial plexus block with mepivacaine and bupivacaine. Lipid therapy was initiated after 10 min of unsuccessful resuscitation and resulted in restoration of cardiovascular activity and hemodynamic stability. This case illustrates the utility of i.v. lipid therapy in the treatment of local anesthetic toxicity. PMID:18420881

Warren, Julio A; Thoma, R Brian; Georgescu, Alexandru; Shah, Saurin J

2008-05-01

233

Continuous subcutaneous insulin infusion in adult type 1 diabetes mellitus: data from a registry at the University Medical Centre Ljubljana, Slovenia.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate the treatment indications, effectiveness and adverse events of continuous subcutaneous insulin infusion (CSII) in adults with type 1 diabetes mellitus using data from a registry at the University Medical Centre Ljubljana, Ljubljana, Slovenia. METHODS: The registry included patients with type 1 diabetes who had converted from multiple daily injection (MDI) to CSII. Patients with complete data sets covering a period of ?3 years were included in the study (n=184). Complications, glycaemic control and insulin dose during CSII were compared with data obtained during MDI. RESULTS: CSII resulted in significant reductions in glycosyated haemoglobin level and total daily insulin dose. The mean number of severe hypoglycaemic episodes during CSII was 0.17 per patient per year. CONCLUSIONS: Treatment of adults with type 1 diabetes mellitus by CSII can improve glycaemic control and reduce insulin requirements compared with MDI, however patient selection, education and continuous care are important parts of this therapy.

Janez A

2012-01-01

234

Phase I and pharmacokinetic study of the ribonucleotide reductase inhibitor, 3-aminopyridine-2-carboxaldehyde thiosemicarbazone, administered by 96-hour intravenous continuous infusion.  

UK PubMed Central (United Kingdom)

PURPOSE: 3-aminopyridine-2-carboxaldehyde thiosemicarbazone (3-AP; Triapine; Vion Pharmaceuticals Inc, New Haven, CT) is a potent inhibitor of ribonucleotide reductase, with activity in preclinical tumor model systems. A phase I trial was initiated to determine the dose-limiting toxicities, maximum-tolerated dose, and pharmacokinetics of a 96-hour intravenous (IV) continuous infusion in patients with advanced cancer. PATIENTS AND METHODS: Initially, courses were administered every 3 weeks, using an accelerated titration design. Subsequently, courses were administered every 2 weeks, and the dose was escalated in cohorts of three to six patients. RESULTS: Twenty-one patients were enrolled, seven on the every-3-week schedule and 14 on the every-other-week schedule. Three of six patients at 160 mg/m(2)/d developed dose-limiting toxicities including neutropenia, hyperbilirubinemia, and nausea or vomiting. Based on these initial results, the dose for 3-AP was re-escalated beginning at 80 mg/m(2)/d but administered every 2 weeks. At 120 mg/m(2)/d, three of seven patients had dose-limiting but reversible asthenia, hyperbilirubinemia, and azotemia or acidosis; however, in the case of renal and hepatic adverse events, the events were related to pre-existing borderline abnormal organ function. Therefore, the recommended phase II dose for 3-AP administered by 96-hour IV infusion is 120 mg/m(2)/d every 2 weeks. Detailed pharmacokinetic studies demonstrated linear kinetics up to 160 mg/m(2), with substantial inter-patient variability. There was no correlation between dose and clearance (R(2) = 0.0137). There were no objective responses, but there was prolonged stabilization of disease or decreases in serum tumor markers associated with stable disease in four patients. CONCLUSION: The 96-hour infusion of 3-AP is safe and well tolerated at the recommended phase II doses. Phase II trials of Triapine are ongoing.

Wadler S; Makower D; Clairmont C; Lambert P; Fehn K; Sznol M

2004-05-01

235

Safety and efficacy of intravenous hypotonic 0.225% sodium chloride infusion for the treatment of hypernatremia in critically ill patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: The purpose of this study was to evaluate the safety and efficacy of central venous administration of a hypotonic 0.225% sodium chloride (one-quarter normal saline [¼ NS]) infusion for critically ill patients with hypernatremia. METHODS: Critically ill, adult patients with traumatic injuries and hypernatremia (serum sodium [Na] >150 mEq/L) who were given ¼ NS were retrospectively studied. Serum sodium, fluid balance, free water intake, sodium intake, and plasma free hemoglobin concentration (fHgb) were assessed. RESULTS: Twenty patients (age, 50 ± 18 years; Injury Severity Score, 29 ± 12) were evaluated. The ¼ NS infusion was given at 1.5 ± 1.0 L/d for 4.6 ± 1.6 days. Serum sodium concentration decreased from 156 ± 4 to 143 ± 6 mEq/L (P < .001) over 3-7 days. Total sodium intake was decreased from 210 ± 153 to 156 ± 112 mEq/d (P < .05). Daily net fluid balance was not significantly increased. Plasma fHgb increased from 4.9 ± 5.4 mg/dL preinfusion to 8.9 ± 7.4 mg/dL after 2.6 ± 1.3 days of continuous intravenous (IV) ¼ NS in 10 patients (P = .055). An additional 10 patients had a plasma fHgb of 10.2 ± 9.0 mg/dL during the infusion. Hematocrit and hemoglobin decreased (26% ± 3% to 24% ± 2%, P < .001 and 9.1 ± 1.1 to 8.2 ± 0.8 g/dL, P < .001, respectively). CONCLUSIONS: Although IV ¼ NS was effective for decreasing serum sodium concentration, evidence for minor hemolysis warrants further research to establish its safety before its routine use can be recommended.

Dickerson RN; Maish GO 3rd; Weinberg JA; Croce MA; Minard G; Brown RO

2013-06-01

236

Formation of biologically active 13,14-dihydro-prostaglandin E1 during intravenous infusion of prostaglandin E1 in newborns with ductus arteriosus-dependent congenital heart disease.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Plasma concentrations of prostaglandin (PG) E1 (12-150, median 25 pg ml-1) and 13,14-dihydro-PGE1 (3-62, median 45.5 pg ml-1) were measured by gas chromatography-mass spectrometry in eight newborns with ductus arteriosus-dependent congenital heart disease during continuous intravenous infusion of PG...

Leonhardt, A; Schweer, H; Wolf, D; Seyberth, H W

237

Plasma matrix metalloproteinase activity in horses after intravenous infusion of lipopolysaccharide and treatment with matrix metalloproteinase inhibitors.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To establish an in vivo method for matrix metalloproteinase (MMP)-2 and MMP-9 induction in horses via IV administration of lipopolysaccharide (LPS) and to evaluate the ability of doxycycline, oxytetracycline, flunixin meglumine, and pentoxifylline to inhibit equine MMP-2 and MMP-9 production. ANIMALS: 29 adult horses of various ages and breeds and either sex. PROCEDURES: In part 1, horses received an IV administration of LPS (n = 5) or saline (0.9% NaCl) solution (5). Venous blood samples were collected before and at specified times for 24 hours after infusion. Plasma was harvested and analyzed for MMP-2 and MMP-9 activities via zymography. In part 2, horses received doxycycline (n = 5), oxytetracycline (5), flunixin meglumine (5), or pentoxifylline (4) before and for up to 12 hours after administration of LPS. Plasma was obtained and analyzed, and results were compared with results from the LPS-infused horses of part 1. RESULTS: Administration of LPS significantly increased MMP-2 and MMP-9 activities in the venous circulation of horses. All MMP inhibitors significantly decreased LPS-induced increases in MMP activities but to differing degrees. Pentoxifylline and oxytetracycline appeared to be the most effective MMP-2 and MMP-9 inhibitors, whereas doxycycline and flunixin meglumine were more effective at inhibiting MMP-2 activity than MMP-9 activity. CONCLUSIONS AND CLINICAL RELEVANCE: IV administration of LPS to horses caused increased venous plasma activities of MMP-2 and MMP-9. These MMP activities were reduced by pentoxifylline and oxytetracycline, suggesting that further evaluation of these medications for treatment and prevention of MMP-associated diseases in horses is indicated.

Fugler LA; Eades SC; Moore RM; Koch CE; Keowen ML

2013-03-01

238

Intravenous infusion of magnesium sulphate during subarachnoid anaesthesia in hip surgery and its effect on postoperative analgesia: our experience.  

UK PubMed Central (United Kingdom)

The treatment of degenerative hip joint disease involves modern operative techniques and the use of prosthetic devices individualized on each patient. Being a surgery of considerable importance, great attention is always given by the anaesthesiologist to postoperative analgesia. In general, our goal is to limit the doses of NSAIDs, known to be associated with haemostasis interference and alteration of gastrointestinal apparatus; component of our baseline analgesic protocols after arthroplasty is morphine given parenterally. In order to steadily improve analgesic techniques, which directly impact on patient outcome, we experimented the use of a continuous infusion of magnesium sulphate during subarachnoid anaesthesia. Magnesium sulphate is the drug of choice in case of eclampsia, and pre-eclampsia (for the risk of evolution in eclampsia). According to the most recent findings, this drug has also analgesic properties: its use as an adjunct to analgesia is based on a non-competitive antagonism towards the NMDA receptor and on the blocking of calcium channels: these properties prevent the mechanisms of central sensitization due to nociceptive stimulation of peripheral nerves.

Pastore A; Lanna M; Lombardo N; Policastro C; Iacovazzo C

2013-01-01

239

[Cardiotoxicity of continuous intravenous infusion of 5-fluorouracil: clinical study, prevention and physiopathology. Apropos of 13 cases].  

Science.gov (United States)

5-Fluorouracil (5FU) cardiotoxicity is thought to be an infrequent toxic effect, usually related to coronary vasospasm. Among 198 patients (pts) receiving 5FU as a continuous infusion (CI) over 96 or 120 h, at a daily dose of 1,000 mg/m2, 13 new cases of 5FU--cardiotoxicity are reported. In all cases but 1, cardiovascular symptoms occurred at the first 5FU-CI course, with mean time of onset of 3 d. Chest pain was the prominent inaugural symptom with angor pectoris (6 pts) and pericarditis (3 pts). Five pts developed cardiogenic shock, which was irreversible in 3 cases. The severity of such an evolution requires prompt 5FU discontinuation, if symptoms occur, and careful hemodynamic supervision during 5FU therapy. One patient experienced typical myocardial infarction, another one epicardo myocardiopathic process with adiastolia. Disorders of repolarisation on electrocardiographic tracing were the prominent abnormalities, associated with a significant increase of QT segment in 3 cases. Re-introduction of 5FU-CI resulted in chest pain recurrence in 2 out of 4 pts, despite calcium antagonist "prevention". In our retrospective study, the incidence of 5FU-CI cardiotoxicity is 6.5%, which is consistent with recent reports (10%). Whether 5FU-induced cardiotoxicity mechanism is related to vasospastic or direct effect remains unclear. However, our series suggests a 5FU-induced post ischaemic myocardial dysfunction as described in the "stunned myocardium" syndrome. PMID:2205312

de Forni, M; Bugat, R; Sorbette, F; Delay, M; Bachaud, J M; Chevreau, C

1990-01-01

240

[Influence of the treatment with continuous subcutaneous insulin infusion (CSII) in the improvement of the quality of life of patients with type 1 diabetes mellitus].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate the influence of the treatment with continuous subcutaneous insulin infusion on the quality of life of type 1 diabetics. METHOD: An analytical study of cohorts was conducted on 80 patients diagnosed with type 1 diabetes mellitus, with more than five years of evolution and without evidence of micro-macro vascular complications, on treatment with CSII or multiple daily insulin injections (MDII). The quality of life of both groups was evaluated by means of a validated modification of the survey "Diabetes Quality of Life Measure" (DQLM). The SPSS 11.0 software was used to determine Chi(2) and establish statistically significant values for a P<0.05. RESULTS: In 86% (31/36) of the questions, the patients on treatment with insulin infusion systems showed higher satisfaction with their quality of life than the patients with multiple daily insulin injections, although only in 16% (6/36) of the questions, were the scores significantly better in the first group. CONCLUSIONS: There were no significant differences in the dimensions studied between both groups, but the patients with CSII obtain better results in many variables of the fe DQLM, and they were more satisfied with the flexibility that their treatment offers them in daily life activities.

Casas-Oñate ML; Montoya-Martínez D

2010-07-01

 
 
 
 
241

CDDP chemotherapy combined with radiation for the head and neck cancer. Comparison between intravenous and intraarterial infusion  

Energy Technology Data Exchange (ETDEWEB)

The present study describes the results of chemotherapy by cisplatin combined with the radiation therapy. A total of 12 patients with the head and neck cancer were treated. The location of the primary site was the maxillary sinus in 4 cases, the tongue in 2 cases, the maxillary gingiva in 2 cases and the mandibular gingiva in 2 cases. The buccal mucosa and mandibular bone were affected in each one case. The Histological types of the tumors were squamous cell carcinomas in 11 cases and adenocarcinoma in one case. Six patients were treated by intraarterial injection of cisplatin and another six patients were treated by intravenous injection of cisplatin. Total dose from 30 to 50 Gy of irradiation was administrated to both groups. Results of the therapy of 10 patients were CR in 6 cases, PR in 3 cases and NC in one case. The CR rate was 60 percent and PR rate was 30 percent. CR was achieved in all 4 cases treated by intraarterial administration of cisplatin.

Mikami, Yutaka; Iseki, Tomio; Kaji, Ryuichi

1987-11-01

242

Efficacy of endotracheal lidocaine administration with continuous infusion of remifentanil for attenuating tube-induced coughing during emergence from total intravenous anesthesia.  

UK PubMed Central (United Kingdom)

PURPOSE: Although attenuation of tube-induced coughing is necessary in specific types of surgery, the best method for such attenuation is still unclear. We studied the combined intervention of endotracheal lidocaine and intravenous remifentanil compared to intravenous remifentanil alone with respect to coughing during emergence from anesthesia. METHODS: We examined 60 ASA 1-2 patients (age, 20-69 years) undergoing tympanoplasty under general anesthesia. Anesthesia was induced with propofol, remifentanil, and rocuronium. The trachea was intubated using a laryngotracheal instillation of topical anaesthetic (LITA) tracheal tube. Anesthesia was maintained with propofol and remifentanil (0.1-0.3 ?g/kg/min). Propofol was discontinued and remifentanil (0.1 ?g/kg/min) was continued at the end of the operation. Patients were randomly allocated to the lidocaine (n = 30) and control groups (n = 30). We administered 3 ml 4 % lidocaine via the LITA tube to patients in lidocaine group at the end of the operation. The trachea was extubated when the patient regained consciousness and followed orders. Coughing was evaluated using a 4-point scale by an observer who examined the video records at extubation. RESULTS: Fewer patients in lidocaine group (8 of 30) than in control group (18 of 30, p < 0.01) coughed. Fewer patients in lidocaine group (2 of 30) than in control group (12 of 30, p < 0.01) had moderate or severe cough (scale 2 or 3). CONCLUSIONS: This study is consistent with the finding that endotracheal lidocaine administration and continuous infusion of remifentanil before extubation is useful to prevent coughing on emergence from anesthesia.

Yamasaki H; Takahashi K; Yamamoto S; Yamamoto Y; Miyata Y; Terai T

2013-05-01

243

Alemtuzumab by continuous intravenous infusion followed by subcutaneous injection plus rituximab in the treatment of patients with chronic lymphocytic leukemia recurrence.  

UK PubMed Central (United Kingdom)

BACKGROUND: Monoclonal antibodies may be used more effectively in combination. A previous study of intravenous (iv) bolus alemtuzumab plus rituximab in patients with chronic lymphocytic leukemia (CLL) recurrence produced a response rate of 54% after a 4-week treatment period. METHODS: To optimize dose, schedule, and route of alemtuzumab, a study was designed exploring continuous intravenous infusion (civ) followed by subcutaneous (sc) alemtuzumab together with weekly iv rituximab in patients with previously treated CLL. RESULTS: Data from 40 patients with a median age of 59 years, and a median of 3 prior regimens (range, 1-8 regimens) were evaluable. Approximately 64% of patients were fludarabine-refractory. Seven patients (18%) achieved a complete response (CR), 4 (10%) a nodular partial response (nPR), and 10 (25%) a partial response for an overall response rate of 53%. Of 11 major responses (CR, nPR), 8 occurred after cycle 1. Response rates were highest in blood (94%), followed by liver/spleen (82%), bone marrow (68%), and lymph nodes (51%). The combination did not generate unexpected toxicities. Cytomegalovirus (CMV) reactivations occurred in 6 patients (15%) and responded well to anti-CMV therapy. High titers of anti-idiotype antibodies after sc alemtuzumab were demonstrated in 1 patient, but remained without clinical sequelae. CONCLUSIONS: The combination of civ/sc alemtuzumab plus rituximab has activity in some patients with recurrent/refractory CLL and maximum response is achieved after 1 cycle (4 weeks) in 73% of patients. Further exploration in other settings of CLL together with accompanying pharmacokinetic studies is recommended.

Faderl S; Ferrajoli A; Wierda W; O'Brien S; Lerner S; Keating MJ

2010-05-01

244

Sodium-retaining effect of insulin in diabetes.  

UK PubMed Central (United Kingdom)

Insulin has long been hypothesized to cause sodium retention, potentially of enough magnitude to contribute to hypertension in obesity, metabolic syndrome, and Type II diabetes. There is an abundance of supportive evidence from correlational analyses in humans, acute insulin infusion studies in humans and animals, and chronic insulin infusion studies in rats. However, the absence of hypertension in human insulinoma patients, and negative results for sodium-retaining or blood pressure effects of chronic insulin infusion in a whole series of dog studies, strongly refute the insulin hypothesis. We recently questioned whether the euglycemic, hyperinsulinemia model used for most insulin infusion studies, including the previous chronic dog studies, was the most appropriate model to test the renal actions of insulin in obesity, metabolic syndrome, and Type II diabetes. In those circumstances, hyperinsulinemia coexists with hyperglycemia. Therefore, we tested the sodium-retaining effect of insulin in chronically instrumented, alloxan-treated diabetic dogs. We used 24 h/day intravenous insulin infusion to regulate plasma insulin concentration. Induction of diabetes (?400 mg/dl) caused sustained natriuresis and diuresis. However, if we clamped insulin at baseline, control levels, i.e., prevented it from decreasing, then the sustained natriuresis and diuresis were completely reversed, despite the same level of hyperglycemia. We also found that 24 h/day intrarenal insulin infusion had the same effect in diabetic dogs but had no sodium-retaining action in normal dogs. This new evidence that insulin has a sodium-retaining effect during hyperglycemia may have implications for maintaining sodium balance in uncontrolled Type II diabetes.

Brands MW; Manhiani MM

2012-12-01

245

Evaluation of bedoradrine sulfate (MN-221), a novel, highly selective beta2-adrenergic receptor agonist for the treatment of asthma via intravenous infusion.  

UK PubMed Central (United Kingdom)

BACKGROUND: The number of hospitalizations or deaths due to asthma, most of which result from acute exacerbations of asthma, has remained the same for the past 20 years. MN-221 (bedoradrine sulfate) is a novel, highly selective beta2- (?2-) adrenergic agonist administered via intravenous (IV) infusion in development for the treatment for acute exacerbation of asthma. OBJECTIVES: Trial MN-221-CL-004 assessed the safety profile and preliminary efficacy of MN-221 in escalating doses in patients with stable mild-to-moderate asthma. Study MN-221-CL-005 assessed the safety profile and preliminary efficacy of MN-221 in patients with stable moderate-to-severe asthma when given as a fixed dose over 1- or 2- hr infusion. METHODS: Two randomized, placebo-controlled clinical trials (n = 40) were performed to evaluate the pharmacokinetic (PK) and clinical effects of a novel, highly selective ?2-agonist, MN-221, via IV infusion. Safety evaluations included vital signs, adverse events (AEs), clinical laboratory parameters, and electrocardiogram results. Efficacy evaluation included measurement of forced expiratory volume in 1 second (FEV) a?nd PK parameters were additionally monitored. The study was reviewed and approved by the Institutional Review Board at each site. RESULTS: Adverse effects were mild or moderate and there were no serious AEs or deaths during the studies. The most frequently reported AEs were tremor, hypokalemia, and headache. There were no consistent dose-dependent effects of MN-221 on any safety parameters, with the exception of heart rate, which was not considered to be clinically significant and did not require any treatment. Moderate hypokalemia occurred once in one subject in the MN-221-CL-004 study and twice in one subject in the MN-221-CL-005 study and were transient and returned to normal range following single oral potassium chloride treatments. PK assessments indicated a linear response in MN-221 plasma concentrations for the doses evaluated. Dose escalation results showed that mean changes in FEV? from pre-infusion were significantly greater than placebo and an overall dose response was statistically significant (p < .0001). Post-infusion FEV1 improvements appeared to plateau at the 30 ?g/min dose level despite a higher peak plasma concentration at 60 ?g/min. Dose-rate escalation results demonstrated greater mean increases in change in FEV? compared to the placebo group with the largest increase associated with the higher MN-221 dose rate and peak plasma concentration. CONCLUSIONS: The safety profile of MN-221 and evidence of dose- and plasma-concentration-related bronchodilation supports further clinical development and suggests the potential for clinical benefit without increased clinical risk, particularly for patients where inhaled or nebulized therapy is not adequate or possible. Trial registry name and registration number:Name: MN-221-CL-005Number: NCT00679263.

Matsuda K; Makhay M; Johnson K; Iwaki Y

2012-12-01

246

Intraosseous infusion.  

UK PubMed Central (United Kingdom)

Establishing vascular access is vital in the resuscitation of critically-ill children and adults. Intraosseous infusion (IOI) is a viable route for providing vascular access when traditional intravenous methods cannot be accomplished. IOI is relatively easy to perform and is a standard recommended intervention for the resuscitation of both adults and children. The authors review the history, anatomy, technique, and clinical application of IOI. They also highlight the use of IOI in the prehospital setting.

LaRocco BG; Wang HE

2003-04-01

247

Analgesic efficacy of continuous intravenous magnesium infusion as an adjuvant to morphine for postoperative analgesia: a systematic review and meta-analysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: The efficacy of perioperative intravenous magnesium administration on postoperative opioid use, opioid-related side effects (e.g., nausea and vomiting) and pain are uncertain, as randomized controlled trials on this topic have reported disparate results. The objective of this systematic review is to determine if perioperative magnesium reduces opioid use, opioid-related side effects, and postoperative pain. METHODS: An electronic search was conducted using the Library of Medicine's PubMed and EMBASE databases. Included studies consisted of randomized controlled trials in an adult population with a clearly defined comparison of perioperative intravenous magnesium administration to a control with a documented assessment of opioid usage and postoperative pain. Relevant data was abstracted from included studies. Pooled estimates for weighted mean difference (WMD) with 95% confidence intervals (CI) were obtained for our primary outcome (opioid usage) using the Cochrane Collaboration's RevMan version 4.2.7 (Cochrane Collaboration; Oxford, United Kingdom). WMD and odds ratios (OR) were calculated using a random effects model. RESULTS: The literature search ultimately yielded 22 trials, enrolling 1177 (599 magnesium, 578 control) patients, who were included in the analysis. A significant decrease in morphine usage by those patients who received magnesium was noted (WMD = -7.40; 95% CI: -9.40 to -5.41, p < 0.00001). Perioperative magnesium administration was not associated with a difference in postoperative nausea or vomiting (RR = 0.76; 95% CI: 0.52 to 1.09, p = 0.14). The pooled visual analog scores for pain at 4-6 hours after surgery were significantly less in those patients who received magnesium surgery (WMD = -0.67; 95% CI: -1.12 to -0.23, p = 0.003); however, there was no difference in pain scores at 20-24 hours after surgery (WMD = -0.25; 95% CI: -0.62 to 0.71, p = 0.17). CONLUSION: Based on the results of this systematic review, perioperative intravenous magnesium may be a useful adjuvant for the management of postoperative pain providing analgesia through a different mechanism of action than that of opioids and would make a potential addition to a multimodal anlgesic treatment plan; however, the decrease in opioid use with perioperative magnesium infusion does not appear to be associated with a decresea in opioid-related side effects.

Murphy JD; Paskaradevan J; Eisler LL; Ouanes JP; Tomas VA; Freck EA; Wu CL

2013-02-01

248

Direct Fetal Intravenous Immunoglobulin Infusion as an Adjunct to Intrauterine Fetal Blood Transfusion in Rhesus-Allommunized Pregnancies: A Pilot Study.  

UK PubMed Central (United Kingdom)

Objectives: To study the usefulness of direct fetal intravenous immunoglobulin (IVIG) infusion along with intrauterine transfusion (IUT) in the management of severe fetal anemia in rhesus (Rh) alloimmunized pregnancies. Methods: Thirty-four consecutive Rh-isoimmunized pregnant women who required serial IUTs received either blood alone (control group, n = 16) or IVIG and blood (study group, n = 18). Pregnancies were followed up to delivery, and fetal outcome was recorded. The rate of fall of hematocrit was measured and compared between the two groups. Results: There was a slower rate of fall of hematocrit in the study group (IUT and IVIG) compared to the control group (only IUT). The mean rate of fall was 0.72 ± 0.54% per day in the study group while it was 1.29 ± 0.95% per day in the control group (p = 0.005). Conclusion: Fall of fetal hematocrit was reduced in the study group. The results of this pilot study can be used to time the next transfusion in patients receiving IVIG along with IUT (taking the rate of fall as 0.70%). This may eventually result in decreasing the number of transfusions per fetus.

Deka D; Sharma KA; Dadhwal V; Singh A; Kumar G; Vanamail P

2013-08-01

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Desarrollo tecnológico de sulfato de cinc 5 mg/mL infusión intravenosa Technological development of zinc sulphate 5 mg/mL intravenous infusion  

Directory of Open Access Journals (Sweden)

Full Text Available Se desarrolló una formulación de sulfato de cinc 5 mg/mL para infusión intravenosa que cumplió con las especificaciones de calidad de la USP 26, así como con el estudio de la estabilidad física, química, microbiológica y biológica de la solución, almacenada en envases de vidrio neutro de 5 mL de calidad hidrolítica I. El producto se expuso al calor por 90 días, y al calor y acción de la luz durante un período de 180 días, así como a vida de estante en condiciones normales de temperatura ambiente. Se comprobó la efectividad de los preservativos antimicrobianos presentes en la formulación. De los estudios realizados se determinó que la solución es estable por un período de más de 18 meses, almacenada a temperatura ambiente.A formulation of zinc sulphate 5 mg/mL for intravenous infusion was developed. It met the quality specifications of the USP 26, and it underwent the study of physical, chemical, microbiological and biological stability of the solution stored in neutral glass flasks of 5 ml of hydrolitic quality I. The product was exposed to heat for 90 days and to heat and the action of light for a period of 180 days, as well as to a shelf life under normal conditions of room temperature. It was proved the effectivity of the antimicrobial preservatives present in the formulation. According to the conducted studies, it was determined that the solution is stable for more than 18 months stored at room temperature.

Armando Gato del Monte; Ania González Villazón; Zenia Pardo Ruiz

2005-01-01

250

A new test of peripheral insulin sensitivity in vivo using artificial beta cell.  

UK PubMed Central (United Kingdom)

A new in vivo test of insulin sensitivity is described. It utilizes closed-loop insulin delivery device (GCIIS, Biostator) capable of infusing glucose and insulin according to preselected algorithms. In euglycemic patients, insulin was infused by GCIIS to maintain euglycemia in the face of challenges with gradually increasing doses on intravenously administered glucose. Under the described experimental conditions, the endogenous insulin release was minimized as evidenced by serum C-peptide levels of less than 2 ng/ml, and thus the peripheral disposal of glucose should have depended entirely on the exogenous insulin. The amount of the insulin infused was considered to be a measure of peripheral insulin sensitivity. The test was applied to normal and non diabetic obese individuals, and to diabetics, both insulin dependent and independent. Significant insulin resistance was demonstrated in the obese and diabetic patients. In two obese females, the test was repeated after a prolonged period of starvation, and showed marked increase in insulin sensitivity. In two poorly controlled insulin dependent diabetics, marked increase in insulin sensitivity was also observed, here following a prolonged period of euglycemia (48 hours). It is concluded that the GCIIS controlled insulin sensitivity test is a simple, reliable test of peripheral insulin sensitivity, most convenient for clinical and experimental studies in vivo.

Valenta LJ; Elias AN; Grossman M; Tanner SM; Friis R

1982-03-01

251

A new test of peripheral insulin sensitivity in vivo using artificial beta cell.  

Science.gov (United States)

A new in vivo test of insulin sensitivity is described. It utilizes closed-loop insulin delivery device (GCIIS, Biostator) capable of infusing glucose and insulin according to preselected algorithms. In euglycemic patients, insulin was infused by GCIIS to maintain euglycemia in the face of challenges with gradually increasing doses on intravenously administered glucose. Under the described experimental conditions, the endogenous insulin release was minimized as evidenced by serum C-peptide levels of less than 2 ng/ml, and thus the peripheral disposal of glucose should have depended entirely on the exogenous insulin. The amount of the insulin infused was considered to be a measure of peripheral insulin sensitivity. The test was applied to normal and non diabetic obese individuals, and to diabetics, both insulin dependent and independent. Significant insulin resistance was demonstrated in the obese and diabetic patients. In two obese females, the test was repeated after a prolonged period of starvation, and showed marked increase in insulin sensitivity. In two poorly controlled insulin dependent diabetics, marked increase in insulin sensitivity was also observed, here following a prolonged period of euglycemia (48 hours). It is concluded that the GCIIS controlled insulin sensitivity test is a simple, reliable test of peripheral insulin sensitivity, most convenient for clinical and experimental studies in vivo. PMID:7040887

Valenta, L J; Elias, A N; Grossman, M; Tanner, S M; Friis, R

1982-03-01

252

Insulin  

Science.gov (United States)

... take your diabetes medicines. You can do it. Insulin Safety Tips Never drink insulin. Do not share ... Women and Diabetes: www.fda.gov/womens My Insulin Guide Ask your health care provider these questions ...

253

Cardioprotective effect of glucose-insulin on acute propafenone toxicity in rat.  

UK PubMed Central (United Kingdom)

OBJECTIVE: We recently observed a case of propafenone self-poisoning in which the patient was initially unresponsive to conventional therapies such as sodium bicarbonate, dopamine, and norepinephrine but recovered with intravenous glucose-insulin infusion. We raised the hypothesis that insulin may have a cardioprotective effect in acute propafenone toxicity. METHODS: We evaluated the effect of glucose-insulin infusion on mortality and electrocardiographic abnormalities during acute propafenone toxicity in rats. After measurements of basal mean arterial pressure, heart rate, PR interval, and QRS duration, rats received intravenous propafenone (36 mg/kg per hour) for 12 minutes. Two minutes after the induction of toxicity, the rats (n=10 per group) received either normal saline solution (NSS) or insulin with glucose. Rats in the insulin-treated (Insulin group) and the NSS-treated (NSS group) groups received an intravenous infusion of 36 mg/kg per hour of propafenone until death occurred. Rats receiving only NSS intravenously without propafenone toxicity served as control (Control group, n=10). RESULTS: Insulin treatment improved survival and delayed the hemodynamic and electrocardiographic consequences of propafenone toxicity. Survival was significantly greater in the insulin group than that in the NSS group (P<.001). Insulin prevented the decline in mean arterial pressure and heart rate (P<.05). Insulin also prevented the increase of the PR interval and the QRS duration (P<.05). CONCLUSION: Glucose-insulin infusion delayed the abnormalities in cardiac conduction and improved rat survival after acute propafenone toxicity. These results suggest a cardioprotective effect of glucose-insulin in acute propafenone toxicity.

Yi HY; Lee JY; Lee SY; Hong SY; Yang YM; Park GN

2012-06-01

254

[Calcium and endocrine pancreas secretion. I. Effects of an infusion of calcium on plasma levels of insulin and glucagon  

UK PubMed Central (United Kingdom)

The authors have investigated the behaviour of IRI, IRG and blood glucose levels during a calcium infusion (15 mg/Kg body weight per 90') and during an equivalent saline infusion, in normal subjects. No evident differences were observed between the two infusions; only a slight but not significant decrease of glucagon levels appeared during calcium administration. Further experiences are clearly required, especially during alpha and beta cells stimulation, to better elucidate relationships between calcium and pancreatic endocrine secretion "in vivo".

Cucinotta D; Quartarone M; Saitta A; De Pasquale R; Perdichizzi G; Squadrito G

1980-02-01

255

Efeitos da infusão contínua de propofol ou etomidato sobre variáveis intracranianas em cães/ Effects of propofol or etomidate intravenous infusion on intracranial variables in dogs  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese Avaliaram-se os efeitos da infusão contínua de propofol ou de etomidato sobre as variáveis intracranianas em cães nomocapneicos. Foram utilizados 20 cães adultos distribuídos aleatoriamente em dois grupos: grupo propofol (GP) e grupo etomidato (GE). Para o GP, os animais foram induzidos à anestesia com propofol (10mg/kg) e, ato contínuo, iniciaram-se a infusão do fármaco (0,6mg/kg/min) e a ventilação controlada. No GE, o etomidato foi usado para indução (5mg (more) /kg) e manutenção empregando-se a dose de 0,5mg/kg/min nos 10 minutos iniciais e, em seguida, de 0,2mg/kg/min. Após 30 minutos da implantação do cateter de fibra óptica do monitor de pressão intracraniana (PIC) na superfície do córtex cerebral direito, realizaram-se as primeiras mensurações (M1) da PIC, da pressão de perfusão cerebral (PPC), da temperatura intracraniana (TIC), de temperatura corpórea (TC), da pressão arterial média (PAM) e da frequência cardíaca (FC). As demais mensurações ocorreram em intervalos de 20 minutos (M2, M3 e M4). O propofol e o etomidato não ocasionaram alterações significativas nas variáveis estudadas com exceção da TC e TIC. Concluiu-se que a infusão contínua desses fármacos em cães mantém a perfusão cerebral e a autorregulação cerebral. Cães anestesiados com etomidato apresentam efeitos adversos intensos e redução gradativa da temperatura corpórea e intracraniana. Abstract in english The effects of total intravenous infusion of propofol or etomidate on intracranial variables in normocapneic dogs were evaluated. Twenty adult mongrel dogs were randomly allotted to: propofol group (GP) or etomidate group (GE). In GP animals, the propofol was used for induction (10mg/kg), followed by immediate continuous infusion of the drug (0.6mg/kg/min) and controlled ventilation. In GE dogs, the etomidate was used for induction (5mg/kg), followed by a continuous rate (more) infusion (CRI) at 0.5mg/kg/min during the first ten minutes and, right after, it was changed to 0.2mg/kg/min. The initial measurement (M1) was recorded 30 minutes after the implant of the fiber optic catheter and, after that, every 20 minutes (M2, M3, and M4). The studied parameters were intracranial pressure (ICP), cerebral perfusion pressure (CPP), intracranial temperature (ICT), body temperature (BT), mean arterial pressure (MAP), and heart rate (HR). The propofol and etomidate did not change the studied variables, except the ICT and BT. It was concluded that the continuous infusion of these drugs maintains the cerebral perfusion and autoregulation. Dogs anesthetized with etomidate have adverse effects and body and intracranial temperature decrease.

Paula, D.P.; Nunes, N.; Nishimori, C.T.D.; Lopes, P.C.F.; Carareto, R.; Santos, P.S.P.

2010-04-01

256

Completa recuperación de grave síndrome de hueso hambriento usando infusión crónica ambulatoria de calcio intravenoso: Caso clínico Complete recovery of life-threatening hungry bone syndrome using long-term ambulatory intravenous calcium infusion: Report of one case  

Directory of Open Access Journals (Sweden)

Full Text Available We report a 29 years old woman with a highly symptomatic primary hyperparathyroidism. After parathyroid adenoma excision, she presented a prolonged and life threatening hypocalcemia, due to a severe hungry bone syndrome. Conventional treatment with oral and intravenous calcium and calcitriol supplementation failed to raise serum and urinary calcium or to relief symptoms. After one month, we indicated a continuous intravenous calcium infusion allowing, during 6 months, an adequate outpatient management. Initial T scores for bone density were markedly low (L2-L4: -3.14; femoral neck: -3.07) and they increased 17% after 18 days of calcium infusion. After 147 days of treatment bone density was normal, increasing by 61%. The present case shows that the hungry bone syndrome can be a real risk for patients and a complex therapeutic challenge. With an appropriate calcium supply an early, fast and complete recovery of bone mass can be achieved (Rev Méd Chile 2003; 131: 779-84)

Claudia Campusano M; José Manuel López M

2003-01-01

257

Comparison of a multiple daily insulin injection regimen (basal once-daily glargine plus mealtime lispro) and continuous subcutaneous insulin infusion (lispro) in type 1 diabetes: a randomized open parallel multicenter study.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Insulin pump therapy (continuous subcutaneous insulin infusion [CSII]) and multiple daily injections (MDIs) with insulin glargine as basal insulin and mealtime insulin lispro have not been prospectively compared in people naïve to either regimen in a multicenter study. We aimed to help close that deficiency. RESEARCH DESIGN AND METHODS: People with type 1 diabetes on NPH-based insulin therapy were randomized to CSII or glargine-based MDI (both otherwise using lispro) and followed for 24 weeks in an equivalence design. Fifty people were correctly randomized, and 43 completed the study. RESULTS: Total insulin requirement (mean +/- SD) at end point was 36.2 +/- 11.5 units/day on CSII and 42.6 +/- 15.5 units/day on MDI. Mean A1C fell similarly in the two groups (CSII -0.7 +/- 0.7%; MDI -0.6 +/- 0.8%) with a baseline-adjusted difference of -0.1% (95% CI -0.5 to 0.3). Similarly, fasting blood glucose and other preprandial, postprandial, and nighttime self-monitored plasma glucose levels did not differ between the regimens, nor did measures of plasma glucose variability. On CSII, 1,152 hypoglycemia events were recorded by 23 of 28 participants (82%) and 1,022 in the MDI group by 27 of 29 patients (93%) (all hypoglycemia differences were nonsignificant). Treatment satisfaction score increased more with CSII; however, the change in score was similar for the groups. Costs were approximately 3.9 times higher for CSII. CONCLUSIONS: In unselected people with type 1 diabetes naïve to CSII or insulin glargine, glycemic control is no better with the more expensive CSII therapy compared with glargine-based MDI therapy.

Bolli GB; Kerr D; Thomas R; Torlone E; Sola-Gazagnes A; Vitacolonna E; Selam JL; Home PD

2009-07-01

258

Adverse Reactions of Intravenous Immunoglobulin  

Directory of Open Access Journals (Sweden)

Full Text Available Immunodeficient patients received 109 intravenous Immunoglobulin (IvIg) infusion, 9 infusions (8.2%) were followed by adverse reactions consisting of 5 mild, 1 moderate and 3 severe reactions. Predisposing factors were: Infusion speed (20 drops per min or more), presence of IgA antibody, and active infection at the time of infusion

A Agha Mohammadi; AH Farhoudi; H Alizadeh

2001-01-01

259

The effect of infusions of glucose, acetate and amino acids on hourly milk yield in fed, fasted and insulin-treated goats.  

UK PubMed Central (United Kingdom)

1. Experiments have been carried out in lactating goats milked hourly to assess the value of this technique in studies of milk secretion.2. On refeeding 24 hr-fasted goats there was an increase in arterial concentration and mammary uptake of volatile fatty acids within an hour, but little increase in hourly milk and lactose yield until the mammary uptake of glucose had also increased (after 2-3 hr).3. Intravascular infusions of acetate had no effect on milk secretion in 24 hr-fasted goats but glucose infusions increased milk yield by 62 +/- 5% and lactose yield by 87 +/- 12% within 3 hr, with no effect on fat secretion. The addition of acetate or acetate plus amino acids had no more effect than glucose alone.4. The yield of milk and lactose could be reduced within an hour by insulin (2 u./kg I.V.) and this was prevented or reversed by injecting glucose. In one goat, where in spite of a fall in blood sugar, mammary arteriovenous difference and blood flow did not fall, there was little or no fall in milk yield.5. In fasted or insulin treated goats an increase in milk and lactose secretion could be obtained within an hour by infusing glucose into the artery of one gland autotransplanted to the neck, which responded before the control gland in situ, thus showing that the effect of glucose is directly on the mammary tissue.6. In two normally fed goats with a low blood sugar, glucose infusions increased the milk or lactose yield by 30% within 3 hr.7. It is concluded that frequent milking, using minimal doses of oxytocin, is a valid method of studying factors controlling milk secretion and that, in the lactating goat, the availability of glucose to the mammary gland can be a limiting factor for maximum milk secretion.

Linzell JL

1967-05-01

260

Effect of tumor necrosis factor-alpha infusion on the incretin effect in healthy volunteers.  

UK PubMed Central (United Kingdom)

BACKGROUND: Type 2 diabetes mellitus (T2DM) is associated with peripheral insulin resistance, impaired incretin effect, and increased plasma levels of tumor necrosis factor-alpha (TNF-?). Whereas TNF-? infusion at a dose that induces systemic inflammation in healthy volunteers has been demonstrated to induce peripheral insulin resistance, the influence of this cytokine on the incretin effect is unknown. METHODS: We investigated whether systemic inflammation induced by TNF-? infusion in healthy volunteers alters the incretin hormone response to an oral and intravenous glucose load in a crossover study design with ten healthy male volunteers (mean age 24?years, mean BMI 23.7?kg/m(2) ). DAYS 1 AND 2: Six-hour infusion of saline. Days 3 and 4: Six-hour infusion of TNF-?. Days 1 and 3: Four-hour oral glucose tolerance test (OGTT). Days 2 and 4: Four hour-corresponding intravenous isoglycemic glucose tolerance test (IVGTT). Glucose tolerance tests were initiated after two hours of saline/TNF-? infusion. Plasma concentrations of TNF-?, IL-6, glucose, incretin hormones, cortisol and serum concentrations of C-peptide and insulin were measured throughout the study days. Insulin sensitivity was estimated by the Matsuda index and HOMA-IR. Pre-hepatic insulin secretion rates were calculated. RESULTS: TNF-? infusion induced symptoms of systemic inflammation, increased plasma levels of cortisol, TNF-?, and IL-6, and increased the HOMA-IR. The secretion of incretin hormones as well as the incretin effect remained unchanged. CONCLUSION: In healthy young male volunteers, acute systemic inflammation induced by infusion of TNF-? is associated with insulin resistance with no change in the incretin effect. This article is protected by copyright. All rights reserved.

Nielsen ST; Lehrskov-Schmidt L; Krogh-Madsen R; Solomon TP; Lehrskov-Schmidt L; Holst JJ; Møller K

2013-07-01

 
 
 
 
261

Comparison of Effects of Thoracic Epidural and Intravenous Administration of Lidocaine on Target-Controlled Infusion of Propofol and Tracheal Intubation Response During Induction of Anesthesia.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To compare the effects of thoracic epidural anesthesia (TEA) and intravenous (IV) lidocaine on the effect-site concentration (Ce) of propofol target-controlled infusion (TCI) and the intubation-induced stress responses during general IV anesthesia induction. DESIGN: A prospective, randomized trial. SETTING: A university hospital. PARTICIPANTS: Sixty patients undergoing elective surgery for thoracotomies. INTERVENTIONS: Patients scheduled for thoracotomies were divided into 3 groups as group TEA, group IV, and control group. Group TEA or group IV received the same doses but not the same concentration of lidocaine via TEA (0.15mL/kg of 1.35% lidocaine) or IV (2mg/kg of 2% lidocaine), respectively, 15 minutes before induction of anesthesia, and the control group received the same volume of 0.9% normal saline epidurally. MEASUREMENTS AND MAIN RESULTS: Heart rate and mean arterial pressure as well as the time to loss of consciousness (LOC), total doses of propofol TCI, and Ce at LOC were recorded during anesthesia induction. Plasma lidocaine concentration detected was 1.9 (0.3) ?g/mL in the IV group and 1.0 (0.3) ?g/mL in the TEA group (p<0.001). The time to LOC, total doses of propofol TCI, and Ce at LOC were significantly lower in the IV group than in the TEA group and the control group (p<0.001). Both lidocaine groups showed significant decreases in the elevation of mean arterial pressure and heart rate and plasma concentrations of epinephrine and norepinephrine induced by intubation compared to the control group (p< 0.05). CONCLUSION: Lidocaine administered via both TEA and IV decreased the induction doses of propofol and suppressed cardiovascular and stress responses to tracheal intubation. Administration of 2mg/kg of 2% lidocaine IV was better, with no side effects of lidocaine toxicity.

Yang W; Geng Y; Liu Y; Li A; Liu J; Xing J; Li W

2013-05-01

262

Bioequivalence and population pharmacokinetic modeling of two forms of antibiotic, cefuroxime lysine and cefuroxime sodium, after intravenous infusion in beagle dogs.  

UK PubMed Central (United Kingdom)

To investigate the bioequivalence and the population pharmacokinetics of cefuroxime lysine and cefuroxime sodium in healthy beagle dogs. A randomized 2-period crossover design in 18 healthy beagle dogs after receiving 20, 40, and 80?mg/kg of cefuroxime lysine or cefuroxime sodium was conducted. A 3-compartment open model was used as the basic model for the population pharmacokinetic study. Both of the antibiotics exhibited dose-proportional pharmacokinetics over the dose range of 20-80?mg/kg. The mean relative bioavailability of cefuroxime lysine versus cefuroxime sodium was 1.05 (range, 0.71 to 1.42), with a significant difference between males and females. The estimates of population pharmacokinetic of CL, V(1), Q(2), V(2), Q(3), V(3) were 3.74?mL/h, 1.70?mL, 29.5?mL/min, 3.58?mL, 0.31?mL/min, and 158?mL for cefuroxime lysine and 4.10?mL/h, 1.00?mL, 38.5?mL/min, 4.19?mL, 0.06?mL/min, and 13.6?mL for cefuroxime sodium, respectively. The inter-individual variability was determined to be less than 29.1%. A linear pharmacokinetic was revealed for cefuroxime lysine and cefuroxime sodium in dogs after intravenous infusion, and the bioequivalence of these forms of the antibiotic was observed with the significant gender-related differences in mean relative bioavailability of cefuroxime lysine versus cefuroxime sodium.

Zhao L; Li Q; Li X; Yin R; Chen X; Geng L; Bi K

2012-01-01

263

Intravenous infusion of phage-displayed antibody library in human cancer patients: enrichment and cancer-specificity of tumor-homing phage-antibodies.  

UK PubMed Central (United Kingdom)

Phage display is a powerful method for target discovery and selection of ligands for cancer treatment and diagnosis. Our goal was to select tumor-binding antibodies in cancer patients. Eligibility criteria included absence of preexisting anti-phage-antibodies and a Stage IV cancer status. All patients were intravenously administered 1 × 10(11) TUs/kg of an scFv library 1 to 4 h before surgical resection of their tumors. No significant adverse events related to the phage library infusion were observed. Phage were successfully recovered from all tumors. Individual clones from each patient were assessed for binding to the tumor from which clones were recovered. Multiple tumor-binding phage-antibodies were identified. Soluble scFv antibodies were produced from the phage clones showing higher tumor binding. The tumor-homing phage-antibodies and derived soluble scFvs were found to bind varying numbers (0-5) of 8 tested normal human tissues (breast, cervix, colon, kidney, liver, spleen, skin, and uterus). The clones that showed high tumor-specificity were found to bind corresponding tumors from other patients also. Clone enrichment was observed based on tumor binding and DNA sequence data. Clone sequences of multiple variable regions showed significant matches to certain cancer-related antibodies. One of the clones (07-2,355) that was found to share a 12-amino-acid-long motif with a reported IL-17A antibody was further studied for competitive binding for possible antigen target identification. We conclude that these outcomes support the safety and utility of phage display library panning in cancer patients for ligand selection and target discovery for cancer treatment and diagnosis.

Shukla GS; Krag DN; Peletskaya EN; Pero SC; Sun YJ; Carman CL; McCahill LE; Roland TA

2013-08-01

264

High-performance liquid chromatographic determination of chlorhexidine in whole blood by solid-phase extraction and kinetics following an intravenous infusion in rats.  

UK PubMed Central (United Kingdom)

This paper presents the extraction and analysis of chlorhexidine (CHX) from whole blood using solid-phase extraction (SPE) together with high-performance liquid chromatography (HPLC). Blood samples, spiked with chlorpromazine used as an internal standard, were fortified with sodium acetate buffer and purified with Bakerbond C(18) SPE columns. The columns were washed, dried, and eluted with experimental optimized solvent systems. The HPLC was performed using a Capcell Pak C(18) MG column (4.6 x 250-mm) and monitored at 260 nm, using a UV detector. A mobile phase consisting of acetonitrile/water (40:60 v/v), containing 0.05% trifluoroacetic acid, 0.05% heptafluorobutyric acid, and 0.1% triethylamine, was employed. The assay was linear over the range of 0.05 to 2.0 microg/g and the limit of detection was 0.01 microg/g for CHX in whole blood. At the concentration range of 0.05 to 2.0 microg/g, the recoveries ranged from 72% to 85%, and the intra- and interday precision, expressed as coefficient of variation, were less than 11% and 13%, respectively. Kinetic characteristics following an intravenous infusion of a CHX product, Maskin solution, at a dose of 15 mg/kg in rats were evaluated using the present method. The kinetic profiles of CHX conformed to a two-compartment model with an alpha half-life (of distribution) at 0.05 h and a beta half-life (of elimination) at 0.55 h in rats. The method is simple and reliable for the determination of CHX in blood samples and could be expected to apply to forensic and clinical specimens.

Xue Y; Tang M; Hieda Y; Fujihara J; Takayama K; Takatsuka H; Takeshita H

2009-03-01

265

High-performance liquid chromatographic determination of chlorhexidine in whole blood by solid-phase extraction and kinetics following an intravenous infusion in rats.  

Science.gov (United States)

This paper presents the extraction and analysis of chlorhexidine (CHX) from whole blood using solid-phase extraction (SPE) together with high-performance liquid chromatography (HPLC). Blood samples, spiked with chlorpromazine used as an internal standard, were fortified with sodium acetate buffer and purified with Bakerbond C(18) SPE columns. The columns were washed, dried, and eluted with experimental optimized solvent systems. The HPLC was performed using a Capcell Pak C(18) MG column (4.6 x 250-mm) and monitored at 260 nm, using a UV detector. A mobile phase consisting of acetonitrile/water (40:60 v/v), containing 0.05% trifluoroacetic acid, 0.05% heptafluorobutyric acid, and 0.1% triethylamine, was employed. The assay was linear over the range of 0.05 to 2.0 microg/g and the limit of detection was 0.01 microg/g for CHX in whole blood. At the concentration range of 0.05 to 2.0 microg/g, the recoveries ranged from 72% to 85%, and the intra- and interday precision, expressed as coefficient of variation, were less than 11% and 13%, respectively. Kinetic characteristics following an intravenous infusion of a CHX product, Maskin solution, at a dose of 15 mg/kg in rats were evaluated using the present method. The kinetic profiles of CHX conformed to a two-compartment model with an alpha half-life (of distribution) at 0.05 h and a beta half-life (of elimination) at 0.55 h in rats. The method is simple and reliable for the determination of CHX in blood samples and could be expected to apply to forensic and clinical specimens. PMID:19239733

Xue, Yuying; Tang, Meng; Hieda, Yoko; Fujihara, Junko; Takayama, Koji; Takatsuka, Hisakazu; Takeshita, Haruo

2009-03-01

266

Prospective, randomized study of ropivacaine wound infusion versus intrathecal morphine with intravenous fentanyl for analgesia in living donors for liver transplantation.  

Science.gov (United States)

Postoperative analgesia and care for living liver donors have become particular interests for clinicians as the use of living donor liver transplantation has increased. Local anesthetic-based analgesia has been known to provide effective pain control. In this prospective, randomized study, we compared the postoperative analgesic efficacy of local anesthetic-based analgesia (PainBuster) with the efficacy of opioid-based analgesia [intrathecal morphine (ITM) with intravenous (IV) fentanyl] in liver donors. Forty adult donors were randomly allocated to 1 of 2 groups: an ITM/IV fentanyl group (n = 21) and a PainBuster group (n = 19). Donors in the PainBuster group received 0.5% ropivacaine via a multi-orifice catheter (ON-Q PainBuster) placed at the wound. Donors in the ITM/IV fentanyl group received ITM sulfate (400 ?g) preoperatively and a continuous IV fentanyl infusion postoperatively. A visual analogue scale (VAS) at rest and with coughing and rescue IV fentanyl and meperidine consumption were assessed for 72 hours after the operation. Side effects, including sedation, dizziness, nausea, vomiting, pruritus, respiratory depression, wound seroma or hematoma, and the first time to flatus, were recorded. The VAS score at rest during the first 12 postoperative hours was significantly lower for the ITM/IV fentanyl group. At other times, the VAS scores were comparable between the groups. In the PainBuster group, rescue IV fentanyl and meperidine use was significantly reduced 24 to 48 hours and 48 to 72 hours after surgery in comparison with the first 24 postoperative hours. The time to first flatus was significantly reduced in the PainBuster group. There were no differences in side effects. In conclusion, analgesia was more satisfactory with ITM/IV fentanyl versus PainBuster during the first 12 hours after surgery, but they became comparable thereafter, with a shortened bowel recovery time in the PainBuster group. The concurrent use of ITM with PainBuster may be considered in a future investigation. Liver Transpl 19:1036-1045, 2013. © 2013 AASLD. PMID:23788468

Lee, Sang Hyun; Gwak, Mi Sook; Choi, Soo Joo; Park, Hui Gyeong; Kim, Gaab Soo; Kim, Myung Hee; Ahn, Hyun Joo; Kim, Jieae; Kwon, Choon Hyuck; Kim, Tae Seok

2013-08-18

267

Effects of intraduodenal glutamine on incretin hormone and insulin release, the glycemic response to an intraduodenal glucose infusion, and antropyloroduodenal motility in health and type 2 diabetes.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Glutamine reduces postprandial glycemia when given before oral glucose. We evaluated whether this is mediated by stimulation of insulin and/or slowing of gastric emptying. RESEARCH DESIGN AND METHODS: Ten healthy subjects were studied during intraduodenal (ID) infusion of glutamine (7.5 or 15 g) or saline over 30 min, followed by glucose (75 g over 100 min), while recording antropyloroduodenal pressures. Ten patients with type 2 diabetes mellitus (T2DM) were also studied with 15 g glutamine or saline. RESULTS: ID glutamine stimulated glucagon-like peptide 1 (GLP-1; healthy: P < 0.05; T2DM: P < 0.05), glucose-dependent insulinotropic polypeptide (GIP; P = 0.098; P < 0.05), glucagon (P < 0.01; P < 0.001), insulin (P = 0.05; P < 0.01), and phasic pyloric pressures (P < 0.05; P < 0.05), but did not lower blood glucose (P = 0.077; P = 0.5). CONCLUSIONS: Glutamine does not lower glycemia after ID glucose, despite stimulating GLP-1, GIP, and insulin, probably due to increased glucagon. Its capacity for pyloric stimulation suggests that delayed gastric emptying is a major mechanism for lowering glycemia when glutamine is given before oral glucose.

Chang J; Wu T; Greenfield JR; Samocha-Bonet D; Horowitz M; Rayner CK

2013-08-01

268

Treatment of diabetic ketoacidosis with subcutaneous insulin lispro: A review of the current evidence from clinical studies.  

UK PubMed Central (United Kingdom)

AIM: Low-dose intravenous infusions of regular insulin, usually initiated in the emergency department and continued in the intensive care unit (ICU), are the standard care for patients with diabetic ketoacidosis (DKA) to ensure rapid resolution of hyperglycaemia and ketoacidosis. Several studies have evaluated whether subcutaneous injections of the rapid-acting analogue insulin lispro may be an alternative to intravenous insulin infusion for avoiding ICU admissions of uncomplicated DKA cases. METHODS: This review summarizes the current clinical evidence for the effectiveness and safety of subcutaneous insulin lispro injections in non-severe DKA patients. Relevant studies were identified by a systematic literature search through the PubMed database. RESULTS: To date, four small randomized studies (156 patients overall; three studies in adults and one in paediatric patients with diabetes) have directly compared subcutaneous insulin lispro injections every 1-2h vs continuous intravenous infusions of regular insulin. Patients with severe complications were excluded. In all studies, the mean time to resolution of DKA was similar in both treatment groups [range (three studies): lispro 10-14.8h; regular insulin 11-13.2h]. The mean time to resolution of hyperglycaemia, total insulin doses required, number of hospitalization days and number of hypoglycaemic episodes were similar in both treatment groups; no severe complications or DKA recurrences were reported, and one study showed a 39% cost reduction for the insulin lispro group. CONCLUSION: In patients with mild-to-moderate DKA, subcutaneous injections of insulin lispro every 1-2h offer a feasible alternative to continuous intravenous infusions of regular insulin, and should now be evaluated in larger, more appropriately powered studies.

Vincent M; Nobécourt E

2013-09-01

269

New approaches to the use of insulin in patients with diabetic ketoacidosis.  

UK PubMed Central (United Kingdom)

Diabetic ketoacidosis (DKA) is one of the most common and serious acute complications of diabetes and is a significant cause of morbidity and mortality. In the last decade the mortality rate from DKA has declined because of greater recognition and improvements in its management. The current available guidelines state that the most effective means of insulin delivery during DKA is a continuous infusion of regular insulin, usually referred to as continuous low-dose insulin infusion. However, the cost of this treatment is usually quite high, because patients are required to be admitted to an intensive care unit in order to be monitored closely. New analogs of human insulin that have a rapid onset of action have become available in the past decade and represent potential alternatives to the use of regular insulin in the treatment of DKA. In several trials it has been demonstrated that the use of subcutaneous rapid-acting insulin analogs represents a safe, cost-effective and technically simpler treatment that precludes intensive care unit admission without significant differences in outcome in the management of patients with mild to moderate, uncomplicated DKA. The long-acting insulin analog may have a role in facilitating the transition from continuous intravenous insulin infusion to subcutaneous maintenance therapy in patients with DKA. This avoids rebound hyperglycaemia and ketogenesis when intravenous insulin is stopped and may avoid excess length of stay.

Barski L; Kezerle L; Zeller L; Zektser M; Jotkowitz A

2013-04-01

270

New approaches to the use of insulin in patients with diabetic ketoacidosis.  

Science.gov (United States)

Diabetic ketoacidosis (DKA) is one of the most common and serious acute complications of diabetes and is a significant cause of morbidity and mortality. In the last decade the mortality rate from DKA has declined because of greater recognition and improvements in its management. The current available guidelines state that the most effective means of insulin delivery during DKA is a continuous infusion of regular insulin, usually referred to as continuous low-dose insulin infusion. However, the cost of this treatment is usually quite high, because patients are required to be admitted to an intensive care unit in order to be monitored closely. New analogs of human insulin that have a rapid onset of action have become available in the past decade and represent potential alternatives to the use of regular insulin in the treatment of DKA. In several trials it has been demonstrated that the use of subcutaneous rapid-acting insulin analogs represents a safe, cost-effective and technically simpler treatment that precludes intensive care unit admission without significant differences in outcome in the management of patients with mild to moderate, uncomplicated DKA. The long-acting insulin analog may have a role in facilitating the transition from continuous intravenous insulin infusion to subcutaneous maintenance therapy in patients with DKA. This avoids rebound hyperglycaemia and ketogenesis when intravenous insulin is stopped and may avoid excess length of stay. PMID:23395363

Barski, Leonid; Kezerle, Louise; Zeller, Lior; Zektser, Miri; Jotkowitz, Alan

2013-02-08

271

Suspended insulin infusion during overnight closed-loop glucose control in children and adolescents with Type 1 diabetes.  

UK PubMed Central (United Kingdom)

AIMS: We assessed an extended interruption of subcutaneous insulin delivery during overnight closed-loop glucose control in children and adolescents with Type 1 diabetes (T1D). METHODS: In seven young subjects with T1D [age 14.2+/-2.1 years, diabetes duration 6.9+/-4.0 years, glycated haemoglobin (HbA1c) 8.0+/-1.5%, body mass index (BMI) 21.4+/-4.0 kg/m2, total daily insulin dose 0.9+/-0.2 units/kg/day; mean+/-sd) participating in overnight closed-loop glucose control studies, insulin delivery was interrupted for at least 90 min on the basis of predicted hypoglycaemia, low prevailing glucose levels or a too-steep decline in glucose levels. RESULTS: Insulin delivery was interrupted for 165 (105, 210) min [median, interquartile range (IQR)]. Plasma glucose was 6.2+/-3.2 mmol/l at the time of interruption and 5.5+/-2.0 mmol/l 105 min later (P=0.15, paired t-test). Plasma glucose declined during the first hour of the interruption at a rate of 0.02+/-0.03 mmol/l per min and reached a nadir of 5.2+/-2.7 mmol/l; 105 min after the interruption, plasma glucose was increasing at a rate of 0.01+/-0.03 mmol/l per min. When insulin delivery restarted, plasma glucose was 6.4+/-2.2 mmol/l and peaked at 7.9+/-2.1 mmol/l in 60 min (P=0.01). Physiological levels of plasma insulin were measured throughout with a nadir of 119+/-78 pmol/l. CONCLUSIONS: A prolonged interruption of insulin delivery during overnight closed-loop glucose control to prevent hypoglycaemia was not associated with an increased risk of hyperglycaemia in young people with T1D.

Elleri D; Allen JM; Nodale M; Wilinska ME; Acerini CL; Dunger DB; Hovorka R

2010-04-01

272

Formation of biologically active 13,14-dihydro-prostaglandin E1 during intravenous infusion of prostaglandin E1 in newborns with ductus arteriosus-dependent congenital heart disease.  

Science.gov (United States)

Plasma concentrations of prostaglandin (PG) E1 (12-150, median 25 pg ml-1) and 13,14-dihydro-PGE1 (3-62, median 45.5 pg ml-1) were measured by gas chromatography-mass spectrometry in eight newborns with ductus arteriosus-dependent congenital heart disease during continuous intravenous infusion of PGE1. Formation of 13,14-dihydro-PGE1 was demonstrated for the first time in neonates. Since 13,14-dihydro-PGE1 has similar biological activities as the parent compound PGE1, pharmacological effects during PGE1 infusion are most likely related to both PGE1 and the generation and action of 13,14-dihydro-PGE1.

Leonhardt, A; Schweer, H; Wolf, D; Seyberth, H W

1992-01-01

273

Chronic reduction of fasting glycemia with insulin glargine improves first- and second-phase insulin secretion in patients with type 2 diabetes.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Insulin secretion is often diminished in hyperglycemic patients with type 2 diabetes. We examined whether chronic basal insulin treatment with insulin glargine improves glucose-induced insulin secretion. RESEARCH DESIGN AND METHODS: Fourteen patients with type 2 diabetes on metformin monotherapy received an add-on therapy with insulin glargine over 8 weeks. Intravenous glucose tolerance tests (IVGTTs) were performed before and after the intervention, with and without previous adjustment of fasting glucose levels using a 3-h intravenous insulin infusion. RESULTS: Fasting glycemia was lowered from 179.6 ± 7.5 to 117.6 ± 6.5 mg/dL (P < 0.001), and HbA(1c) levels declined from 8.4 ± 0.5 to 7.1 ± 0.2% (P = 0.0046). The final insulin dose was 59.3 ± 10.2 IU. Acute normalization of fasting glycemia by intravenous insulin reduced C-peptide levels during the IVGTT (P < 0.0001). In contrast, insulin and C-peptide responses to intravenous glucose administration were significantly greater after the glargine treatment period (P < 0.0001, respectively). Both first- and second-phase insulin secretion increased significantly after the glargine treatment period (P < 0.05, respectively). These improvements in insulin secretion were observed during both the experiments with and without acute adjustment of fasting glycemia. CONCLUSIONS: Chronic supplementation of long-acting basal insulin improves glucose-induced insulin secretion in hyperglycemic patients with type 2 diabetes, whereas acute exogenous insulin administration reduces the ?-cell response to glucose administration. These data provide a rationale for basal insulin treatment regiments to improve postprandial endogenous insulin secretion in hyperglycemic patients with type 2 diabetes.

Pennartz C; Schenker N; Menge BA; Schmidt WE; Nauck MA; Meier JJ

2011-09-01

274

The effect of high-dose sodium salicylate on chronically elevated plasma nonesterified fatty acid-induced insulin resistance and ?-cell dysfunction in overweight and obese nondiabetic men.  

UK PubMed Central (United Kingdom)

Prolonged elevation of plasma nonesterified fatty acids (NEFA) induces insulin resistance and impairs pancreatic ?-cell adaptation to insulin resistance. Studies in rodents suggest that inflammation may play a role in this "lipotoxicity." We studied the effects of sodium salicylate, an anti-inflammatory agent, on lipid-induced alterations in ?-cell function and insulin sensitivity in six overweight and obese nondiabetic men. Each subject underwent four separate studies, 4-6 wk apart, in random order: 1) SAL, 1-wk placebo followed by intravenous (iv) infusion of saline for 48 h; 2) IH, 1-wk placebo followed by iv infusion of intralipid plus heparin for 48 h to raise plasma NEFA approximately twofold; 3) IH + SS, 1-wk sodium salicylate (4.5 g/day) followed by 48-h IH infusion; and 4) SS, 1-wk oral sodium salicylate followed by 48-h saline infusion. After 48-h saline or lipid infusion, insulin secretion and sensitivity were assessed by hyperglycemic clamp and euglycemic hyperinsulinemic clamp, respectively, in sequential order. Insulin sensitivity was reduced by lipid infusion (IH = 67% of SAL) and was not improved by salicylate (IH + SS = 56% of SAL). Lipid infusion also reduced the disposition index (P < 0.05), which was not prevented by sodium salicylate. Salicylate reduced insulin clearance. These data suggest that oral sodium salicylate at this dose impairs insulin clearance but does not ameliorate lipid-induced insulin resistance and ?-cell dysfunction in overweight and obese nondiabetic men.

Xiao C; Giacca A; Lewis GF

2009-11-01

275

The effect of high-dose sodium salicylate on chronically elevated plasma nonesterified fatty acid-induced insulin resistance and ?-cell dysfunction in overweight and obese nondiabetic men.  

Science.gov (United States)

Prolonged elevation of plasma nonesterified fatty acids (NEFA) induces insulin resistance and impairs pancreatic ?-cell adaptation to insulin resistance. Studies in rodents suggest that inflammation may play a role in this "lipotoxicity." We studied the effects of sodium salicylate, an anti-inflammatory agent, on lipid-induced alterations in ?-cell function and insulin sensitivity in six overweight and obese nondiabetic men. Each subject underwent four separate studies, 4-6 wk apart, in random order: 1) SAL, 1-wk placebo followed by intravenous (iv) infusion of saline for 48 h; 2) IH, 1-wk placebo followed by iv infusion of intralipid plus heparin for 48 h to raise plasma NEFA approximately twofold; 3) IH + SS, 1-wk sodium salicylate (4.5 g/day) followed by 48-h IH infusion; and 4) SS, 1-wk oral sodium salicylate followed by 48-h saline infusion. After 48-h saline or lipid infusion, insulin secretion and sensitivity were assessed by hyperglycemic clamp and euglycemic hyperinsulinemic clamp, respectively, in sequential order. Insulin sensitivity was reduced by lipid infusion (IH = 67% of SAL) and was not improved by salicylate (IH + SS = 56% of SAL). Lipid infusion also reduced the disposition index (P < 0.05), which was not prevented by sodium salicylate. Salicylate reduced insulin clearance. These data suggest that oral sodium salicylate at this dose impairs insulin clearance but does not ameliorate lipid-induced insulin resistance and ?-cell dysfunction in overweight and obese nondiabetic men. PMID:19755670

Xiao, Changting; Giacca, Adria; Lewis, Gary F

2009-09-15

276

[Analysis of efficacy and safety of multiple intravenous infusion of anti-tumor necrosis factor-alpha monoclonal antibody (Remicade) combined with methotrexate compared with sodium aurothiomalate and intramuscular depot methylprednisolone in rheumatoid arthritis].  

UK PubMed Central (United Kingdom)

The objective of the paper was compare the effects and tolerability of combined therapy of multiple intravenous infusions of anti-tumour necrosis factor-alfa (TNF-alfa) monoclonal antibody (Remicade) with methotrexate versus treatment with sodium aurothiomalate and intramuscular depot methylprednisolone in rheumatoid arthritis (RA). We investigate also the interval necessary to obtain the improvement in both treatment groups. 36 patients commencing intramuscular sodium aurothiomalate therapy with intramuscular depot methylprednisolone acetate at weeks 0, 4, 8 and 12 in addition to chrysotherapy were compared in retrospective analysis with 32 patients starting with multiple intravenous infusions of infliximab, anti-TNF-alfa monoclonal antibody (Remicade) and methotrexate at a stable dose. Patients were assessed by composite clinical score (DAS 28) and C-reactive protein during 22 weeks of therapy. At week 2 and 6 a significantly greater percentage of infliximab-treated than gold-treated RA patients achieved improvement in each clinical measurement of disease activity. At 22 week of treatment moderate and good response according to EULAR criteria was achieved in 91% of infliximab-treated patients and 58% gold treated patients (p < 0.001). Adverse events were more frequently observed in infliximab-treated patients, but only gold-treated patients discontinued treatment because adverse events (2 patients due to proteinuria, 2 patients due to mucocutaneous changes and one patient due to leucopenia). The higher percentage of adverse events in infliximab-treated patients was caused mainly by the occurrence of infusion reactions (23 reactions out of 160 infusions); most of them were mild (somnolentia and headache) and transient. Viral infections (including herpes simplex and zoster) were more common in patients treated with infliximab and methotrexate. Combination therapy of infliximab and methotrexate is more effective in reducing clinical and biochemical disease activity than gold with methylprednisolone treatment in RA patients during 22 weeks of treatment, especially in the first 6 weeks.

Wiland P; G?owska A; Chlebicki A; Szechi?ski J

2002-11-01

277

A pharmacokinetic and dosing study of intravenous insulin-like growth factor-I and IGF-binding protein-3 complex to preterm infants.  

Science.gov (United States)

In preterm infants, low levels of insulin like growth factor 1 (IGF-I) have been associated with impaired growth and retinopathy of prematurity. Our objective was to study safety and pharmacokinetics of i.v. administered rhIGF-I with its binding protein 3 (rhIGFBP-3) to preterm infants. At 3 d chronological age, an i.v. 3 h infusion of rhIGF-I/rhIGFBP-3 was administered followed by serial measurements of IGF-I and IGFBP-3. Infants were evaluated for physiologic safety measurements. The individual dose of rhIGF-I ranged from 1 to 12 microg/kg. The study was conducted at Queen Silvia Children's Hospital, Gothenburg, Sweden, between January and November 2007. Five patients (3 F) with mean (range) post menstrual age 27 wk (26-29) and birth weight 1022 g (810-1310) participated. IGF-I and IGFBP-3 levels before infusion were median (range) 18 (12-28) and 771 (651-1047) ng/mL, respectively. Immediately after study drug infusion, serum IGF-I and IGFBP-3 levels were 38 (25-59) and 838 (754-1182) ng/mL, respectively. Median (range) half-life for IGF-I and IGFBP-3 was 0.79 (0.59-1.42) and 0.87 (0.85-0.94) hours, respectively. Blood glucose, insulin, sodium, potassium, and physiologic safety measures were within normal ranges. The rhIGF-I/rhIGFBP-3 equimolar proportion was effective in increasing serum IGF-I levels and administration under these study conditions was safe and well tolerated. PMID:19190540

Löfqvist, Chatarina; Niklasson, Aimon; Engström, Eva; Friberg, Lena E; Camacho-Hübner, Cecilia; Ley, David; Borg, Jan; Smith, Lois E H; Hellström, Ann

2009-05-01

278

Infusão de insulina em terapia intensiva: ensaio controlado randomizado/ Infusion de insulina en cuidados intensivos: ensayo controlado aleatorizado/ Insulin infusion in intensive care: randomized controlled trial  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese Ensaio clínico controlado e aleatorizado que comparou o uso de protocolo de insulina intensivo e convencional na evolução clínica de pacientes em sepse grave e choque séptico, nas primeiras 72 h. Foi conduzido em um hospital universitário na cidade de São Paulo. Os pacientes (n=46) foram alocados em dois grupos: glicêmico intensivo (glicemia entre 80-110mg/dl) e convencional (180-220mg/dl). Utilizaram-se testes t-Student e Qui-Quad (more) rado na análise dos dados. Observou-se diferença estatisticamente significativa (p<0,001) na média glicêmica, mas não houve diferença para as variáveis pressão arterial média mínima (p=0,06) e máxima (p=0,11), creatinina sérica (p=0,33) e na mortalidade (p=0,11). Apesar de não haver diferença entre os grupos quanto à mortalidade, a instabilidade hemodinâmica no grupo convencional foi mais duradoura e somente nele ocorreram óbitos. Abstract in spanish Ensayo clínico aleatorio controlado y randomizado que comparó el uso de protocolo de insulina intensivo y convencional en la evolución clínica de pacientes en sepsis grave y shock séptico, en las primeras 72 horas. Fue realizado en un hospital universitario de la ciudad de São Paulo. Los pacientes (n=46) fueron distribuidos en dos grupos: glucémico intensivo (glucemia entre 80-110mg/dl) y convencional (180-220mg/dl). Se utilizaron tests (more) t-Student y Chi-cuadrado para análisis de los datos. Se observó diferencia estadísticamente significativa (p<0,001) en la media glucémica, pero no hubo diferencia para las variables presión arterial mínima (p=0,06) y máxima (p=0,11), creatinina sérica (p=0,33) y en la mortalidad (p=0,11). A pesar de no existir diferencia entre los grupos en cuanto a mortalidad, la inestabilidad hemodinámica en el grupo convencional fue más duradera y sólo en él existieron decesos. Abstract in english This randomized controlled trial compared the use of an intensive and conventional insulin protocol on clinical outcomes in patients with severe sepsis and septic shock, in the first 72 hours. It was conducted at a university hospital in the city of São Paulo. Patients (n=46) were allocated into two groups: intensive glycemic (blood glucose between 80-110mg/dl) and conventional (180-220mg/dl). The Student's t-test and chi-square test were used for data analysis. A s (more) tatistically significant (p<0.001) difference was observed in mean glycemia, but there was no difference in the variables of mean minimum arterial pressure (p=0.06) or maximum (p=0.11), serum creatinine (p=0,33) or in mortality (p=0.11). Although there was no difference between the groups regarding mortality, hemodynamic instability in the conventional group was longer and the only deaths occurred in it.

Miranda, Milena Penteado Ferraro; Crespo, Jeiel Carlos Lamonica; Secoli, Silvia Regina

2013-06-01

279

Effects of glucose infusion on hormone secretion and hepatic glucose production during heavy exercise.  

UK PubMed Central (United Kingdom)

Blood-borne metabolic feedback vs. neural feedforward regulation of glucose homeostasis during exercise was investigated by infusion glucose and [3H]glucose for glucose appearance determination intravenously in rats running for 20 min at 28 m/min [approximately 85% of maximal O2 consumption (VO2max)]. Infused glucose corresponded to the exercise-induced increase in hepatic glucose production (HGP) found in saline-infused rats. Saline- and glucose-infused resting rats were also studied. Arterial blood was sampled for analyses of hormones and metabolites. Plasma epinephrine, norepinephrine, and insulin were always similar and HGP was initially similar in the two exercising groups, although glucose infusion resulted in higher plasma glucose compared with control (P < 0.05). Late during exercise, high plasma glucose (11.3 +/- 0.4 vs. 9.6 +/- 0.3 mM) and low glucagon (16 +/- 2 vs. 27 +/- 3 pM) in glucose- vs. saline-infused rats caused an inhibition of HGP in glucose-infused rats, although never below preexercise levels. In resting rats, glucose infusion resulted in elevated plasma glucose and insulin and, in turn, inhibition of HGP but had no effect on catecholamines, corticosterone, or glucagon. The findings indicate that during heavy exercise, glucose homeostasis is regulated primarily by neural feedforward mechanisms and that blood-borne metabolic feedback mechanisms play a regulatory role if metabolic error signals are pronounced.

Wiersma MM; Vissing J; Steffens AB; Galbo H

1993-12-01

280

Intramammary infusion of Panax ginseng extract in the bovine mammary gland at cessation of milking modifies components of the insulin-like growth factor system during involution.  

UK PubMed Central (United Kingdom)

The objective of this study was to evaluate the effects of a single intramammary infusion of Panax ginseng extract (GS) on insulin-like growth factors (IGF) in bovine mammary gland during early involution. Eight mammary quarters from six nonpregnant cows in late lactation were infused with 10 mL of ginseng extract solution (3 mg/mL), six quarters were treated with 10 mL of placebo (vehicle alone) and six quarters were maintained as uninoculated controls. Milking was interrupted after infusion. Concentrations of IGF1 in mammary secretions were higher in GS-treated quarters than in placebo and uninoculated control quarters at 24, 48 and 72 h post-treatment (p<0.05). Treatment with GS did not affect mammary secretion of IGF2 (p=0.942). At 7 d of post-lactational involution, a decrease of immunostained area and mRNA expression for IGF1 was observed in mammary tissue of GS-treated quarters compared with placebo-treated quarters and uninoculated controls (p<0.05). The IGF2 immunostained area and mRNA expression for this growth factor were not affected by GS treatment (p=0.216 and p=0.785, respectively). An increase in protein levels and mRNA expression in mammary tissue of IGFBP3, IGFBP4 and IGFBP5 was observed in GS-treated quarters compared with placebo-treated quarters and uninoculated controls (p<0.05). These results provide evidence that intramammary inoculation of GS extract at cessation of milking may promote early mammary involution through the inhibition of IGF1 local production and bioavailability.

Dallard BE; Pujato SA; Baravalle C; Pereyra EA; Rey F; Renna MS; Calvinho LF

2013-06-01

 
 
 
 
281

Intramammary infusion of Panax ginseng extract in the bovine mammary gland at cessation of milking modifies components of the insulin-like growth factor system during involution.  

Science.gov (United States)

The objective of this study was to evaluate the effects of a single intramammary infusion of Panax ginseng extract (GS) on insulin-like growth factors (IGF) in bovine mammary gland during early involution. Eight mammary quarters from six nonpregnant cows in late lactation were infused with 10 mL of ginseng extract solution (3 mg/mL), six quarters were treated with 10 mL of placebo (vehicle alone) and six quarters were maintained as uninoculated controls. Milking was interrupted after infusion. Concentrations of IGF1 in mammary secretions were higher in GS-treated quarters than in placebo and uninoculated control quarters at 24, 48 and 72 h post-treatment (p<0.05). Treatment with GS did not affect mammary secretion of IGF2 (p=0.942). At 7 d of post-lactational involution, a decrease of immunostained area and mRNA expression for IGF1 was observed in mammary tissue of GS-treated quarters compared with placebo-treated quarters and uninoculated controls (p<0.05). The IGF2 immunostained area and mRNA expression for this growth factor were not affected by GS treatment (p=0.216 and p=0.785, respectively). An increase in protein levels and mRNA expression in mammary tissue of IGFBP3, IGFBP4 and IGFBP5 was observed in GS-treated quarters compared with placebo-treated quarters and uninoculated controls (p<0.05). These results provide evidence that intramammary inoculation of GS extract at cessation of milking may promote early mammary involution through the inhibition of IGF1 local production and bioavailability. PMID:23566927

Dallard, Bibiana E; Pujato, Silvina A; Baravalle, Celina; Pereyra, Elizabet A L; Rey, Florencia; Renna, María S; Calvinho, Luis F

2013-02-08

282

Course of improvement in depressive symptoms to a single intravenous infusion of ketamine vs add-on riluzole: results from a 4-week, double-blind, placebo-controlled study.  

UK PubMed Central (United Kingdom)

The N-methyl-D-aspartate antagonist ketamine has rapid antidepressant effects in patients with treatment-resistant major depression (TRD); these effects have been reported to last for 1 week in some patients. However, the extent and duration of this antidepressant effect over longer periods has not been well characterized under controlled conditions. Riluzole, a glutamatergic modulator with antidepressant and synaptic plasticity-enhancing effects, could conceivably be used to promote the antidepressant effects of ketamine. This study sought to determine the extent and time course of antidepressant improvement to a single-ketamine infusion over 4 weeks, comparing the addition of riluzole vs placebo after the infusion. Forty-two subjects (18-65) with TRD and a Montgomery-Asberg Depression Rating Scale (MADRS) score of ? 22 received a single intravenous infusion of ketamine (0.5?mg/kg). Four to six hours post-infusion, subjects were randomized to double-blind treatment with either riluzole (100-200?mg/day; n=21) or placebo (n=21) for 4 weeks. Depressive symptoms were rated daily. A significant improvement (P<0.001) in MADRS scores from baseline was found. The effect size of improvement with ketamine was initially large and remained moderate throughout the 28-day trial. Overall, 27% of ketamine responders had not relapsed by 4 weeks following a single ketamine infusion. The average time to relapse was 13.2 days (SE=2.2). However, the difference between the riluzole and placebo treatment groups was not significant, suggesting that the combination of riluzole with ketamine treatment did not significantly alter the course of antidepressant response to ketamine alone.

Ibrahim L; Diazgranados N; Franco-Chaves J; Brutsche N; Henter ID; Kronstein P; Moaddel R; Wainer I; Luckenbaugh DA; Manji HK; Zarate CA Jr

2012-05-01

283

A comparison of nicotine and cocaine self-administration in the dog: fixed-ratio and progressive-ratio schedules of intravenous drug infusion.  

Science.gov (United States)

Beagle dogs pressed a lever under a 15-response fixed-ratio schedule of i.v. nicotine or cocaine infusion or water presentation. A 4-min time-out period followed each fixed-ratio trial and each daily session ended after 16 successive fixed-ratio trials. Both nicotine and cocaine were self-administered above saline levels, with the maximum number of infusions occurring at a dose of 30 micrograms/kg of nicotine and 100 micrograms/kg of cocaine. Rates of responding first increased, reaching a maximum at 10 to 30 micrograms/kg/infusion and then decreased, as the dose of nicotine or cocaine was varied between 3 and 300 micrograms/kg/infusion. The rate of responding and number of infusions obtained per session were higher under the schedule of cocaine self-administration than under the schedule of nicotine self-administration. Presession treatment with the nicotinic antagonist, mecamylamine (1.0 mg/kg i.v.), for seven consecutive sessions, decreased nicotine-maintained responding to levels not unlike those seen when saline was substituted for drug. Neither cocaine- nor water-maintained responding was affected by presession treatment with mecamylamine. A second group of beagle dogs pressed a lever under a schedule of i.v. nicotine (50-400 micrograms/kg/infusion) or cocaine (200-1600 micrograms/kg/infusion) infusion in which the fixed-ratio requirement was increased daily (i.e., a progressive-ratio schedule). The maximum fixed-ratio value at which responding was maintained first increased as the dose per infusion increased and then, at the highest dose, either remained the same or decreased. Cocaine maintained considerably higher fixed-ratio values than did nicotine, but maximum fixed-ratio values for nicotine were well above those seen with saline. The effects of i.v. nicotine (3, 30 or 300 micrograms/kg) or mecamylamine (1.0 mg/kg) on heart rate, rectal temperature and pupillary diameter were measured in a third group of beagle dogs. Nicotine produced dose- and time-related changes in all three physiological parameters; the effects of mecamylamine were considerably greater than those seen with nicotine. PMID:6822957

Risner, M E; Goldberg, S R

1983-02-01

284

A comparison of nicotine and cocaine self-administration in the dog: fixed-ratio and progressive-ratio schedules of intravenous drug infusion.  

UK PubMed Central (United Kingdom)

Beagle dogs pressed a lever under a 15-response fixed-ratio schedule of i.v. nicotine or cocaine infusion or water presentation. A 4-min time-out period followed each fixed-ratio trial and each daily session ended after 16 successive fixed-ratio trials. Both nicotine and cocaine were self-administered above saline levels, with the maximum number of infusions occurring at a dose of 30 micrograms/kg of nicotine and 100 micrograms/kg of cocaine. Rates of responding first increased, reaching a maximum at 10 to 30 micrograms/kg/infusion and then decreased, as the dose of nicotine or cocaine was varied between 3 and 300 micrograms/kg/infusion. The rate of responding and number of infusions obtained per session were higher under the schedule of cocaine self-administration than under the schedule of nicotine self-administration. Presession treatment with the nicotinic antagonist, mecamylamine (1.0 mg/kg i.v.), for seven consecutive sessions, decreased nicotine-maintained responding to levels not unlike those seen when saline was substituted for drug. Neither cocaine- nor water-maintained responding was affected by presession treatment with mecamylamine. A second group of beagle dogs pressed a lever under a schedule of i.v. nicotine (50-400 micrograms/kg/infusion) or cocaine (200-1600 micrograms/kg/infusion) infusion in which the fixed-ratio requirement was increased daily (i.e., a progressive-ratio schedule). The maximum fixed-ratio value at which responding was maintained first increased as the dose per infusion increased and then, at the highest dose, either remained the same or decreased. Cocaine maintained considerably higher fixed-ratio values than did nicotine, but maximum fixed-ratio values for nicotine were well above those seen with saline. The effects of i.v. nicotine (3, 30 or 300 micrograms/kg) or mecamylamine (1.0 mg/kg) on heart rate, rectal temperature and pupillary diameter were measured in a third group of beagle dogs. Nicotine produced dose- and time-related changes in all three physiological parameters; the effects of mecamylamine were considerably greater than those seen with nicotine.

Risner ME; Goldberg SR

1983-02-01

285

[Evaluating the feature of hypoglycemia detected by continuous glucose monitoring system during temporary continuous subcutaneous insulin infusion in type 2 diabetes patients].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To use continuous glucose monitoring system (CGMS) to investigate the features of hypoglycemia in control of hyperglycemia in T2DM patients by continuous subcutaneous insulin infusion (CSII) and to study the influencing factors of hypoglycemia. METHODS: Sixty-one T2DM patients, 35 males and 26 females, age 23-88, with the disease duration of 0.5-12 years, HbA1c level of (11.1 +/- 1.6)%, and glycosylated serum protein of (32 +/- 6)%, underwent. CSII and finger blood sugar test. On the second day CGMS was used for 72 hours. Logistic regression was used to analyze the correlation among different factors. RESULTS: CGMS discovered 31 hypoglycemic events in 18 patients in the early stage of CSII treatment, 20 events occurring at night, a number significantly higher than that by self-monitoring of blood sugar. The C-peptide and mean blood glucose (BMG) of the patients with hypoglycemia.were significantly lower than those of the patients without hypoglycemia, and the total cholesterol, standard deviation of blood glucose (SDBG), and insulin pump basal rate of the patients with hypoglycemia were significantly higher than those of the patients without hypoglycemia (all P < 0.05). Multiple regression indicated that MBG was negatively correlated with hypoglycemia but SDBG and basal rate were positively correlated with hypoglycemia. CONCLUSION: (1) Hypoglycemia detected by CGMS occurs in about 1/3 of the type 2 diabetes patients at the early stage of CSII therapy. (2) In addition of MBG and insulin pump basal rate, glycemic excursion is related closely to hypoglycemia.

Li M; Zhou J; Bo YQ; Lu W; Jia WP; Xiang KS

2008-06-01

286

B-type natriuretic peptide blood levels identify patients with non-ST elevation acute coronary syndromes at high risk for complications during intravenous beta-blocker infusion.  

UK PubMed Central (United Kingdom)

BACKGROUND: We hypothesized that measurement of B-type natriuretic peptide could identify patients with non-ST elevation acute coronary syndromes at high risk for complications during beta-blocker (esmolol) infusion. METHODS: We reviewed the records of 340 consecutive patients admitted with a non-ST elevation acute coronary syndrome. Seventy three (47 males, aged 62 ± 14 years) received esmolol up to a maximum dose of 300 ?g/ kg/min until the symptoms were relieved or an adverse event occurred. RESULTS: The median infusion rate at steady state was 175 ?g/kg/min (median infusion time 18 h). Infusion was halted in 14 patients. The frequency of drug discontinuation increased across admission BNP quartiles. BNP > 141 pg/ml at admission had a 95% predictive value for subsequent withdrawal of esmolol. The presence of BNP > 141 pg/ml in combination with systolic blood pressure < 130 mmHg and left ventricular ejection fraction < 50% identified a group of patients at high risk for drug interruption (interruption frequency = 83%, 95% CI: 55-95%). CONCLUSIONS: In conclusion, BNP measurement in combination with systolic blood pressure and 2D echocardiography may identify patients with non-ST elevation acute coronary syndromes at high risk for adverse events during esmolol infusion.

Nikolaou NI; Koutouzis MJ; Christou A; Fournarakis GM; Patsilinakos SP; Rompola A; Maisel AS

2011-09-01

287

Timing of insulin delivery with meals.  

UK PubMed Central (United Kingdom)

In non-diabetics neural and/or gastrointestinal humoral factors cause anticipatory insulin release with meals. The importance of this mechanism was illustrated by administration of a standard meal to six insulin dependent diabetics on two occasions. Insulin was delivered intravenously by an "open-loop" (preprogrammed) insulin infusion system designed to simulate the normal insulin response to meals. On one occasion insulin delivery was delayed 15 minutes. This time approximates the physiology delay before blood glucose rises after the start of a meal. The delay resulted in significantly greater hyperglycaemia continuing over three hours, compared with the study in which insulin delivery increased coincident with the start of the meal. A mechanism for initiating early insulin release with meals would be a helpful addition to "closed-loop" insulin delivery systems, this being apparent in a further comparison made between performance of the open-loop and closed-loop systems. Moreover, the delayed insulin response seen in maturity onset diabetics is likely to be an important cause of persistent hyperglycaemia.

Kraegen EW; Chisholm DJ; McNamara ME

1981-07-01

288

Insulin Dysregulation.  

UK PubMed Central (United Kingdom)

Abnormalities of insulin metabolism include hyperinsulinaemia and insulin resistance, and these problems are collectively referred to as insulin dysregulation in this review. Insulin dysregulation is a key component of equine metabolic syndrome (EMS); a collection of endocrine and metabolic abnormalities associated with the development of laminitis in horses, ponies, and donkeys. Insulin dysregulation can also accompany prematurity and systemic illness in foals. Causes of insulin resistance are discussed, including pathological conditions of obesity, systemic inflammation, and pituitary pars intermedia dysfunction (PPID), as well as the physiological responses to stress and pregnancy. Most of the discussion of insulin dysregulation to date has focused on insulin resistance, but there is increasing interest in hyperinsulinaemia itself and insulin responses to feeding. Oral sugar test or in-feed oral glucose tolerance tests can be performed to assess insulin responses to dietary carbohydrates, and these tests are now recommended for use in clinical practice. Incretin hormones are likely to play an important role in postprandial hyperinsulinaemia and are the subject of current research. Insulin resistance exacerbates hyperinsulinaemia, and insulin sensitivity can be measured by performing a combined glucose-insulin test or intravenous insulin tolerance test. In both of these tests, exogenous insulin is administered and the rate of glucose uptake into tissues measured. Diagnosis and management of hyperinsulinaemia is recommended to reduce the risk of laminitis. The term insulin dysregulation is introduced here to collectively refer to excessive insulin responses to sugars, fasting hyperinsulinaemia, and insulin resistance (IR), which are all components of equine metabolic syndrome (EMS).

Frank N; Tadros EM

2013-08-01

289

Plasma nonesterified Fatty Acid intolerance and hyperglycemia are associated with intravenous lipid-induced impairment of insulin sensitivity and disposition index.  

Science.gov (United States)

Context: It is currently unclear why susceptibility to lipid-induced impairment of beta-cell function varies in different populations. Objective: The aim of the study was to determine whether mild hyperglycemia may be associated with nonesterified fatty acid (NEFA) intolerance and increased iv lipid-induced lipotoxic effect on the beta-cell. Design and Setting: The study consisted of an experimental design with control group conducted at an academic clinical research center. Participants: Twenty-six overweight or obese individuals (12 with normal glucose tolerance, nine with impaired glucose tolerance or type 2 diabetes, and five subjects who previously had impaired glucose tolerance or type 2 diabetes but at the time of study had normal glucose tolerance after biliopancreatic diversion). Interventions: We assessed insulin sensitivity (S(I)) and beta-cell function [insulin disposition index (DI)] after an overnight iv infusion of heparin + Intralipid (HI) vs. normal saline for 16 h using a stepwise, incremental iv glucose infusion followed by a hyperglycemic clamp. Main Outcome Measures: We measured S(I), DI, HI-induced change in plasma NEFA, and its association with HI-induced change in S(I) and DI. Results: HI resulted in significant reduction in S(I) and DI across the three groups of participants. HI-induced elevation of plasma NEFA was higher in hyperglycemic vs. normoglycemic groups. Both fasting glucose level and the magnitude of HI-induced NEFA elevation were associated with the reduction in S(I) (P = 0.007 and P = 0.01, respectively) and DI (P = 0.001 and P = 0.007, respectively). Conclusion: Mild hyperglycemia and NEFA intolerance to iv lipid are associated with susceptibility to lipid-induced reduction in S(I) and DI. PMID:20097711

Carpentier, André C; Bourbonnais, Annie; Frisch, Frédérique; Giacca, Adria; Lewis, Gary F

2010-01-22

290

Plasma nonesterified Fatty Acid intolerance and hyperglycemia are associated with intravenous lipid-induced impairment of insulin sensitivity and disposition index.  

UK PubMed Central (United Kingdom)

Context: It is currently unclear why susceptibility to lipid-induced impairment of beta-cell function varies in different populations. Objective: The aim of the study was to determine whether mild hyperglycemia may be associated with nonesterified fatty acid (NEFA) intolerance and increased iv lipid-induced lipotoxic effect on the beta-cell. Design and Setting: The study consisted of an experimental design with control group conducted at an academic clinical research center. Participants: Twenty-six overweight or obese individuals (12 with normal glucose tolerance, nine with impaired glucose tolerance or type 2 diabetes, and five subjects who previously had impaired glucose tolerance or type 2 diabetes but at the time of study had normal glucose tolerance after biliopancreatic diversion). Interventions: We assessed insulin sensitivity (S(I)) and beta-cell function [insulin disposition index (DI)] after an overnight iv infusion of heparin + Intralipid (HI) vs. normal saline for 16 h using a stepwise, incremental iv glucose infusion followed by a hyperglycemic clamp. Main Outcome Measures: We measured S(I), DI, HI-induced change in plasma NEFA, and its association with HI-induced change in S(I) and DI. Results: HI resulted in significant reduction in S(I) and DI across the three groups of participants. HI-induced elevation of plasma NEFA was higher in hyperglycemic vs. normoglycemic groups. Both fasting glucose level and the magnitude of HI-induced NEFA elevation were associated with the reduction in S(I) (P = 0.007 and P = 0.01, respectively) and DI (P = 0.001 and P = 0.007, respectively). Conclusion: Mild hyperglycemia and NEFA intolerance to iv lipid are associated with susceptibility to lipid-induced reduction in S(I) and DI.

Carpentier AC; Bourbonnais A; Frisch F; Giacca A; Lewis GF

2010-03-01

291

Comparison of the Pharmacodynamics of Biapenem in Bronchial Epithelial Lining Fluid in Healthy Volunteers Given Half-Hour and Three-Hour Intravenous Infusions?  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The time above the MIC (T>MIC) is the pharmacokinetic/pharmacodynamic (PK/PD) parameter that correlates with the therapeutic efficacy of beta-lactam antibiotics. A prolonged infusion can provide plasma drug concentrations that remain above the MIC for a long period. The objective of this study was t...

Kikuchi, Eiki; Kikuchi, Junko; Nasuhara, Yasuyuki; Oizumi, Satoshi; Ishizaka, Akitoshi; Nishimura, Masaharu

292

[Changes in the dietary regimen during treatment of type I diabetes mellitus with continuous insulin infusion. II. Omitting food  

UK PubMed Central (United Kingdom)

The authors investigated in 11 type diabetics the effect of omission of a meal on the compensation of diabetes during treatment with an insulin pump IP 1003. After stabilization of treatment by the pump, the patients were left on the 5th day without breakfast, while the basal operation of the pump was maintained and the patient received their insulin bolus in the morning. The test was terminated as planned after 180 mins. in 6 patients, in 5 it was terminated early because of typical signs of clinical hypoglycaemia. The course of the blood sugar curves revealed differences between patients from abrupt drops of hyperglycaemic values to hypoglycaemia to balanced low blood sugar levels. For the rest of the day till the following morning after the test the blood sugar was elevated, as compared with the control level of the 4th day. Conclusions: the tests revealed the relatively small drop of the blood sugar level after omission of the meal, hypoglycaemia develops in the majority of diabetics only after 120 to 180 mins. The danger of early hypoglycaemia within 60 minutes was recorded only in patients with a known history of severe hypoglycaemic states. Posthypoglycaemic hyperglycaemia influences the compensation of diabetics during the rest of the day.

Svacina S; Masek Z; Páv J; Kábrt J; Hilgertová J

1991-02-01

293

Effect of intravenous omega-3 fatty acid infusion and hemodialysis on fatty acid composition of free fatty acids and phospholipids in patients with end-stage renal disease  

DEFF Research Database (Denmark)

Patients treated with hemodialysis (HD) have been reported to have decreased levels of ?-3 polyunsaturated fatty acids (PUFAs) in plasma and cells. The aim of this study was to investigate the effect of ?-3 PUFAs administered intravenously during HD, as well as the effect of HD treatment, on the fatty acid composition of plasma free fatty acids (FFAs), plasma phospholipids, and platelet phospholipids.

Madsen, Trine; Christensen, Jeppe Hagstrup

2011-01-01

294

Glucose-induced changes in renal haemodynamics in proteinuric type 1 (insulin-dependent) diabetic patients: inhibition by acetylsalicilic acid infusion.  

UK PubMed Central (United Kingdom)

The effect of hyperglycaemia on renal function in diabetic nephropathy remains poorly understood. We investigated the renal haemodynamic response to an acute plasma glucose rise from sustained euglycaemia to sustained hyperglycaemia in eight persistently proteinuric Type 1 (insulin-dependent) diabetic patients. Studies were performed in a double-blind cross-over manner after i.v. injection of 450 mg lysine acetylsalicilate (equivalent to 250 mg acetylsalicilic acid) or equal volume of 0.9% NaCl (isotonic saline). In the isotonic saline experiments hyperglycaemia produced a significant rise, by approximately 35%, in glomerular filtration rate in all patients from 41.5 +/- 5.2 to 55 +/- 6 ml.min-1.1.73 m-2 (p < 0.005) and an increase in sodium paraminohippurate clearance from 178 +/- 22.7 to 220 +/- 20.0 ml.min-1.1.73 m-2 (p < 0.05). These changes took place within the first 30 min of glucose infusion and were maintained for a 90 min hyperglycaemic period. Filtration fraction did not change significantly. Infusion of lysine acetylsalicilate lowered baseline glomerular filtration rate (isotonic saline vs lysine acetylsalicilate 41.5 +/- 5.2 vs 30.0 +/- 5.7 ml.min-1.1.73 m-2; p < 0.05) and significantly blunted the rise in glomerular filtration rate during hyperglycaemia (glomerular filtration rate increment: saline vs lysine acetylsalicilate: 13.6 +/- 2.8 vs 5.3 +/- 1.8 ml.min-1.1.73 m-2; p < 0.005). The effects on renal plasma flow were similarly blunted. In five additional patients, time- and volume-controlled isotonic saline experiments during sustained euglycaemia showed no significant changes in glomerular filtration rate and sodium paraminohippurate clearance.(ABSTRACT TRUNCATED AT 250 WORDS)

De Cosmo S; Earle K; Morocutti A; Walker J; Ruggenenti P; Remuzzi G; Viberti GC

1993-07-01

295

Derivation and experimental proof of a new algorithm for the artificial B-cell based on the individual analysis of the physiological insulin-glucose relationship.  

UK PubMed Central (United Kingdom)

Normal dogs were submitted to oral glucose loads or to intravenous glucose infusions. Insulin secretion rates (CISR) were calculated considering the resulting peripheral venous concentration differences in short intervals and the experimentally determined half life and apparent distribution space of exogenous insulin. Multiple regression analysis was done between CISR and both the level and the rate of change of plasma glucose. The regression coefficients were used as algorithm parameters for continuous plasma glucose dependent intravenous insulin administration in the same animals after induction of an insulin-dependent diabetes. Normal glycemic regulation over the day could be resotred by this sytem. The insulin responsiveness, however, varies from day to day; tusing this insulin dosage pattern we observed nearly normal plasma glucose curves and slightly elevated insulin reactions after glucose loading. This kind of algorithm could also be used in diabetic humans.

Fischer U; Jutzi E; Freyse EJ; Salzsieder E

1978-02-01

296

[Satisfaction and quality of life evaluation in patients with type 1 diabetes mellitus treated using continuous subcutaneous insulin infusion compared with multiple daily injections].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess the quality of life (QOL) and satisfaction (SF) in patients with type 1 diabetes mellitus (T1DM) treated with continuous subcutaneous insulin infusion (CSII) compared with multiple daily insulin injections (MDI). METHOD: A descriptive study was conducted to assess the QOL and SF of 68 patients on CSII or MDI treatment (1:2). The instruments used were, the Spanish version of the Diabetes Quality of Life (EsDQOL) specific for diabetes related QOL, SF-36 for general QOL, and the Diabetes Treatment Satisfaction Questionnaire (DTSQ) for SF evaluation. RESULTS: The EsDQOL scores for patients on CSII therapy were similar to those treated with MDI (87.20±21.11 vs 86.83±20.7, P=.86), with lower scores in the SF-36 questionnaire (66.91±15.76 vs 75.90±14.56, P=.03) except in Health Transition section, where patients treated with CSII showed higher scores (68.75±19.66 vs 57.93±17.18, p=.02). The values obtained in the DTSQ questionnaire were higher in CSII patients compared with the MDI group in last weeks (31.50±4.66 vs 27.83±6.06, p=.01) and last three months periods (13.2±6.73 vs 8.77±7.40, p=.01). CONCLUSIONS: Patients with T1DM on CSII therapy showed a poorer global QOL, although they felt more satisfied with their treatment than those treated with MDI. No differences in diabetes related QOL were detected between groups.

Lozano-Serrano M; García-Seco JA; García-Seco F; Lozano-Hernández MC; Seco-Segura ÁM; Moreno-Fernández J; Muñoz-Cazallas PA; Ferreiro-Vicario C; Sánchez-Covisa MA

2013-05-01

297

Diferença entre volume de fluidos cristaloides intravenosos prescritos e infundidos em pacientes no pós-operatório precoce/ Difference between intravenous crystalloid fluids prescribed and infused in patients during early postoperative period  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese OBJETIVO: O objetivo deste trabalho foi auditar a real quantidade de fluídos cristalóides infundidos por via intravenosa em pacientes submetidos a operações abdominais de grande porte num hospital universitário. MÉTODOS: Computou-se a carga hídrica total (CHT) de fluidos cristalóides intravenosos infundida diariamente do 1º ao 4º dia de PO em 31 pacientes submetidos à operações de grande porte. Comparou-se a CHT com a carga hídrica prescrita (CHP) pelo médi (more) co. A CHT foi definida como a somatória da CHP acrescida de diluentes e medicações intravenosas. O protocolo do serviço recomendava a hidratação venosa no peri-operatório entre 30 e 50 mL/Kg/dia em pacientes com prescrição de jejum oral. A comparação entre CHT e CHP foi realizada em todos os dias de pós-operatório pelo teste t pareado. Estabeleceu-se em 5% o nível de significância estatística. RESULTADOS: A CHT infundida do 1º ao 4ºdia de pós-operatório foi de 12,8 (6,4-17,5) L. Desse total, 9,5 litros (74,3%) corresponderam a CHP e 3,3 L (25,7%) a diluentes e medicações venosas. Em todos os dias de pós-operatório a CHT foi significativamente maior que a CHP (p Abstract in english OBJECTIVE: The aim of this study was to audit the real amount of crystalloid intravenous fluids infused in patients underwent major abdominal operations in a University hospital. METHODS: The whole intravenous crystalloid fluid load (CHT) infused from the 1st to the 4th postoperative day in 31 patients underwent major abdominal operations was registered. This amount was compared to the volume daily prescribed (CHP) by the physician. CHT was defined as the sum of CHP plus (more) diluents and intravenous drugs received by the patients. Hydration protocol of the service was 30-50 mL/Kd/day for patient with nil per os prescription. Comparisons between CHT and CHP was done in each postoperative day using paired T test. A 5% level was established as significant. RESULTS: CHT summed from 1st to 4th PO days was (mean and range) 12.8 (6.4-17.5) L corresponding to 9.5 L (74.3%) of CHP and 3.3 L (25.7%) of diluents and intravenous drugs. In each postoperative day, CHT was significantly greater than CHP (p

Aguilar-Nascimento, José Eduardo de; Diniz, Breno Nadaf; Neves, José de Souza

2010-02-01

298

Cleveland Clinic cardiovascular intensive care unit insulin conversion protocol.  

UK PubMed Central (United Kingdom)

BACKGROUND: The importance of near-normal blood glucose in the immediate postoperative period is generally accepted and is best achieved in the perioperative period with a constant intravenous (IV) infusion of insulin. This requires intensive nursing only achievable in an intensive care unit (ICU) setting. Glucose management after transfer to a regular nursing floor (RNF) has not been studied systematically. In August 2006, the Cleveland Clinic began using long-acting insulin glargine as the insulin infusion was terminated in the ICU. METHODS: This prospective analysis examined all patients receiving IV insulin infusion after cardiothoracic surgery in a 1 month period. The analyses evaluated the safety and efficacy of a protocol using a transition to subcutaneous insulin glargine of 50% of the calculated 24 h requirement at the end of the ICU insulin infusion protocol in preparation for transfer to the RNF. Results: Only 1 patient in 99 developed hypoglycemia, and no patient suffered severe hypoglycemia (glucose < 40 mg/dl), while the majority (70%) had euglycemia (glucose between 70 and 150 mg/dl). CONCLUSIONS: This approach was both safe-as there was very little hypoglycemia (1 patient in 99)-and effective, as blood sugar was well controlled in most subjects. Efficacy for achieving euglycemia was 70%. Efficacy was likely reduced because of the upper limit of insulin glargine dosage imposed by some providers as a safety consideration. Although there was a physician option to override, the maximum protocol dose of 30 U was rarely exceeded, leading to inadequate dosing in some subjects who required high insulin infusion rates in the ICU.

Olansky L; Sam S; Lober C; Yared JP; Hoogwerf B

2009-05-01

299

Effect of increased plasma non-esterified fatty acids (NEFAs) on arginine-stimulated insulin secretion in obese humans.  

UK PubMed Central (United Kingdom)

AIMS/HYPOTHESIS: We have shown previously that the increase of plasma non-esterified fatty acids for 48 h results in decreased glucose-stimulated insulin secretion in lean and non-diabetic obese subjects. It is currently not known if a prolonged increase in non-esterified fatty acids also impairs the insulin secretory response to non-glucose secretagogues. METHODS: Heparin and intralipid (to increase plasma non-esterified fatty acid concentrations by about two- to fourfold) or normal saline was infused intravenously for 48 h in 14 non-diabetic obese subjects. On the third day in both studies, insulin, C-peptide, proinsulin, and insulin secretion rate were assessed in response to an intravenous arginine infusion at fasting glucose concentration and a second arginine infusion after a 60-min 11 mmol/l hyperglycaemic clamp. RESULTS: There were no significant differences detected in acute (5 min) or total (90 min) arginine-stimulated C-peptide or insulin secretion response in the heparin-intralipid study compared with the control group at fasting glucose or during hyperglycaemia. CONCLUSION/INTERPRETATION: We have shown that a prolonged increase in plasma NEFA does not blunt arginine-stimulated insulin secretion or plasma insulin concentrations in non-diabetic obese subjects. These findings suggest that the previously demonstrated NEFA-induced impairment in insulin secretory response to glucose cannot be generalized for non-glucose secretagogues.

Carpentier A; Giacca A; Lewis GF

2001-11-01

300

A phase I study of hepatic arterial infusion of nab-paclitaxel in combination with intravenous gemcitabine and bevacizumab for patients with advanced cancers and predominant liver metastases.  

UK PubMed Central (United Kingdom)

PURPOSE: We conducted a phase I clinical trial for patients with advanced cancer and predominant liver disease. METHODS: Patients were treated with HAI nab-paclitaxel (120-210 mg/m(2); day 1); intravenous bevacizumab (10 mg/kg; day 1); and intravenous gemcitabine (600-800 mg/m(2); days 1 and 8). A conventional "3 + 3" study design was used. RESULTS: Fifty patients with advanced cancer and predominant liver metastases were treated (median age, 58 years; 27 women, 23 men; median number of prior therapies, 3 [range 0-12]). The most common cancers were breast (n = 9) and pancreatic (n = 9). Overall, 264 cycles were administered (median/patient, 4; range 1-17). No dose-limiting toxicities were noted during the escalation phase. On dose level 4, 3 patients were unable to receive gemcitabine on day 8 because of severe thrombocytopenia. Dose level 3 was selected as the maximum-tolerated dose (HAI nab-paclitaxel 180 mg/m(2) and intravenous gemcitabine 800 mg/m(2) and bevacizumab 10 mg/kg); 32 patients were treated in the expansion phase. The most common treatment-related toxicities were thrombocytopenia (n = 17), neutropenia (n = 10), and fatigue (n = 12). Of 46 patients evaluable for response, 9 (20 %) had a partial response (PR) and 9 (20 %) had stable disease for ?6 months. The median overall survival duration was 7.0 months (95 % CI: 4, 22 months), and the median progression-free survival duration was 4.2 months (95 % CI: 2.7, 8.6 months). CONCLUSIONS: HAI nab-paclitaxel in combination with gemcitabine and bevacizumab was well tolerated and had antitumor activity in selected patients with advanced cancer and liver metastases.

Tsimberidou AM; Ye Y; Wheler J; Naing A; Hong D; Nwosu U; Hess KR; Wolff RA

2013-04-01

 
 
 
 
301

Estudos hemodinâmicos e da função endotelial em porcas saudáveis após injeção em bolus endovenoso de azul de metileno Hemodynamic and vascular endothelium function studies in healthy pigs after intravenous bolus infusion of methylene blue  

Directory of Open Access Journals (Sweden)

Full Text Available OBJETIVO: Benefícios clínicos obtidos pelo azul de metileno (AM) no tratamento da vasoplegia induzida pela ação do óxido nítrico (NO) têm sido relatados na sepse, na síndrome da resposta inflamatória sistêmica (SIRS) em cirurgia cardíaca e no choque anafilático, mas a sua segurança é muitas vezes questionada, principalmente relacionada aos seus efeitos hemodinâmicos e à possibilidade de causar disfunção endotelial. O objetivo deste estudo foi examinar os efeitos hemodinâmicos e a função endotelial da infusão endovenosa in vivo do AM em porcos. MÉTODOS: O protocolo de estudo incluiu dois grupos experimentais de porcas fêmeas: Grupo I (Controle) - os animais (n = 6) não receberam AM; Grupo II (AM) - os animais receberam 3 mg/kg de AM em forma de bolus endovenoso. Após quinze minutos de registro dos parâmetros hemodinâmicos os animais foram sacrificados por exsangüinação, e os estudos in vitro foram conduzidos usando segmentos de artérias coronária, hepática, mesentérica superior, renal, para determinar o efeito do AM na função endotelial relacionada com a liberação de NO. Mediu-se também o NO plasmático nos dois grupos experimentais. RESULTADOS: Os resultados obtidos no presente estudo foram: 1) a infusão endovenosa de AM (3,0 mg/kg) não causou nenhuma alteração hemodinâmica significativa; 2) os valores absolutos e porcentuais e nitrito/nitrato plasmático (NOx) não apresentaram diferenças nos dois grupos experimentais; 3) o estudo in vitro dos segmentos arteriais (coronária, hepática, renal e mesentérica superior) não apresentou disfunção endotelial nos dois grupos. Os resultados sugerem que a injeção endovenosa de AM é segura. Esse dado concorda com dados clínicos no qual o AM foi utilizado para tratar a síndrome vasoplégica após circulação extracorpórea, síndrome da resposta infamatória sistêmica (SIRS) e anafilaxia. Os resultados não foram inesperados porque os animais não apresentavam vasoplegia, não se esperando que a inibição da guanilatociclase tenha algum efeito. CONCLUSÃO: A infusão em bolus endovenoso in vivo na dose investigada (3 mg/kg) não causou alterações hemodinâmicas e comprometimento da liberação in vitro de NO.OBJECTIVE: Clinical benefit of methylene blue (MB) treating NO-induced vasoplegia has been reported in sepsis, systemic inflammatory response syndrome (SIRS) in cardiac surgery and anaphylactic shock, but its safety is sometimes questioned, mainly regarding its hemodynamic effects and the possibility of causing endothelium dysfunction. To examine the nitric oxide plasma levels and cardiovascular effects of the infusion of MB in vivo and its effects on endothelium-dependent and endothelium-independent in vitro vascular relaxation. METHODS: The study protocol included two experimental groups of female pigs: Group I (Control) - the animals (n=6) did not receive MB; Group II (MB) - the animals received 3 mg/kg of MB intravenous bolus infusion. After fifteen minutes of hemodynamic parameter recording the animals were sacrificed by exsanguination, and in vitro studies were conducted using segments of coronary, hepatic, superior mesenteric and renal arteries, to determine the effect of MB on the arterial endothelium function with regard to NO release. Nitric oxide plasma levels (NOx) were measured in each of the experimental groups. RESULTS: The results obtained in the present investigation were: 1) intravenous infusion of MB (3.0 mg/kg) caused no hemodynamic changes; 2) absolute and percent plasma NOx values did not differ between the experimental groups; and 3) in vitro study of vascular relaxation showed no significant difference between groups. These results show that MB intravenous infusion seems to be safe. This finding agrees with data from clinical experiments where MB was used to treat vasoplegic syndrome after cardiopulmonary bypass, systemic inflammatory response syndrome (SIRS) and anaphylaxis. These results were not unexpected because, as in healthy subjects, hemodynamics is only fine tuned an

Antonio Carlos Menardi; Fernanda Viaro; Walter Vilella de Andrade Vicente; Alfredo José Rodrigues; Paulo Roberto Barbosa Évora

2006-01-01

302

Infusão de insulina subcutânea contínua em gestante com diabetes tipo 1: relato de caso e revisão da literatura Continuous subcutaneous insulin infusion in type 1 diabetic during pregnancy: case report and literature review  

Directory of Open Access Journals (Sweden)

Full Text Available A gestação em portadoras de diabetes tipo 1 é alvo de múltiplas tentativas para o bom controle glicêmico desde o período pré-concepcional, com a terapia com infusão de insulina subcutânea contínua apresentando opção terapêutica adicional na tentativa de alcançar as metas glicêmicas. Apresentamos o caso de uma paciente com diabetes tipo 1, não controlada com múltiplas injeções diárias, cuja instalação da bomba de insulina ocorreu durante o segundo trimestre de gestação, com sucesso terapêutico.The type 1 diabetic patient pregnancy is subjected to various attempts to obtain good glycemic control, since the pre-conception period throughout the gestation. Continuous subcutaneous insulin infusion (CSII) is a therapeutic tool to achieve the glycemic targets. Here it is presented the case of a Type 1 diabetic woman, who was not under multiple insulin daily injections therapy, and whose insulin therapy started on CSII during the second trimester of gestation, obtaining successful therapeutic outcome.

Janice Sepúlveda Reis; Rodrigo Nunes Lamounier; Patrícia A. F. C. Menezes; Maria R. Calsolari; Saulo Purisch

2008-01-01

303

Pramlintide improved measures of glycemic control and body weight in patients with type 1 diabetes mellitus undergoing continuous subcutaneous insulin infusion therapy.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess the safety and efficacy of the addition of pramlintide to continuous subcutaneous insulin infusion (CSII) therapy in patients with type 1 diabetes mellitus (T1DM). RESEARCH DESIGN AND METHODS: We conducted a post hoc analysis of 2 studies: a 29-week, multicenter, randomized, double-blind, placebo-controlled trial (referred to as RCT) (pramlintide, n = 82; placebo, n = 73) and an open-ended, multicenter, open-label, single-arm, observational study (referred to as clinical practice trial) (n = 150), which assessed the addition of pramlintide to CSII therapy in patients with T1DM. Pramlintide was initiated at 15 ?g and titrated to 30 or 60 ?g with major meals. The mealtime insulin dose was reduced by 30% to 50% at initiation, and then adjusted to optimize glycemic control. Endpoints at 29 weeks (RCT) and 6 months (clinical practice trial) included change in glycated hemoglobin (HbA1c) level, insulin dose, body weight, pre- and postprandial blood glucose level, and tolerability and safety. RESULTS: In both studies, mean baseline age was approximately 42 years, duration of diabetes was 20 to 24 years, and HbA1c level was approximately 8%. Pramlintide reduced blood glucose excursions and improved the percentage of recorded postprandial blood glucose levels < 180 mg/dL. Mean (± standard deviation) reduction in HbA1c level in the clinical practice trial was -0.3% ± 0.1% (P < 0.0001), and in the RCT was similar between pramlintide- and placebo-treated patients (-0.4% ± 0.1% and -0.3% ± 0.1%, respectively). Glycemic improvements were accomplished, with reductions in mealtime insulin doses (RCT: pramlintide, -23.8% ± 5.2%; placebo, -3.2% ± 4.1%; P < 0.0005; clinical practice trial: -27.5% ± 2.9%; P < 0.0001) and body weight (RCT: pramlintide, -2.2 kg ± 0.5 kg; placebo, +1.4 kg ± 0.3 kg; P < 0.0001; clinical practice trial: -3.2 kg ± 0.4 kg; P < 0.0001). Short-lived nausea, primarily mild to moderate in intensity, was the most common adverse event associated with pramlintide therapy. Severe hypoglycemic events occurred at a rate of 0.56 and 0.34 events per patient-year in pramlintide- and placebo-treated patients, respectively, in the RCT, and at a rate of 0.12 events per patient-year in the clinical practice trial. CONCLUSION: Addition of pramlintide to CSII therapy was safe and effective in patients with T1DM. Pramlintide should be considered for patients who are not able to optimize glycemic control with CSII therapy alone, particularly those with difficulty controlling postprandial blood glucose levels and/or body weight. Trial registration: www.ClinicalTrials.gov identifiers: NCT00042458, NCT00108004.

Herrmann K; Frias JP; Edelman SV; Lutz K; Shan K; Chen S; Maggs D; Kolterman OG

2013-05-01

304

Cardiopulmonary effects of intravenous fentanyl infusion in dogs during isoflurane anesthesia and with concurrent acepromazine or dexmedetomidine administration during anesthetic recovery.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate the cardiopulmonary effects of IV fentanyl administration in dogs during isoflurane anesthesia and during anesthetic recovery with or without dexmedetomidine or acepromazine. ANIMALS: 7 sexually intact male purpose-bred hound-type dogs aged 11 to 12 months. PROCEDURES: Dogs received a loading dose of fentanyl (5 ?g/kg, IV) followed by an IV infusion (5 ?g/kg/h) for 120 minutes while anesthetized with isoflurane and for an additional 60 minutes after anesthesia was discontinued. Dogs were randomly assigned in a crossover design to receive dexmedetomidine (2.5 ?g/kg), acepromazine (0.05 mg/kg), or saline (0.9% NaCl) solution (1 mL) IV after anesthesia ceased. Cardiopulmonary data were obtained during anesthesia and for 90 minutes after treatment administration during anesthetic recovery. RESULTS: Concurrent administration of fentanyl and isoflurane resulted in significant decreases in mean arterial blood pressure, heart rate, and cardiac index and a significant increase in Paco2. All but Paco2 returned to pretreatment values before isoflurane anesthesia was discontinued. During recovery, dexmedetomidine administration resulted in significant decreases in heart rate, cardiac index, and mixed venous oxygen tension and a significant increase in arterial blood pressure, compared with values for saline solution and acepromazine treatments. Acepromazine administration resulted in significantly lower blood pressure and higher cardiac index and Po2 in mixed venous blood than did the other treatments. Dexmedetomidine treatment resulted in significantly lower values for Pao2 and arterial pH and higher Paco2 values than both other treatments. CONCLUSIONS AND CLINICAL RELEVANCE: Fentanyl resulted in transient pronounced cardiorespiratory effects when administered during isoflurane anesthesia. During anesthetic recovery, when administered concurrently with an IV fentanyl infusion, dexmedetomidine resulted in evidence of cardiopulmonary compromise and acepromazine transiently improved cardiopulmonary performance.

Keating SC; Kerr CL; Valverde A; Johnson RJ; McDonell WN

2013-05-01

305

Regulation of gonadal and somatotropic axis by chronic intraventricular infusion of insulin-like growth factor 1 antibody at the initiation of puberty in male rats.  

Science.gov (United States)

There has been increasing experimental evidence to suggest that insulin-like growth factor 1 (IGF-I) may be one of the essential regulators in the reproductive system of the rat. IGF-I is synthesized in the hypothalamus and IGF-I immunoreactivity increases during puberty. Consequently we hypothesized that centrally located IGF-I might contribute to the initiation of puberty. Centrally located IGF-I was immunoneutralized to assess this hypothesis. Male Wistar rats, 28 days old, were infused intracerebroventricularly with specific purified IgGs from rabbit IGF-I antiserum (IGF-I-Ab). The intracerebroventricular administration of IGF-I-Ab resulted in a reduction in testicular weight and consequently in delayed pubertal development. There was also a reduction in serum testosterone, pituitary immunoreactive (IR) luteinizing hormone (LH) and serum IR follicle-stimulating hormone (FSH). The accumulation of betaLH mRNA was not modified, whereas betaFSH mRNA was increased. An increment in the serum growth hormone (GH) levels was also observed. There were no significant alterations in hypothalamic IR growth hormone releasing factor content, although IR somatostatin (SRIH) content was increased by IGF-I-Ab. The body weight gain remained unaltered. As a whole, our study suggests that centrally located IGF-I influences pubertal development, production and release of gonadotropins and supports the finding that endogenous centrally located IGF-I plays a role at the initiation of puberty in the male rat. It also gives support to the physiological role of centrally located IGF-I in the release of GH mediated by hypothalamic SRIH at the initiation of puberty. PMID:10364692

Pazos, F; Sánchez-Franco, F; Balsa, J; López-Fernandez, J; Escalada, J; Cacicedo, L

1999-06-01

306

Intravenous smart pumps.  

UK PubMed Central (United Kingdom)

Intravenous (IV) smart pumps provide substantial safety features during infusion. However, nurses need to understand the requisite education necessary to fully benefit from and improve IV smart pump use and clinical integration. Failure to use IV smart pumps places the nurse and patient at increased risk.

Harding AD

2013-05-01

307

MATLAB-implemented estimation procedure for model-based assessment of hepatic insulin degradation from standard intravenous glucose tolerance test data.  

UK PubMed Central (United Kingdom)

Present study provides a novel MATLAB-based parameter estimation procedure for individual assessment of hepatic insulin degradation (HID) process from standard frequently-sampled intravenous glucose tolerance test (FSIGTT) data. Direct access to the source code, offered by MATLAB, enabled us to design an optimization procedure based on the alternating use of Gauss-Newton's and Levenberg-Marquardt's algorithms, which assures the full convergence of the process and the containment of computational time. Reliability was tested by direct comparison with the application, in eighteen non-diabetic subjects, of well-known kinetic analysis software package SAAM II, and by application on different data. Agreement between MATLAB and SAAM II was warranted by intraclass correlation coefficients ?0.73; no significant differences between corresponding mean parameter estimates and prediction of HID rate; and consistent residual analysis. Moreover, MATLAB optimization procedure resulted in a significant 51% reduction of CV% for the worst-estimated parameter by SAAM II and in maintaining all model-parameter CV% <20%. In conclusion, our MATLAB-based procedure was suggested as a suitable tool for the individual assessment of HID process.

Di Nardo F; Mengoni M; Morettini M

2013-05-01

308

The use of high-dose insulin therapy and intravenous lipid emulsion to treat severe, refractory diltiazem toxicosis in a dog.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To describe the novel use of high-dose insulin (HDI) therapy and intravenous lipid emulsion (ILE) to treat refractory, severe diltiazem toxicosis in a dog. CASE SUMMARY: A 4-year-old Pomeranian was presented for treatment 2.5 hours following ingestion of a diltiazem extended-release capsule. Toxic ingestion was calculated at a maximum exposure of 79 mg/kg, with a reported canine LD50 of 50 mg/kg. Clinical signs of progressive hypotension and severe bradycardia with atrial standstill were observed, which persisted despite treatment with atropine, calcium, glucagon, and dopamine. The novel use of HDI and ILE as part of therapy for diltiazem toxicosis resulted in clinical resolution of life-threatening signs. Within 1 hour of initiating HDI therapy, the clinical signs improved, and with continued treatment, the patient remained normotensive and survived to discharge. NEW OR UNIQUE INFORMATION PROVIDED: To the authors' knowledge, this is the first reported clinical case describing the use of both HDI and ILE therapy in the treatment of severe refractory diltiazem toxicosis in veterinary medicine. No significant adverse effects were observed from the treatment. In veterinary patients with severe refractory calcium channel blocker toxicosis, the use of HDI and ILE should be considered for life-threatening clinical signs.

Maton BL; Simmonds EE; Lee JA; Alwood AJ

2013-05-01

309

Beta-Agonist Lung injury TrIal-2 (BALTI-2): a multicentre, randomised, double-blind, placebo-controlled trial and economic evaluation of intravenous infusion of salbutamol versus placebo in patients with acute respiratory distress syndrome.  

UK PubMed Central (United Kingdom)

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a major cause of mortality in intensive care patients and lacks effective treatments. A previous randomised controlled Phase II trial suggested that an intravenous (i.v.) infusion of salbutamol may be beneficial, as it reduced extravascular lung water and plateau airway pressure. The Beta-Agonist Lung injury TrIal-2 (BALTI-2) was initiated to evaluate the effects of this intervention on mortality in patients with ARDS. OBJECTIVES: To evaluate whether or not, in patients with ARDS, an i.v. infusion of salbutamol given at 15??g/kg ideal body weight (IBW)/hour for up to 7 days, compared with a placebo (0.9% sodium chloride) infusion, reduces 28-day all-cause mortality and other clinical outcomes. To evaluate salbutamol's clinical effectiveness and its cost-effectiveness in subgroups of patients. DESIGN: A multicentre, randomised, placebo-controlled trial. SETTING: Forty-six intensive care units (ICUs) in the UK. PARTICIPANTS: Patients were eligible if they (1) were intubated and mechanically ventilated patients in participating ICUs; (2) were within 72 hours of onset of ARDS; (3) fulfilled American-European Consensus Conference definition for ARDS {acute-onset, severe hypoxaemic respiratory failure [partial pressure of oxygen in arterial blood/fraction of inspired oxygen ??26.7?kPa (200?mmHg)] and bilateral infiltrates on the chest radiograph in the absence of clinical evidence of left atrial hypertension}; and (4) were aged ??16 years. INTERVENTIONS: Intravenous infusion of salbutamol (15??g/kg IBW/hour) or placebo (0.9% saline) for up to 7 days. MAIN OUTCOME MEASURES: All-cause mortality 28 days after randomisation, mortality at (first) discharge from ICU, mortality at (first) discharge from hospital, number of ventilator-free days, number of organ failure-free days, mortality at 12 months post randomisation, side effects (tachycardia/new arrhythmia/lactic acidosis) sufficient to stop treatment with trial drug, health-related quality of life (European Quality of Life-5 Dimensions and Short Form questionnaire-12 items at 6 and 12 months after randomisation), length of stay in critical care unit and length of stay in hospital. RESULTS: Forty-six ICUs recruited patients to the trial. A total of 326 patients were randomised; 162 were allocated to salbutamol and 164 to placebo. One patient in each group withdrew consent. Recruitment was stopped after the second interim analysis because of safety concerns. Salbutamol increased 28-day mortality: 55 (34%) of 161 patients died in the salbutamol group compared with 38 (23%) of 163 in the placebo group (risk ratio 1.47, 95% confidence interval 1.03 to 2.08). CONCLUSIONS: Treatment with i.v. salbutamol early in the course of ARDS was poorly tolerated, is unlikely to be beneficial and could worsen outcomes. Further trials of ?-agonists in patients with ARDS are unlikely to be conducted. Some questions remain, such as whether or not there may be benefit at a different dose or in specific populations, but any studies investigating these would require a very strong rationale. TRIAL REGISTRATION: Current Controlled Trials ISRCTN38366450. FUNDING: The National Institute for Health Research Health Technology Assessment programme.

Gates S; Perkins G; Lamb S; Kelly C; Thickett D; Young J; McAuley D; Snaith C; McCabe C; Hulme C; Gao Smith F

2013-09-01

310

Safety and Pharmacokinetics of 120 mg/kg versus 60 mg/kg Weekly Intravenous Infusions of Alpha-1 Proteinase Inhibitor in Alpha-1 Antitrypsin Deficiency: A Multicenter, Randomized, Double-Blind, Crossover Study (SPARK).  

UK PubMed Central (United Kingdom)

Abstract Augmentation therapy with the approved dose of 60 mg/kg weekly intravenous (IV) alpha-1 proteinase inhibitor (alpha1-PI), achieves a trough serum level of 11 ?M in individuals with alpha-1 antitrypsin deficiency (AATD), yet this is still below the level observed in healthy individuals. This study assessed the safety and pharmacokinetic profile of weekly infusions of a 120 mg/kg dose of alpha1-PI in 30 adults with AATD. Subjects with symptomatic, genetically determined (genotypes PI*ZZ, PI*Z(null), PI*(null)(null) or PI*(Z)Mmalton) AATD were randomly assigned to weekly infusions of 60 or 120 mg/kg alpha1-PI (Prolastin-C®) for 8 weeks before crossing over to the alternate dose for 8 weeks. Adverse events (AEs) (including exacerbations), vital signs, pulmonary function tests, and laboratory assessments were recorded. Pharmacokinetic measurements included AUC0-7days, Cmax, trough, tmax, and t1/2, based on serum alpha1-PI concentrations. In total for both treatments, 112 AEs were reported, with exacerbation of COPD being the most frequent, consistent with the subjects' diagnoses. Mean steady-state serum alpha1-PI concentrations following 120 mg/kg weekly IV alpha1-PI were higher than with the 60 mg/kg dose and mean trough concentrations were 27.7 versus 17.3 ?M, respectively. Dose proportionality was demonstrated for AUC0-7days and Cmax, with low inter-subject variability. The 120 mg/kg alpha1-PI weekly dose was considered to be safe and well tolerated, and provided more favorable physiologic alpha1-PI serum levels than the currently recommended 60 mg/kg dose. The effect of this dosing regimen on slowing and/or preventing emphysema progression in subjects with AATD warrants further investigation.

Campos MA; Kueppers F; Stocks JM; Strange C; Chen J; Griffin R; Wang-Smith L; Brantly ML

2013-07-01

311

A review of types 1 and 2 diabetes mellitus and their treatment with insulin.  

UK PubMed Central (United Kingdom)

Diabetes is a chronic disease characterized by hyperglycemia, and the prevalence of type 2 diabetes is growing to epidemic proportions in certain populations. Type 1 diabetes is primarily the result of autoimmune destruction of beta cells. Type 2 diabetes is found in those with resistance to the action of insulin, usually as a result of obesity, and deficient insulin secretion. Insulin use not only prevents hyperglycemic emergencies, but also is the best safeguard to prevent the long-term complications of diabetes by correcting fasting and postprandial hyperglycemia. Intensive glycemic control can lead to a substantial decrease in the development of microvascular changes found in patients with diabetes. Human insulin analogs, insulins manufactured by recombinant technology which contain substituted or rearranged amino acids, allow more physiological patterns of insulin replacement, termed the basal-bolus approach. Serious hypoglycemia is the biggest obstacle for patients with diabetes treated with intensive insulin programs. Insulin is now available in prefilled pens or can be delivered by a programmable pump to allow greater flexibility in use and to improve glycemic control. Whereas hyperglycemic emergencies are usually treated with intravenous fluids and an intravenous continuous insulin infusion, patients who are less critically ill can be treated with fluid and subcutaneous insulin analogs.

Salsali A; Nathan M

2006-07-01

312

A review of types 1 and 2 diabetes mellitus and their treatment with insulin.  

Science.gov (United States)

Diabetes is a chronic disease characterized by hyperglycemia, and the prevalence of type 2 diabetes is growing to epidemic proportions in certain populations. Type 1 diabetes is primarily the result of autoimmune destruction of beta cells. Type 2 diabetes is found in those with resistance to the action of insulin, usually as a result of obesity, and deficient insulin secretion. Insulin use not only prevents hyperglycemic emergencies, but also is the best safeguard to prevent the long-term complications of diabetes by correcting fasting and postprandial hyperglycemia. Intensive glycemic control can lead to a substantial decrease in the development of microvascular changes found in patients with diabetes. Human insulin analogs, insulins manufactured by recombinant technology which contain substituted or rearranged amino acids, allow more physiological patterns of insulin replacement, termed the basal-bolus approach. Serious hypoglycemia is the biggest obstacle for patients with diabetes treated with intensive insulin programs. Insulin is now available in prefilled pens or can be delivered by a programmable pump to allow greater flexibility in use and to improve glycemic control. Whereas hyperglycemic emergencies are usually treated with intravenous fluids and an intravenous continuous insulin infusion, patients who are less critically ill can be treated with fluid and subcutaneous insulin analogs. PMID:16858171

Salsali, Afshin; Nathan, Muriel

313

Insulin Pump Therapy: What Is the Evidence for Using Different Types of Boluses for Coverage of Prandial Insulin Requirements?  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Bolus infusion of insulin along with a meal is a standard procedure with continuous subcutaneous insulin infusion. Modern insulin pumps allow applying this bolus in four different ways: infusion of the total dose at once or splitting the dose into two boluses, infusion of a part of the bolus in the ...

Heinemann, Lutz

314

Effect of Aggressive Early High-Dose Intravenous Amino Acid Infusion and Early Trophic Enteral Nutrition on Very Low Birth Weight Infants  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: Very-low-birth-weight (VLBW) preterm infants are at risk of growth delay if they do not receive adequate nutritional support. This study evaluated the effect of aggressive early high-dose amino acid infusion plus early enteral trophic feeding on growth in VLBW infants within the first day of life. Study design: The effect of a high-dose 3 g amino acid (HAA)/kg/d regimen beginning on the first day of life was compared with that of low-dose amino acid (LAA) supplementation at a dose of 0.5 or 1.0 g/kg/d. The primary outcome measures were the days of regained birth weight and achieved full enteral feeding. Result: Compared with the 19 infants in the LAA group, the 17 infants in the HAA group achieved significantly earlier full enteral feeding (7.8 ± 3.6 vs. 15.2 ± 8.9, p = 0.003) and regained birth weight (13.3 ± 3.8 vs. 17.5 ± 7.9, p = 0.047). In addition, shorter parenteral nutrition time was achieved by HAA administration (p < 0.05). Total energy intake was greater during the first 7 days of life in the HAA group (85 ± 12 kcal/kg/d on day 7) than in the LAA group (60 ± 16 kcal/kg/d on day 7, p < 0.001). Other clinical parameters such as length of hospital stay and morbidity favored the use of HAA. Conclusion: Aggressive early simultaneous amino acid administration plus enteral feeding during the first few days of life for preterm infants was associated with improved weight gain and earlier full enteral feeding.

Man-Yau Ho; Yu-Hsuan Yen; Hsiang-Yin Chen; Shu-Chen Chien; Mao-Chih Hsieh; Yao-Shun Yang

2012-01-01

315

[TIVA-TCI (Total IntraVenous Anesthesia-Target Controlled Infusion) versus isoflurane anesthesia for laparoscopic cholecystectomy. Postoperative nausea and vomiting, and patient satisfaction  

UK PubMed Central (United Kingdom)

Numerous studies have shown that TIVA is followed by a significant reduction in the incidence of PONV in day-case surgery, including laparoscopic cholecystectomy, where the incidence of PONV can reach 70% according to some studies. TCI is the TIVA technique that maintain a constant plasma concentration due to pharmacokynetic models incorporated in TCI device that inject the anesthetic agent. Besides implementing TIVA-TCI in clinical practice in Romania, our study was designed to evaluate the impact of TIVA-TCI on postoperative outcome and our patient satisfaction after laparoscopic cholecystectomy. PATIENTS AND METHODS: After informed consent, 70 patients ASAI/II undergoing laparoscopic cholecystectomy were randomized in 2 equal study groups: group 1 (n = 35) included patients with TIVA-TCI with propofol (Cpi = 4 microg/ml) and remifentanil, and group 2 (n = 35) were patients undergoing Isoflurane anesthesia. In both groups propofol was administered during induction and remifentanil followed the same protocol: 0.5 microg/kg/min in the first minute during induction, followed by 0.25 microg/kg/min. This infusion was modified by 0.05 microg/kg/min steps according to analgesic needs. PONV (evaluated as both incidence and number of episodes), severity of pain and patient satisfaction score IOWA were compared between study groups. RESULTS: Both the incidence of PONV (p = 0.03) and the number of episodes/24 h/patients (p = 0.01) were significantly lower in TIVA-TCI group, while there was no significant difference in opioid requirements in study groups (p = 0.21). Patients IOWA satisfaction score at 24 hours postoperatively was significantly higher in TIVA-TCI groups (p = 0.0001). CONCLUSIONS: Compared with Isoflurane, TIVA-TCI was followed by significantly lower incidence of PONV and significantly greater patients satisfaction.

Ionescu D; M?rg?rit S; Vlad L; Iancu C; Alexe A; Deac D; R?du? A; Tudoric? G; Necula A; Pop T

2009-03-01

316

Managing diabetic ketoacidosis in non-intensive care unit setting: Role of insulin analogs.  

UK PubMed Central (United Kingdom)

AIM: To compare the efficacy and safety of rapid acting insulin analog lispro given subcutaneously with that of standard low-dose intravenous regular insulin infusion protocolin patients with mild to moderate diabetic ketoacidosis. MATERIALS AND METHODS: In this prospective, randomized and open trial, 50 consecutive patients of mild to moderate diabetic ketoacidosis were randomly assigned to two groups. The patients in group 1 were treated with intravenous regular insulin infusion and admitted in intensive care unit. The patients in group 2 were treated with subcutaneous insulin lispro 2 hourly and managed in the emergency medical ward. Response to therapy was assessed by duration of treatment and amount of insulin administered until resolution of hyperglycemia and ketoacidosis, total length of hospital stay, and number of hypoglycemic events in the two study groups. RESULTS: The baseline clinical and biochemical parameters were similar between the two groups. There were no differences in the mean duration of treatment and amount of insulin required for correction of hyperglycemia and ketoacidosis. There was no mortality and no difference in the length of hospital stay between the two groups. The length of stay and amount of insulin required for correction of hyperglycemia was greater in patients who had infection as the precipitating cause than those with poor compliance. The hypoglycemic events were higher in the regular insulin group (2 vs1) than in the lispro group. CONCLUSION: Patients with uncomplicated diabetic ketoacidosis can be managed in the medical wards with appropriate supervision and careful monitoring. Rapid acting insulin analog lispro is a safe and effective alternative to intravenous regular insulin for this subset of patients.

Karoli R; Fatima J; Salman T; Sandhu S; Shankar R

2011-07-01

317

Mycobacterium abscessus Bacteremia After Receipt of Intravenous Infusate of Cytokine-Induced Killer Cell Therapy for Body Beautification and Health Boosting.  

UK PubMed Central (United Kingdom)

Background.?We report the first series of Mycobacterium abscessus bacteremia after cytokine-induced killer cell therapy for body beautification and health boosting. Methods.?The clinical manifestations, laboratory and radiological investigations, cytokine/chemokine profiles, and outcomes were described and analyzed. Results.?Four patients were admitted, and 3 patients had septic shock. Chest radiographs showed pulmonary infiltrates in all patients. Three patients developed peripheral gangrene, and 1 patient required lower limb and finger amputations. Patient 1 also developed disseminated infection including meningitis and urinary tract infection. Postmortem examination of patient 1 showed focal areas of pulmonary hemorrhage and diffuse alveolar damage, splenic infarct, adrenal necrosis, and hemorrhage, and acid-fast bacilli (AFB) were seen in the lung, liver, kidney, and adrenal gland. Patient 2 developed inguinal granulomatous lymphadenitis about 40 days after onset of lower limb gangrene. Wedge-shaped pulmonary infarcts were found in patient 3, and retinitis and subcutaneous lesions developed in patient 4. Patients in septic shock had dysregulated cytokine/chemokine profiles. Patient 4 with relatively milder presentation had increasing levels of interleukin 17 and cytokines in the interferon-?/interleukin 12 pathway. All survivors required prolonged intravenous antibiotics. Blood cultures grew M. abscessus for all patients, and admission peripheral blood smear revealed AFB for 3 patients. Mycobacterium abscessus was also isolated from respiratory specimens (2 patients), urine (1 patient), and cerebrospinal fluid (1 patient). Time to initial blood culture positivity (patients 1, 2, and 3: ?52 hours; patient 4: 83 hours) appeared to correlate with disease severity. Conclusions.?Empirical coverage for rapidly growing mycobacteria should be considered in patients with sepsis following cosmetic procedures.

Liu R; To KK; Teng JL; Choi GK; Mok KY; Law KI; Tso EY; Fung KS; Wu TC; Wu AK; Fung SH; Wong SC; Trendell-Smith NJ; Yuen KY

2013-10-01

318

Mycobacterium abscessus Bacteremia After Receipt of Intravenous Infusate of Cytokine-Induced Killer Cell Therapy for Body Beautification and Health Boosting.  

Science.gov (United States)

Background.?We report the first series of Mycobacterium abscessus bacteremia after cytokine-induced killer cell therapy for body beautification and health boosting. Methods.?The clinical manifestations, laboratory and radiological investigations, cytokine/chemokine profiles, and outcomes were described and analyzed. Results.?Four patients were admitted, and 3 patients had septic shock. Chest radiographs showed pulmonary infiltrates in all patients. Three patients developed peripheral gangrene, and 1 patient required lower limb and finger amputations. Patient 1 also developed disseminated infection including meningitis and urinary tract infection. Postmortem examination of patient 1 showed focal areas of pulmonary hemorrhage and diffuse alveolar damage, splenic infarct, adrenal necrosis, and hemorrhage, and acid-fast bacilli (AFB) were seen in the lung, liver, kidney, and adrenal gland. Patient 2 developed inguinal granulomatous lymphadenitis about 40 days after onset of lower limb gangrene. Wedge-shaped pulmonary infarcts were found in patient 3, and retinitis and subcutaneous lesions developed in patient 4. Patients in septic shock had dysregulated cytokine/chemokine profiles. Patient 4 with relatively milder presentation had increasing levels of interleukin 17 and cytokines in the interferon-?/interleukin 12 pathway. All survivors required prolonged intravenous antibiotics. Blood cultures grew M. abscessus for all patients, and admission peripheral blood smear revealed AFB for 3 patients. Mycobacterium abscessus was also isolated from respiratory specimens (2 patients), urine (1 patient), and cerebrospinal fluid (1 patient). Time to initial blood culture positivity (patients 1, 2, and 3: ?52 hours; patient 4: 83 hours) appeared to correlate with disease severity. Conclusions.?Empirical coverage for rapidly growing mycobacteria should be considered in patients with sepsis following cosmetic procedures. PMID:23825355

Liu, Raymond; To, Kelvin K W; Teng, Jade L L; Choi, Garnet K Y; Mok, Ka-Yi; Law, Kin-Ip; Tso, Eugene Y K; Fung, Kitty S C; Wu, Tak-Chiu; Wu, Alan K L; Fung, Shing-Hoi; Wong, Sally C Y; Trendell-Smith, Nigel J; Yuen, Kwok-Yung

2013-07-03

319

Calcineurin inhibitors acutely improve insulin sensitivity without affecting insulin secretion in healthy human volunteers  

DEFF Research Database (Denmark)

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: New Onset Diabetes After Transplantation is related to treatment with immunosuppressive medica-tions. Clinical studies have shown that risk of new onset diabetes is greater with tacrolimus compared with cyclosporine. The diabetogenicity of cyclosporine and tacrolimus has been attributed to both beta cell dysfunction and impaired insulin sensitivity. WHAT THIS STUDY ADDS: This is the first trial to investigate beta cell function and insulin sensitivity using gold standard methodology in healthy human volunteers treated with clinically relevant doses of cyclosporine and tacrolimus. We document that both drugs acutely increase insulin sensitivity, while first phase and pulsatile insulin secretion remain unaffected. This study demonstrates that cyclosporine and tacrolimus have similar acute effects on glucose metabolism in healthy humans. ABSTRACT: BACKGROUND AND PURPOSE. Introducing the calcineurin inhibitors (CNIs) cyclosporine (CsA) and tacrolimus (Tac) has improved the outcome of organ transplants, but complications such as New Onset Diabetes mellitus After Transplantation (NODAT) cause impairment of survival rates. The relative contribution of each CNI to the pathogenesis and development of NODAT remains unclear. We sought to compare the impact of CsA and Tac on glucose metabolism in human subjects. EXPERIMENTAL APPROACH. Ten healthy men underwent 5-hour infusions of CsA, Tac and saline in a randomized, double-blind, cross-over study. During infusion glucose metabolism was investigated using following methods: A hyperinsulinemic-euglycemic clamp, an intravenous glucose tolerance test (IVGTT), glucose-stimulated insulin concentration time-series and indirect calorimetry. RESULTS. Clamp derived insulin sensitivity was increased by 25 % during CsA (P <0.0001) and 13 % during Tac administration (P= 0.047), whereas first phase and pulsatile insulin secretion were unaffected. Coinciding with the CNI induced improved insulin sensitivity, glucose oxidation rates increased, whileinsulin clearance rates decreased, only non-significantly. Tac singularly lowered hsCRP levels, otherwise no changes were observed in circulating glucagon, FFA or adiponectin levels. Mean blood levels of CNIs were 486.9 ± 23.5 ?g/l for CsA and 12.8 ± 0.5 ?g/l for Tac. CONCLUSIONS. In conclusion acute effects of intravenous CsA and to a lesser degree Tac infusions in healthy volunteers include increased insulin sensitivity, without any effect on first phase or pulsatile insulin secretion.

Øzbay, Aygen; MØller, Niels

2012-01-01

320

Determination of hydromorphone in human plasma by a sensitive RP-HPLC-ESI-MS method and its application to a clinical pharmacokinetic study in postoperative patients after low dose intravenous administration with infusion pump.  

UK PubMed Central (United Kingdom)

A sensitive reverse phase high performance liquid chromatography-electrospray ionization-mass spectrometry (RP-HPLC-ESI-MS) method has been developed and validated for the determination of hydromorphone in human plasma using naloxone as the internal standard (IS). After alkalization with saturated sodium bicarbonate, the plasma samples were extracted with ethyl acetate. Chromatographic separation was performed on a C18 column with the column temperature of 50 °C and a mobile phase of 5mM ammonium acetate buffer containing 1% formic acid-methanol (88:12, v/v). Hydromorphone and the IS were detected by selected ion monitoring using the protonated molecules at m/z 286.2 for hydromorphone and m/z 328.2 for the IS. Calibration curve was linear over the range of 0.01-50 ng/mL. The lower limit of quantification was 0.01 ng/mL. The method was successfully applied to the pharmacokinetic study in postoperative patients after intravenous infusion of 1.5mg hydromorphone hydrochloride. The obtained main pharmacokinetic parameters of hydromorphone in postoperative patients were as follows: the maximum hydromorphone plasma concentration (C(max)) was (24.15 ± 12.51)ng/mL, the time to the C(max) was (10.0 ± 0.0)min, and the elimination half-life was (2.7 ± 0.8)h.

Sun L; Pan Y; Ding L; Luo X; Yan Z; Liu C; Qian Y; Chu Y

2012-03-01

 
 
 
 
321

Infusion of pramlintide, a human amylin analogue, delays gastric emptying in men with IDDM.  

UK PubMed Central (United Kingdom)

Pramlintide, a human amylin analogue, reduces hyperglycaemia after meals in patients with insulin-dependent diabetes mellitus (IDDM). We investigated whether this was due to delayed gastric emptying. Eight men with uncomplicated IDDM were studied twice in a randomised, double-blind crossover design. Euglycaemia was maintained overnight by intravenous infusion of glucose and/or insulin and the following morning a 5-h infusion of pramlintide 25 micrograms/h or placebo was started at 08.00 hours. At 08.30 hours the patients injected their normal morning insulin dose subcutaneously and 30 min later ate a meal (600 kcal, 50% carbohydrate) of which the solid component was labelled with Technetium-99 m and the liquid with Indium-111 to quantify gastric emptying. Gamma-scintigraphic images were obtained every 20 min for the next 4 h. Insulin and glucose were infused as necessary to maintain blood glucose levels within 3 mmol/l of the pre-meal value. Compared to placebo, pramlintide significantly delayed emptying of both liquid (median lag time 69 vs 7.5 min) and solid (median lag time 150 vs 44.5 min) components of the meal. Pramlintide delayed gastric emptying so much that t50 values could not be calculated for solid or liquid. Amylin agonists such as pramlintide may, therefore, be of value in improving glycaemic control in IDDM by modifying gastric emptying.

Kong MF; King P; Macdonald IA; Stubbs TA; Perkins AC; Blackshaw PE; Moyses C; Tattersall RB

1997-01-01

322

Accuracy assessment of online glucose monitoring by a subcutaneous enzymatic glucose sensor during exercise in patients with type 1 diabetes treated by continuous subcutaneous insulin infusion.  

UK PubMed Central (United Kingdom)

AIM: Online continuous glucose monitoring (CGM) during physical exercise would be highly useful in patients with insulin-treated diabetes. For this reason, this study assessed whether such a goal could be reached with a subcutaneous 'needle-type' enzymatic sensor. METHODS: Ten patients (five women/five men), aged 51 ± 12 years, with type 1 diabetes for 24 ± 11 years treated by continuous subcutaneous insulin infusion (CSII) for more than 1 year (HbA1c: 7.5 ± 0.8%) performed a 30-min bout of exercise at a constant high-intensity load (15% above their individual ventilatory threshold) on a cycle ergometer. All patients wore a subcutaneous 'needle-type' enzymatic glucose sensor linked to a portable monitor (Guardian(®) RT, Medtronic-MiniMed, Northridge, CA, USA) that had been inserted the previous evening. Sensor calibration was performed against capillary blood glucose immediately before the exercise. CGM values were recorded every 5 min from T(-10) to T(+30), then every 10 min during the recovery period from T(+30) to T(+90). These recorded values were compared with blood glucose assays performed on simultaneously collected venous samples. RESULTS: Sensor functioning and tolerability raised no problems except for one sensor that could not be adequately calibrated. Data from this patient were excluded from the data analysis. An average blood glucose decrease of 63 ± 63 mg/dL (3.5 ± 3.5 mmol/L) (median decrease: 58 mg/dL [3.22 mmol/L]; range: -3 mg/dL [0.16 mmol/L] to 178 mg/dL [9.8 mmol/L]) occurred during exercise bouts, while CGM values decreased by 38 ± 49 mg/dL (2.11 ± 2.72 mmol/L) (median: 32 mg/dL [1.7 mmmol/L]; range: -15 mg/dL [0.83 mmol/L] to 58 mg/dL [3.22 mmol/L]). Cumulative paired glucose values (n = 135) could be analyzed. The correlation factor between CGM and blood glucose values was 0.957 with an intercept of 0.275. The mean difference between paired values according to Bland-Altman analysis was 10 ± 31 mg/dL (0.56 ± 1.72 mmol/L). Clarke error grid analysis showed 91% of paired points in A and B zones, while 0%, 9% and 0% of paired points were in the C, D and E zones, respectively. CONCLUSION: Blood glucose changes during intensive physical-exercise bouts performed by CSII-treated type 1 diabetes patients can be estimated with acceptable clinical accuracy by online CGM.

Radermecker RP; Fayolle C; Brun JF; Bringer J; Renard E

2013-05-01

323

Intraportal GLP-1 stimulates insulin secretion predominantly through the hepatoportal-pancreatic vagal reflex pathways.  

UK PubMed Central (United Kingdom)

We previously reported that glucagon-like peptide-1 (GLP-1) appearance in the portal vein facilitates hepatic vagal afferent activity, and this further augments reflexively the pancreatic vagal efferents in anesthetized rats, suggesting a neuroincretin effect of GLP-1. To determine whether the GLP-1-induced vagal pathways lead to a neuronal-mediated component (NMC) of insulin secretion, we infused GLP-1 at a physiological or pharmacological dose (1 or 3 pmol·kg(-1)·min(-1), respectively) into the portal vein in conscious rats with selective hepatic vagotomy (Vagox) or sham operation (Sham). The experiments consisted of two sequential 10-min intraportal infusions (P1 and P2): glucose at a physiological rate (56 ?mol·kg(-1)·min(-1)) in P1 and the glucose plus GLP-1 or vehicle in P2. Under arterial isoglycemia across the groups, the physiological GLP-1 infusion in Sham augmented promptly and markedly arterial insulin levels, approximately twofold the levels in glucose alone infusion (P < 0.005), and insulin levels in Vagox diminished apparently (P < 0.05). Almost 60% of the GLP-1-induced insulin secretion (AUC) in Sham met the NMC, i.e., difference between insulin secretion in Sham and Vagox, (AUC 976 ± 65 vs. 393 ± 94 pmol·min/l, respectively, P < 0.005). Intraportal pharmacological GLP-1 infusion further augmented insulin secretion in both groups, but the NMC remained in 46% (NS; Sham vs. Vagox). In contrast, "isoglycemic" intravenous GLP-1 infusion (3 pmol·kg(-1)·min(-1)) evoked an equal insulin secretion in both groups. Thus, the present results indicate that GLP-1 appearing in the portal vein evokes a powerful neuronal-mediated insulinotropic effect, suggesting the neuroincretin effect.

Nishizawa M; Nakabayashi H; Uehara K; Nakagawa A; Uchida K; Koya D

2013-08-01

324

Direct effects of TNF-? on local fuel metabolism and cytokine levels in the placebo controlled bilaterally infused human leg; increased insulin sensitivity, increased net protein breakdown and increased IL-6 release  

DEFF Research Database (Denmark)

TNF-? has widespread metabolic actions. Systemic TNF-? administration, however, generates a complex hormonal and metabolic response. Our study was designed to test whether regional, placebo controlled TNF-? infusion directly affects insulin resistance and protein breakdown. We studied eight healthy volunteers once with bilateral femoral vein and artery catheters during a 3 h basal period and a 3 h hyperinsulinemic euglycemic clamp. One artery was perfused with saline and one with TNF-?. During the clamp TNF-? perfusion increased glucose arterio-venous differences (0.91±0.17 mmol/l vs. 0.74±0.15 mmol/l, p=0.012) and leg glucose uptake rates. Net phenylalanine release was increased by TNF-? perfusion with concomitant increases in appearance and disappearance rates. Free fatty acid kinetics were not affected by TNF-?, whereas IL-6 release increased. Insulin and protein signaling in muscle biopsies was not affected by TNF-?. TNF-? directly increased net muscle protein loss, which may contribute to cachexia and general protein loss during severe illness. The finding of increased insulin sensitivity, which could relate to IL-6, is of major clinical interest and may concurrently act to provide adequate tissue fuel supply and contribute to the occurrence of systemic hypoglycemia. This distinct metabolic feature places TNF-? among the rare insulin mimetics of human origin.

Bach, Ermina; Nielsen, Roni R

2013-01-01

325

Direct effects of TNF-? on local fuel metabolism and cytokine levels in the placebo controlled bilaterally infused human leg; increased insulin sensitivity, increased net protein breakdown and increased IL-6 release.  

UK PubMed Central (United Kingdom)

TNF-? has widespread metabolic actions. Systemic TNF-? administration, however, generates a complex hormonal and metabolic response. Our study was designed to test whether regional, placebo controlled TNF-? infusion directly affects insulin resistance and protein breakdown. We studied eight healthy volunteers once with bilateral femoral vein and artery catheters during a 3 h basal period and a 3 h hyperinsulinemic euglycemic clamp. One artery was perfused with saline and one with TNF-?. During the clamp TNF-? perfusion increased glucose arterio-venous differences (0.91±0.17 mmol/l vs. 0.74±0.15 mmol/l, p=0.012) and leg glucose uptake rates. Net phenylalanine release was increased by TNF-? perfusion with concomitant increases in appearance and disappearance rates. Free fatty acid kinetics were not affected by TNF-?, whereas IL-6 release increased. Insulin and protein signaling in muscle biopsies was not affected by TNF-?. TNF-? directly increased net muscle protein loss, which may contribute to cachexia and general protein loss during severe illness. The finding of increased insulin sensitivity, which could relate to IL-6, is of major clinical interest and may concurrently act to provide adequate tissue fuel supply and contribute to the occurrence of systemic hypoglycemia. This distinct metabolic feature places TNF-? among the rare insulin mimetics of human origin.

Bach E; Nielsen RR; Vendelbo MH; Møller AB; Jessen N; Buhl M; Hafstrøm TK; Holm L; Pedersen SB; Pilegaard H; Biensø RS; Jørgensen JO; Møller N

2013-07-01

326

MEDICATION INFUSION SET  

UK PubMed Central (United Kingdom)

An infusion set is provided for use in delivering fluid through a cannula, which is housed on a cannula housing, to a selected subcutaneous infusion site on a patient. The fluid is generally a medication, e.g., insulin. The cannula is in fluid communication with a fluid passageway surrounded by a projection on the cannula housing that includes one or more rail-like extensions acting as guides. A connector connects the cannula housing to a fluid delivery system, e.g., an infusion pump. The connector includes a needle, one or more guide arms that slide over the rail-like extensions to guide the needle into the self-sealing septum, and one or more locking arms, with barbs at the end, to connect with corresponding recesses in the cannula housing. An introducer having one or more similar guide arms and locking arms, and a longer needle, may be used to insert the cannula into the patient.

MAULE SUSIE E; MOBERG SHELDON B; HOLECEK ARIN N; GRIFFIN CHRISTOPHER G; KAVAZOV JULIAN D; KOVELMAN PAUL H

327

Anestesia venosa total em regime de infusão alvo-controlada: uma análise evolutiva Anestesia venosa total en régimen de infusión objeto controlada: un análisis evolutivo Total intravenous anesthesia as a target-controlled infusion: an evolutive analysis  

Directory of Open Access Journals (Sweden)

Full Text Available JUSTIFICATIVA E OBJETIVOS: A anestesia venosa total (AVT) sofreu diversos avanços desde o início da utilização da técnica. Desde a síntese dos primeiros anestésicos venosos, com a introdução dos barbitúricos (1921) e do tiopental (1934), a AVT evoluiu até o desenvolvimento da AVT com auxílio de bombas com infusão alvo-controlada (IAC). O primeiro modelo farmacocinético para uso em IAC foi descrito por Schwilden em 1981. Foi demonstrado, a partir daí, que era possível manter a concentração plasmática desejada de um fármaco utilizando-se bomba de infusão gerenciada por computador. CONTEÚDO: Este artigo visou a descrever as bases teóricas da IAC, a apresentar uma proposta de desenvolvimento de um vocabulário comum em IAC ainda não publicado no Brasil e a fazer uma análise crítica dos aspectos atuais da IAC no mundo e no Brasil. CONCLUSÕES: A chegada de novas bombas de infusão dotadas dos modelos farmacocinéticos do remifentanil, sufentanil e propofol inaugura outro capítulo da AVT e alinha o Brasil com a tendência mundial em IAC. Esses sistemas possibilitarão a IAC de hipnóticos e opióides concomitantemente. A conclusão mais importante, no entanto, refere-se à economia à medida que os fármacos utilizados nessas bombas não ficarão restritos apenas a uma empresa farmacêutica, a exemplo do que ocorreu com o propofol. Hoje já se dispõe de equipamentos para utilização de propofol e opióides, em IAC, que aceitam qualquer apresentação farmacêutica com a vantagem da possibilidade de alteração da concentração do fármaco na seringa, de acordo com a diluição desejada.JUSTIFICATIVA Y OBJETIVOS: La anestesia venosa total (AVT) tuvo diversos avances desde el inicio de la utilización de la técnica. Desde la síntesis de los primeros anestésicos venosos, con la introducción de los barbitúricos (1921) y del tiopental (1934), la AVT evolucionó hasta el desarrollo de la AVT con el auxilio de bombas con infusión objeto controlada (IOC). El primer modelo farmacocinético descrito para uso en IOC, fue descrito por Schwilden en 1981. Quedó demostrado a partir de entonces, que era posible mantener la concentración plasmática deseada de un fármaco utilizando bomba de infusión por computador. CONTENIDO: Este artigo quiso dejar sentadas las bases teóricas de la IOC, presentar una propuesta de desarrollo de un vocabulario común en IOC todavía no publicado en Brasil y hacer un análisis crítico de los aspectos actuales de la IOC en el mundo y en Brasil. CONCLUSIONES: La llegada de nuevas bombas de infusión dotadas de los modelos farmacocinéticos del remifentanil, sufentanil y propofol inaugura otro capítulo de la AVT y coloca a Brasil a tono con la tendencia mundial en IOC. Esos sistemas facilitarán la IOC de hipnóticos y opioides concomitantemente. La conclusión más importante, sin embargo, se refiere a la economía en la medida en que los fármacos utilizados en esas bombas no quedarán restrictos a solamente una empresa farmacéutica, como por ejemplo lo que ocurrió con el propofol. Hoy ya disponemos de equipos para la utilización de propofol y opioides en IOC, que aceptan cualquier presentación farmacéutica con la ventaja de poder alterar la concentración del fármaco en la jeringuilla de acuerdo con la dilución que se desee.BACKGROUND AND DOBJECTIVES: Total intravenous anesthesia (TIVA) has seen several developments since it was first used. Since the synthesis of the first intravenous anesthetics, with the introduction of barbiturates (1921) and thiopental (1934), TIVA has evolved until the development of TIVA with target-controlled infusion pumps (TCI). The first pharmacokinetic model for the use of TCI was described by Schwilden in 1981. From that moment on, it was demonstrated that it is possible to maintain the desired plasma concentration of a drug using an infusion pump managed by a computer. CONTENTS: The objective of this report was to describe the theoretical bases of TCI, propose the development of a common TCI vocabulary, which has

Fernando Squeff Nora

2008-01-01

328

Anestesia venosa total em regime de infusão alvo-controlada: uma análise evolutiva/ Total intravenous anesthesia as a target-controlled infusion: an evolutive analysis/ Anestesia venosa total en régimen de infusión objeto controlada: un análisis evolutivo  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: A anestesia venosa total (AVT) sofreu diversos avanços desde o início da utilização da técnica. Desde a síntese dos primeiros anestésicos venosos, com a introdução dos barbitúricos (1921) e do tiopental (1934), a AVT evoluiu até o desenvolvimento da AVT com auxílio de bombas com infusão alvo-controlada (IAC). O primeiro modelo farmacocinético para uso em IAC foi descrito por Schwilden em 1981. Foi demonstrado, a partir daí, que er (more) a possível manter a concentração plasmática desejada de um fármaco utilizando-se bomba de infusão gerenciada por computador. CONTEÚDO: Este artigo visou a descrever as bases teóricas da IAC, a apresentar uma proposta de desenvolvimento de um vocabulário comum em IAC ainda não publicado no Brasil e a fazer uma análise crítica dos aspectos atuais da IAC no mundo e no Brasil. CONCLUSÕES: A chegada de novas bombas de infusão dotadas dos modelos farmacocinéticos do remifentanil, sufentanil e propofol inaugura outro capítulo da AVT e alinha o Brasil com a tendência mundial em IAC. Esses sistemas possibilitarão a IAC de hipnóticos e opióides concomitantemente. A conclusão mais importante, no entanto, refere-se à economia à medida que os fármacos utilizados nessas bombas não ficarão restritos apenas a uma empresa farmacêutica, a exemplo do que ocorreu com o propofol. Hoje já se dispõe de equipamentos para utilização de propofol e opióides, em IAC, que aceitam qualquer apresentação farmacêutica com a vantagem da possibilidade de alteração da concentração do fármaco na seringa, de acordo com a diluição desejada. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: La anestesia venosa total (AVT) tuvo diversos avances desde el inicio de la utilización de la técnica. Desde la síntesis de los primeros anestésicos venosos, con la introducción de los barbitúricos (1921) y del tiopental (1934), la AVT evolucionó hasta el desarrollo de la AVT con el auxilio de bombas con infusión objeto controlada (IOC). El primer modelo farmacocinético descrito para uso en IOC, fue descrito por Schwilden en 1981. Qued? (more) ? demostrado a partir de entonces, que era posible mantener la concentración plasmática deseada de un fármaco utilizando bomba de infusión por computador. CONTENIDO: Este artigo quiso dejar sentadas las bases teóricas de la IOC, presentar una propuesta de desarrollo de un vocabulario común en IOC todavía no publicado en Brasil y hacer un análisis crítico de los aspectos actuales de la IOC en el mundo y en Brasil. CONCLUSIONES: La llegada de nuevas bombas de infusión dotadas de los modelos farmacocinéticos del remifentanil, sufentanil y propofol inaugura otro capítulo de la AVT y coloca a Brasil a tono con la tendencia mundial en IOC. Esos sistemas facilitarán la IOC de hipnóticos y opioides concomitantemente. La conclusión más importante, sin embargo, se refiere a la economía en la medida en que los fármacos utilizados en esas bombas no quedarán restrictos a solamente una empresa farmacéutica, como por ejemplo lo que ocurrió con el propofol. Hoy ya disponemos de equipos para la utilización de propofol y opioides en IOC, que aceptan cualquier presentación farmacéutica con la ventaja de poder alterar la concentración del fármaco en la jeringuilla de acuerdo con la dilución que se desee. Abstract in english BACKGROUND AND DOBJECTIVES: Total intravenous anesthesia (TIVA) has seen several developments since it was first used. Since the synthesis of the first intravenous anesthetics, with the introduction of barbiturates (1921) and thiopental (1934), TIVA has evolved until the development of TIVA with target-controlled infusion pumps (TCI). The first pharmacokinetic model for the use of TCI was described by Schwilden in 1981. From that moment on, it was demonstrated that it is (more) possible to maintain the desired plasma concentration of a drug using an infusion pump managed by a computer. CONTENTS: The objective of this report was to describe

Nora, Fernando Squeff

2008-04-01

329

Beta Agonist Lung Injury TrIal-2 (BALTI-2) trial protocol: A randomised, double-blind, placebo-controlled of intravenous infusion of salbutamol in the acute respiratory distress syndrome  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The Acute Respiratory Distress Syndrome (ARDS) is a common cause of respiratory failure in critically ill patients. Experimental studies suggest that treatment with beta agonists may be helpful in ARDS. The Beta Agonist Lung Injury TrIal (BALTI-2) is a multicentre, pragmatic, randomised, double-blind, placebo-controlled clinical trial which aims to determine if sustained treatment with intravenous (IV) salbutamol will improve survival in ARDS. Methods/Design Patients fulfilling the American-European Consensus Conference Definition of ARDS will be randomised in a 1:1 ratio to receive an IV infusion either of salbutamol (15 ?g kg ideal body weight-1 hr-1) or placebo (0.9% sodium chloride solution), for a maximum of seven days. Allocation to randomised groups will use minimisation to ensure balance with respect to hospital of recruitment, age group (85 years) and PaO2/FiO2 ratio (?6.7, 6.8- 13.2, ?13.3 kPa). Data will be recorded by participating ICUs until hospital discharge, and all surviving patients will be followed up by post at six and twelve months post randomisation. The primary outcome is mortality at 28 days after randomisation; secondary outcomes are mortality in ICU, mortality in hospital, number of ventilator-free days, number of organ failure-free days, mortality at twelve months post-randomisation, quality of life at six and twelve months, length of stay in ICU, length of stay in hospital, adverse effects (tachycardia, arrhythmia or other side effects sufficient to stop treatment drug). 1,334 patients will be recruited from about fifty ICUs in the UK. An economic evaluation will be conducted alongside the trial. Trial Registration Current Controlled Trials ISRCTN38366450.

Perkins Gavin D; Gates Simon; Lamb Sarah E; McCabe Chris; Young Duncan; Gao Fang

2011-01-01

330

Safety and pharmacokinetics of PF-04360365 following a single-dose intravenous infusion in Japanese subjects with mild-to-moderate Alzheimer's disease: a multicenter, randomized, double-blind, placebo-controlled, dose-escalation study.  

UK PubMed Central (United Kingdom)

Objective: PF-04360365 is a humanized IgG2?a anti-amyloid ? (A?) antibody designed to improve outcome in Alzheimer's disease (AD). Single doses of 0.1 - 10 mg/kg were safe and well tolerated in Western (mostly Caucasian) subjects with mild-to-moderate AD. This Phase 1, multicenter, randomized, double-blind, dose-escalation study was the first to evaluate the safety, pharmacokinetics, pharmacodynamics, and immunogenicity of PF-04360365 in Japanese subjects. Materials and methods: 30 subjects with mild-to-moderate AD were enrolled. In each cohort, 3 subjects received PF-04360365 (0.1, 0.5, 1, 5, or 10 mg/kg) and 1 subject received placebo as a single 2-hour intravenous infusion. Subjects were monitored as inpatients for 24 hours and then as outpatients for 1 year. Results: All subjects completed the study. There were no serious or National Cancer Institute Common Terminology Criteria for Adverse Events grade ? 3 adverse events, hypersensitivity reactions, or antidrug antibodies. No clinical or MRI evidence of brain microhemorrhage, cerebral edema, or encephalitis was observed. PF-04360365 plasma concentrations increased with dose, and pharmacokinetics were consistent with a small steady-state volume of distribution, slow clearance, and long elimination half-life. Cerebrospinal fluid (CSF):plasma ratios were < 0.5%. Plasma A? species showed dose-dependent increases in Cmax and AUC?, but CSF biomarkers did not differ clearly between treatment arms. Conclusions: PF-04360365 was safe and well tolerated in Japanese subjects. Pharmacokinetics and plasma pharmacodynamic responses in Japanese subjects were comparable to those in Western subjects.

Miyoshi I; Fujimoto Y; Yamada M; Abe S; Zhao Q; Cronenberger C; Togo K; Ishibashi T; Bednar MM; Kupiec JW; Binneman B

2013-10-01

331

Actions of prolonged ghrelin infusion on gastrointestinal transit and glucose homeostasis in humans.  

UK PubMed Central (United Kingdom)

BACKGROUND: Ghrelin is produced by enteroendocrine cells in the gastric mucosa and stimulates gastric emptying in healthy volunteers and patients with gastroparesis in short-term studies. The aim of this study was to evaluate effects of intravenous ghrelin on gastrointestinal motility and glucose homeostasis during a 6-h infusion in humans. METHODS: Ghrelin (15 pmol kg(-1) min(-1)) or saline was infused intravenously for 360 min after intake of radio-opaque markers, acetaminophen, and lactulose after a standardized breakfast in 12 male volunteers. Gastric emptying, orocecal transit, colonic transit, postprandial plasma concentrations of glucose, insulin, glucagon-like peptide-1 (GLP-1), and peptide YY were assessed. In vitro studies of gastrointestinal muscle contractility were performed. KEY RESULTS: The gastric emptying rate was faster for ghrelin compared to saline (P = 0.002) with a shorter half-emptying time (50.3 +/- 3.9 vs 59.9 +/- 4.4 min, P = 0.004). There was no effect of ghrelin on orocecal or colonic transit. Postprandial elevations of plasma glucose, insulin, and GLP-1 occurred 15 min earlier and were higher with ghrelin. The insulinogenic index did not change during ghrelin infusion. Basal in vitro contractility was unaffected by ghrelin. CONCLUSIONS & INFERENCES: The effect of a 6-h ghrelin infusion on gastrointestinal motility is limited to the stomach without affecting orocecal or colonic transit. Plasma glucose, insulin, and GLP-1 are elevated postprandially, probably as a result of the hastened gastric emptying. Changes in glucose homeostasis as a consequence of stimulated gastric emptying and hormone release, need to be taken into account in the use of pharmacological stimulants for the treatment of motility disorders.

Falkén Y; Hellström PM; Sanger GJ; Dewit O; Dukes G; Grybäck P; Holst JJ; Näslund E

2010-06-01

332

Intraosseous infusion of hypertonic glucose and dopamine.  

UK PubMed Central (United Kingdom)

Intraosseous infusion of drugs for resuscitation and of fluids has been advocated as an alternate emergency technique to intravenous infusion. The reliability of intraosseous infusion of many substances has not been established. Glucose and dopamine hydrochloride are two commonly used emergency drugs in pediatric practice that have not been carefully studied when administered into the bone marrow. In an animal model, we compared the response of an intraosseous injection of hypertonic glucose with that of an intravenous injection of hypertonic glucose. Serum glucose measurements following the injection revealed both routes of administration to be effective. A dopamine infusion was then administered through the bone marrow for 20 minutes. A statistically significant rise in blood pressure was observed two minutes after initiation of the infusion. Intraosseous infusion of hypertonic glucose and dopamine is an effective route by which to administer these medications and is potentially useful in emergency situations in which intravascular access is delayed.

Neish SR; Macon MG; Moore JW; Graeber GM

1988-08-01

333

Acute pseudogout after pamidronate infusion.  

UK PubMed Central (United Kingdom)

A 72-year-old man, treated with a 60-mg intravenous infusion of pamidronate for shoulder hand syndrome, developed after few hours an acute pseudogout arthritis of his right knee. Diagnosis was confirmed by synovial fluid analysis and was associated with hypocalcemia. Only a few cases are reported in the literature. The mechanism of this potential side effect remains speculative.

Wendling D; Tisserand G; Griffond V; Saccomani C; Toussirot E

2008-09-01

334

Acute pseudogout after pamidronate infusion.  

Science.gov (United States)

A 72-year-old man, treated with a 60-mg intravenous infusion of pamidronate for shoulder hand syndrome, developed after few hours an acute pseudogout arthritis of his right knee. Diagnosis was confirmed by synovial fluid analysis and was associated with hypocalcemia. Only a few cases are reported in the literature. The mechanism of this potential side effect remains speculative. PMID:18500436

Wendling, Daniel; Tisserand, Guillaume; Griffond, Vincent; Saccomani, Clarisse; Toussirot, Eric

2008-05-24

335

Remifentanil infusion prolongs spinal anesthesia.  

UK PubMed Central (United Kingdom)

Spinal anesthesia was given to a patient undergoing transurethral resection ofprostate (TURP). A total of 3.2 ml of bupivacaine 0.5% mixed with fentanyl 20 mcg were used. The patient started experiencing sensation after 150 min. Remifentanil intravenous infusion prolonged the duration of anesthesia for an additional 105 minutes.

Soliman MH; Ibrahim SM; Saeed K; El-Omrani H; Kokach O

2013-02-01

336

PREPARATION OF HEMOGLOBIN SOLUTIONS FOR INTRAVENOUS INFUSION  

Digital Repository Infrastructure Vision for European Research (DRIVER)

A procedure has been detailed for the preparation of sterile non-pyrogenic solutions of oxyhemoglobin which have the approximate protein content and electrolyte composition of plasma. Large volumes of solution can be rapidly prepared, with 95 to 98 per cent of the hemoglobin in the active form capa...

Hamilton, Paul B.; Farr, Lee E.; Hiller, Alma; Van Slyke, Donald D.

337

PREPARATION OF HEMOGLOBIN SOLUTIONS FOR INTRAVENOUS INFUSION.  

UK PubMed Central (United Kingdom)

A procedure has been detailed for the preparation of sterile non-pyrogenic solutions of oxyhemoglobin which have the approximate protein content and electrolyte composition of plasma. Large volumes of solution can be rapidly prepared, with 95 to 98 per cent of the hemoglobin in the active form capable of combining with oxygen. The solutions contain no particulate matter; 95 per cent of total blood lipids are removed. Solutions stored at 4 degrees C. showed no conversion of hemoglobin to methemoglobin over a period of 2(1/2) months; over a 6 month period a small and variable amount of methemoglobin may be formed.

Hamilton PB; Farr LE; Hiller A; Van Slyke DD

1947-11-01

338

Amino acid-enriched glucose-insulin-potassium infusion improves hemodynamic function after coronary bypass surgery. A double-blind study in patients with unstable angina and/or compromised left ventricular function.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The goal of this study was to assess the effects of a combination of glucose-insulin-potassium (GIK) and the amino acids aspartate and glutamate upon perioperative hemodynamics in coronary surgery patients with unstable angina and/or compromised left ventricular function. DESIGN: Prospective, randomized, and double-blind clinical study. SETTING: Operating theatre and intensive care unit (ICU) of a university hospital. PATIENTS: 44 coronary artery bypass graft (CABG) patients with unstable angina and/or compromised left ventricular function. INTERVENTIONS: 22 patients (group A) were given 1l of an infusion with 250g glucose, 100 I.U. fast-acting human insulin, 72 mmol potassium, 32 mmol magnesium, 20 mmol phosphate, 65 mmol aspartate, and 65 mmol glutamate, while another 22 patients (group C) were given 1l of an infusion with 50 g glucose, 72 mmol potassium, 32 mmol magnesium, and 8 mmol phosphate. The infusion rate was 1.2 ml/kg/h from the anesthesia induction onward to the commencement of cardiopulmonary bypass, when it was reduced to 0.8 ml/kg/h. When 11 had been infused, but not later than 4 a.m., the infusion was continued by giving 10% glucose at the same rate to both groups. Additional insulin (median: 14.2 I.U., range: 0-41.5) or saline was given during bypass to the A and C patients, respectively. A blood cardioplegia technique containing aspartate and glutamate was used in both groups. RESULTS: At aortic cannulation, the cardiac index (CI) had increased from the pre-anesthetic level by 15.3% (mean) (SD: 31.7%) in group A and decreased by 7.7% (15.1%) in C patients, p = 0.0069. Also the changes in stroke index (SI; p = 0.022), left (LVSWI; p = 0.0037) and right ventricular stroke work index (RVSWI; p = 0.0097) were more favorable in group A. Despite longer aortic cross-clamp, p = 0.031, and perfusion times, p = 0.042, in A patients, the change in cardiac index was also better in this group after bypass: At decannulation, the difference between mean values was 31.8%, p = 0.0001, and at arrival in the ICU it was 16.1%, p = 0.028. The same was also seen 8 h postoperatively and on the 1st and 2nd postoperative mornings; p = 0.034, 0.040, and 0.037, respectively (Wilcoxon test). Favorable changes were seen for the A patients also regarding SI at decannulation (p = 0.0002) and after 8 h (p = 0.017); LVSWI at decannulation (p = 0.0002), at arrival in the ICU (p = 0.0023), and after 8 h (p = 0.0011); and RVSWI at decannulation (p = 0.0027), at the ICU (p = 0.021), after 8 h (p = 0.014), and on the 1st postoperative morning (p = 0.039). However, the response to a hemodynamic loading test (6% hydroxyethyl starch 5 ml/kg) was similar in the 2 groups, and there was no difference in the need for inotropic support. CONCLUSIONS: Amino acid-enriched GIK infusion improves hemodynamic function in CABG patients with unstable angina and/or compromised left ventricular function.

Wistbacka JO; Lepojärvi MV; Karlqvist KE; Koistinen J; Kaukoranta PK; Nissinen J; Peltola T; Rainio P; Ruokonen A; Nuutinen LS

1995-04-01

339

Infusion alarm  

UK PubMed Central (United Kingdom)

The invention discloses an infusion alarm. The alarm comprises a shell 1, an alarm device 2 and an infusion liquid metering electric contact device 3, wherein the alarm device 2 comprises a circuit control chip 21, a battery 22, a touch switch 23 and a buzzer 25 the infusion liquid metering electric contact device 3 comprises a spring tube 31, a spring 32, a sliding conductive bar 33 and an infusion bottle rod 34 the spring tube 31 is arranged in shell 1 an open slot 35 is arranged on the wall of the spring tube 31 the spring 32 is arranged in the spring tube 31 the sliding conductive bar 33 is connected to the upper end or the lower end of the spring 32 the two ends of the sliding conductive bar 33 are positioned in the open slot 35 the upper end of the infusion bottle rod 34 is fixedly connected with the sliding conductive bar 33, while the lower end is connected with a hook 36 and the sliding conductive bar 33 is connected with the circuit control chip 21. The alarm has the advantage of realizing the automatic alarming when no infusion liquid is left and timely treatment is needed so as to avoid the trouble and fatigue of a person special in charge of the infusion process.

CHAOSHENG