Biomedical subjects

C J Rollins

Publications and source records attributed to C J Rollins.

5 recordsLinked to original sources

PubMed1995

Low itraconazole serum concentrations following administration of itraconazole suspension to critically ill allogeneic bone marrow transplant recipients.

OBJECTIVE: To report itraconazole serum concentrations following administration of itraconazole suspension via orogastric feeding tubes to 2 critically ill allogeneic bone marrow transplant recipients. CASE SUMMARIES: A 38-year-old man and a 29-year-old man, each allogeneic bone marrow transplant recipients, were treated with oral itraconazole for documented fungal infections. Intubation and mechanical ventilation impeded ingestion of itraconazole capsules. Itraconazole was prepared initially as a suspension in intravenous lipid emulsion 20% and later as a suspension in citric acid 1.5% in D5W USP. Itraconazole serum concentrations were assayed using HPLC. Predose itraconazole serum concentrations were undetectable to 72 ng/mL. Postdose itraconazole serum concentrations were 5-97 ng/mL. Itraconazole concentrations measured in these patients were markedly lower than serum concentrations reported in the literature for similar doses administered to fed subjects. DISCUSSION: Efficacy of this antifungal agent is limited currently by the patient's ability to ingest and absorb the itraconazole capsules. Pathophysiologic factors and suspension formulation issues that likely contributed to decreased itraconazole absorption are discussed. CONCLUSIONS: Preparation and administration of itraconazole as a suspension did not enhance drug absorption in these patients. Furthermore, efficacy of itraconazole suspension may be affected by physical compatibility and chemical stability of the extemporaneous preparations.

Adult↗

PubMedDate not supplied

Three-in-one parenteral nutrition: a safe and economical method of nutritional support for infants.

The medical records of 20 infants under 1 year of age who received parenteral nutrition (PN) for a minimum of 1 week were reviewed. Patients were divided into two groups based on the method of PN administration. One group received PN by the traditional two-plus-one method where lipid emulsion is given separately from the dextrose-amino acid mixture. The second group received PN by the three-in-one method where lipid emulsion is admixed with the dextrose and amino acids. There were no statistically significant differences between the two groups in the amount of calories, lipid, dextrose, protein, calcium, and phosphorus received per kg of body weight. Average daily weight gain was not statistically different, and no obvious trends were noted in serum biochemical parameters between the two groups. Average total PN days for the groups (13 +/- 7 days for the two-plus-one group vs 39 +/- 35 days for the three-in-one group) were significantly different (p less than 0.05). A cost comparison of the two methods of PN administration indicated that the two-plus-one method costs our hospital $11.78 more per day than the three-in-one solution. We conclude that the three-in-one method of PN administration is safe, efficacious, and cost effective for infants under 1 year of age.

Cost-Benefit Analysis↗

PubMedDate not supplied

Albumin and prealbumin concentrations in patients receiving postoperative parenteral nutrition.

This prospective, nonrandomized study was conducted to compare the increases in albumin and prealbumin concentrations in postoperative patients given adequate nutrition support. All surgery patients at least 18 years of age and who required parenteral nutrition were included. Of 86 patients evaluated, 16 met all criteria for study entry. Blood for albumin concentrations was drawn within 48 hours of beginning parenteral nutrition and then weekly. Blood for prealbumin concentrations was drawn within 48 hours of beginning parenteral nutrition and then twice weekly. Albumin concentrations increased from 2.00 +/- 0.35 to 2.21 +/- 0.42 g/dl (NS). Prealbumin concentrations increased from 11.97 +/- 6.31 to 17.29 +/- 8.93 mg/dl (p = 0.017). All but one prealbumin concentration was in the normal range for our laboratory when parenteral nutrition was discontinued. None of the albumin concentrations were ever in the normal range. The prealbumin concentration is a better indicator than albumin of nutrition status in the postoperative patient. Since prealbumin concentrations typically rise into the normal range within a week after adequate caloric supplementation, clinicians may avoid unnecessary increases in protein-calorie intake and laboratory testing of nutrition status by using this measurement.

Adolescent↗

PubMedDate not supplied

Role of clinical pharmacy specialist in nutrition management of bone marrow transplant patient.

I describe the role of the clinical pharmacy specialist (CPS) in the nutrition management of bone marrow transplant (BMT) patients. An example is used to demonstrate the complex nature of nutritional support in BMT patients and the ability of the CPS to provide expertise in the fluid and electrolyte aspect of nutrition management. This example also illustrates the multitude of factors considered by the CPS before changes in parenteral-nutrition therapy are recommended to BMT physicians. The role of the CPS in nutrition assessment, parenteral-formula design, consultation on compatibility and stability issues, formula alteration to meet changing nutrition requirements, and home nutrition management is outlined.

Bone Marrow Transplantation↗

PubMedDate not supplied

Total nutrient admixtures: stability issues and their impact on nursing practice.

Parenteral nutrition formulations containing lipid emulsion in one container with all other components are known as total nutrient admixtures. These formulations require maintenance of solution solubility and stability as well as emulsion stability. Phenomena associated with emulsion destabilization are reviewed. The multiple factors that destabilize total nutrient admixture formulations are discussed, along with potential nursing implications.

Drug Stability↗