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Biomedical subjects

K E Record

Publications and source records attributed to K E Record.

29 records · Page 2Linked to original sources
PubMed1980

Theophylline hemodialysis clearance.

The hemodialysis clearance, total body clearance off dialysis, and protein binding for theophylline were determined in a 64-year-old cigarette-smoking male in acute renal failure. The hemodialysis clearance of 39.4 ml/kg/hr was comparable to two other reports and indicated that theophylline was significantly hemodialyzed. The total body clearance of 52.4 ml/kg/hr was similar to that observed in non-renal-failure smoking patients and suggested that renal failure did not appreciably affect the total body clearance in the patient. The plasma protein binding was 40% before dialysis and 33% after dialysis. This finding implied that renal failure and hemodialysis may alter protein binding compared to that in normal adults. Theophylline plasma levels should be monitored in renal failure patients because the drug is hemodialyzed. Decreased plasma protein binding may indicate the need for a lower therapeutic range in this patient population.

Acute Kidney Injury↗
PubMed1980

Amikacin pharmacokinetics in morbidly obese patients.

The pharmacokinetics of single-dose amikacin sulfate was studied in seven morbidly obese patients to determine the fraction of fat weight (FW) that, when added to ideal body weight (IBW), will normalize the volume of distribution. Seven patients (mean total body weight of 166.5 kg) were each given a 1,250-g intravenous injection of amikacin. Amikacin serum levels over eight hours were measured by radioimmunoassay. A correction factor (CF) of 0.38 was found to normalize the patients' volume of distribution (Varea) to 0.26 liters/kg, when added to the patients' IBW. There was no significant difference between peak amikacin levels predicted using the actual Varea and using the Varea plus the CF. Predictions using the actual Varea and those using Varea estimated by ideal body weight were significantly different. In morbidly obese patients, peak amikacin serum levels can be predicted best when a volume of distribution based on IBW plus a correction factor of 38% of FW is used.

Adult↗
PubMed1979

Oral phenytoin loading in adults: rapid achievement of therapeutic plasma levels.

Oral loading doses of phenytoin were estimated from a simplified pharmacokinetic model. Twenty patients were administered a calculated average dose of 19.1 mg per kilogram of phenytoin divided into two to four increments given over 3 to 21 hours (10.55 +/- 4.74, mean +/- SD). Plasma samples drawn 2 to 22 hours (10.75 +/- 4.32, mean +/- SD) after completion of the loading dose resulted in therapeutic levels ranging from 8.1 to 18.0 microgram per milliliter (11.42-11.37 +/- 2.41, mean +/- SD). Thus, this regimen in which no increment of the loading dose exceeds 600 mg is sufficient to achieve and maintain therapeutic plasma concentrations 18 to 24 hours after initiation of the loading dose.

Administration, Oral↗
PubMed1979

Tobramycin pharmacokinetics in morbidly obese patients.

Tobramycin kinetics were examined in 9 morbidly obese women following a single intravenous (120 mg) bolus. After the injection, serum elimination conformed to a 2-compartment open model with alpha and beta t1/2s of 0.285 and 2.1 hr. The volume of distribution (Varea) was determined to be 0.44 1/kg ideal body weight (IBW) and 0.20 1/kg total body weight (TBW). To normalize Varea to 0.26 1/kg, 58% of the patients' adipose weight (TBW -- IBW) must also be taken into account.

Anti-Bacterial Agents↗
PubMedDate not supplied

Comparison of urinary urea nitrogen excretion and measured energy expenditure in spinal cord injury and nonsteroid-treated severe head trauma patients.

Severe head trauma patients (HT) exhibit markedly elevated energy expenditure and 24-hr urinary urea nitrogen excretion (UUN) values. The objective of this study was to compare seven spinal cord injured patients (SCI) to seven HT for changes in UUN and measured energy expenditure (MEE) over the first 18 days following injury. Energy expenditure was measured by indirect calorimetry and compared to values predicted by the Harris Benedict Equation (PEE). There were six quadriplegics and one paraplegic in the SCI group. HT patients had peak Glasgow Coma Scale scores of 3 to 10 for the first 24 hr postinjury. Patients were studied prospectively and matched for age, sex, and admitting weight Week 1 following the injury, SCI had mean UUN values of 0.18 +/- 0.04 g/kg/day vs 0.18 +/- 0.01 for HT patients. The mean MEE/PEE ratio was 0.56 for the SCI and 1.4 for HT (p less than 0.01). Over the entire study period the mean UUN value for SCI was 0.23 +/- 0.03 g/kg vs 0.21 +/- 0.01 for HT. The mean MEE/PEE ratio for SCI was 0.94 while HT remained elevated at 1.5 (p less than 0.05). Although the UUN was comparable in SCI vs HT, there was a significant difference in MEE/PEE between the groups. The elevation in UUN observed in SCI is not due to a hypermetabolic state. This suggests that different mechanisms promote the increased nitrogen excretion observed in these two populations.

Acute Disease↗
PubMedDate not supplied

Evaluation of new cephalosporins for prophylaxis of surgical infection.

The appropriate use of recently marketed cephalosporins for antimicrobial prophylaxis during surgery is discussed. New cephalosporins (cefamandole, cefoxitin, cefotaxime, moxalactam, and cefoperazone) are often substituted in situations where older, "first-generation" cephalosporins or other antimicrobials traditionally have been used. Adoption of these newer agents for routine use in prophylaxis of surgical infection has led to concerns of substantially increased costs as well as development of bacterial resistance. To date, some of the newer cephalosporins have been investigated for prophylaxis of postoperative infection in cesarean section, vaginal hysterectomy, gastrointestinal surgery, open-heart surgery, and total-hip replacement. Assessment of new cephalosporins for surgical prophylaxis should include: (1) the nature of infection with each specific type of procedure, (2) the effect of antimicrobials on prevention of infection with specific procedures, and (3) factors related to the institutional environment. For the surgical procedures listed above, newer cephalosporins either have not been studied or studies have not demonstrated a reduction in postoperative infection rates in comparisons with "first-generation" cephalosporins. Valid prophylactic uses for the newer agents may arise if comparative studies demonstrate postoperative infection rates lower than with regimens using the older cephalosporins or with other established regimens. Currently, none of the newer cephalosporins can be recommended for routine use in the prophylaxis of surgical infection.

Cardiac Surgical Procedures↗
PubMedDate not supplied

Cytomegalovirus colitis after 5-fluorouracil and interferon-alpha therapy.

Cytomegalovirus (CMV) infection is an opportunistic viral infection primarily affecting immunocompromised patients. Patients with inflammatory bowel disease have an increased risk for developing CMV infections of the gastrointestinal tract. While receiving continuous infusion of 5-fluorouracil and interferon-alpha, a 72-year-old woman with stage IV pancreatic carcinoma developed severe colitis with diarrhea that was refractory to conventional antidiarrheals. A biopsy specimen from the colon revealed CMV inclusions, which were confirmed by immunofluorescence. The patient was given ganciclovir 210 mg (5 mg/kg) every 12 hours for 14 days, and the diarrhea resolved after approximately 8 days of therapy. This is the first reported case of CMV colitis associated with combination 5-fluorouracil and interferon-alpha therapy.

Aged↗