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Biomedical subjects

R L Slaughter

Publications and source records attributed to R L Slaughter.

At least 73 records · Page 4Linked to original sources
PubMed1980

Chloramphenicol sodium succinate kinetics in critically ill patients.

Chloramphenicol sodium succinate (SCAP) kinetics were studied in 10 critically ill patients. High-performance liquid chromatography was used to assay SCAP and chloramphenicol (CAP) in serum and urine. Total body (ClTB), metabolic (ClM), and renal (ClR) clearances of SCAP were variable. Correlations were found between creatinine clearance (Clcr) and ClTB, ClM, and ClR of SCAP (r = 0.92, p less than 0.001; r = 0.84, p less than 0.005; and r = 0.84, p less than 0.005). Recovery of SCAP in the urine also demonstrated large interpatient variability. Between 6.5% and 43.5% of the SCAP dose was recovered in the urine of 6 patients. This variability could not be explained by incomplete urine collection or by differences in renal function. Renal excretion of SCAP was shown to influence CAP serum levels. CAP ClTB was diminished, but no relationship was found between routine liver function studies and CAP ClTB. Therefore we caution the use of such relationships in using CAP in critically ill patients.

Acute Disease↗
PubMed1980

Seizures associated with high cerebrospinal fluid concentrations of cefazolin.

Three cases of generalized seizures in patients with high cerebrospinal fluid (CSF) concentrations of cefazolin are reported. Patient 1, a 60-year-old woman with impaired renal function and a Klebsiella pneumoniae infection, was treated with 70 mg every eight hours of i.v. gentamicin sulfate and 1.5 g every four hours of i.v. cefazolin sodium. Gentamicin was discontinued on day 11. On day 12, the patient had a generalized tonic-clonic seizure. Serum and CSF concentrations of cefazolin one day later were 470 and 64 micrograms/ml, respectively. Patient 2, a 70-year-old man with impaired renal function, was given i.v. cefazolin, 1 g every 12 hours; the dosage interval was shortened later to every six hours. Two days later, the patient had two tonic-clonic seizures. Serum and CSF concentrations eight hours after the last dose of cefazolin were 360 and 34 micrograms/ml, respectively. Patient 3, a 67-year-old woman with renal vein thrombosis, received 55 mg every eight hours of i.v. gentamicin and 2 g every six hours of i.v. cefazolin. The antibiotics were discontinued after eight days when the patient had two tonic-clonic seizures. Serum and CSF concentrations of cefazolin measured 28 hours later were 1000 and 106 micrograms/ml, respectively. Previous reports of cefazolin-associated seizures are reviewed. In patients with renal failure, cefazolin may obtain high CSF concentrations. To avoid seizures, cefazolin doses should be adjusted in these patients.

Aged↗
PubMed1980

Effect of hemodialysis on total body clearance of chloramphenicol.

The effect of hemodialysis on the total body clearance (ClTB) of chloramphenicol was studied in two patients with renal failure and hepatic dysfunction. Chloramphenicol sodium succinate was administered intravenously eight hours before dialysis in doses of 20 and 26.1 mg/kg/day to Patients 1 and 2, respectively. Serum samples were taken at 48 hours after initiation of the drug, 2.5 hours after the last dose and 5 minutes into dialysis for Patient 1, and before dosing and at 0.5, 1, 2, 4, 6, 8 and 11 hours after dosing for Patient 2. Serum levels of chloramphenicol were measured by high-performance liquid chromatography. Chloramphenicol ClTB values on dialysis (162.2 and 118 ml/min for Patients 1 and 2, respectively) were 58% and 72% higher than off-dialysis ClTB values (102.9 and 69 ml/min) for Patients 1 and 2, respectively. Dialysis extraction ratios for chloramphenicol were 0.52 and 0.31 for Patients 1 and 2, respectively. Although the increased clearance of chloramphenicol that occurred during dialysis may be important only in patients with hepatic dysfunction, it is recommended that the normal maintenance dose of the drug be administered after dialysis to avoid the possibility of increased clearance.

Adult↗
PubMed1979

Chloramphenicol pharmacokinetics in hospitalized patients.

The apparent body clearance of chloramphenicol was investigated in 21 hospitalized adult patients on 27 occasions. Apparent body clearance was found to be significantly lower (1.99 +/- 1.49 ml/min per kg) in patients with total serum bilirubin concentrations of >1.5 mg/100 ml than in patients with serum bilirubin concentrations of </=1.5 mg/100 ml (3.57 +/- 1.72 ml/min per kg; P < 0.001). Serum protein binding of chloramphenicol was lower in cirrhotic patients (42.2 +/- 6.8% bound) than in normal adults (53.1 +/- 5.2% bound; P < 0.001). Low binding of chloramphenicol was also found in the serum of premature neonates (32.4 +/- 8.2% bound; P < 0.001). Reduced binding in neonates implies the need for a lower therapeutic range of total chloramphenicol concentration (3.5 to 13.9 mug/ml) compared with the usual adult range (5 to 20 mug/ml). Finally, three case reports are presented which demonstrate marked abnormalities and intrasubject variation in chloramphenicol clearance.

Adolescent↗
PubMed1979

Relationship between serum and saliva chloramphenicol concentrations.

The relationship between serum and saliva chloramphenicol (CAP) concentrations was evaluated in 27 paired specimens collected from 20 hospitalized patients during therapy with the drug. A significant (R = 0.80, P < 0.001) but variable relationship was found to exist. Serum protein binding of CAP was also evaluated (43.7 +/- 5.7% bound; N = 24). Differences in CAP binding did not apparently account for a significant portion of the variability in the observed saliva/serum CAP concentration ratios. The degree of variation observed indicated that saliva CAP concentrations could not be relied upon for the prediction of serum CAP concentrations.

Adult↗
PubMed1978

Appropriateness of the use of serum digoxin and digitoxin assays.

The use of 145 digoxin and digitoxin assays was studied in a teaching hospital to determine if performance of assays was appropriate and therapeutically beneficial. Patient charts (121) were randomly selected from a list of all patients for whom digoxin or digitoxin assays were performed. Charts were compared with established criteria to determine whether the assay was indicated and performed correctly and whether dosage was adjusted correctly based on assay results. Of the assays reviewed, 49% were performed for irrational indications; 86% were performed appropriately under steady-state conditions; and 96% used serum samples appropriately drawn more than six hours after administration of the last digitalis glycoside dose. Of the assays performed at appropriate times in relation to dose and at steady-state plasma concentrations (120), 31 should have and 89 should not have resulted in a dosage change. Of the latter, 98% were evaluated correctly. Of the former, 36% were not evaluated correctly (i.e., indicated dosage adjustments were not made). Control of the use of digitalis glycoside assays is needed. Pharmacists should become involved in monitoring drug assays to assure appropriateness of assay request, interpretation and follow-up.

Digitoxin↗
PubMed1976

Proximal gastric vagotomy: effects of two operative techniques on clinical and gastric secretory results.

PGV performed in 39 patients by separating the lesser omentum from the stomach beginning 6 or 7 cm proximal to the pylorus and skeletonizing the distal 1 to 2 cm of esophagus was followed by 15.4% of proven and 10.2 of suspected recurrent ulcers. Insulin tests were done during the first 3 months postoperatively on 31 of the patients, including the 6 with proven and the 4 with suspected recurrent ulcers. The peak acid output to insulin minus tha basal acid output (PAOI-BAO) was less than 5 mEq/hr in 16 cases (52%) and from 5 to 25 mEq/hr in the remaining 15 cases. In 6 patients with proven recurrent ulcer, PAOI-BAO averaged 21.9 mEq/hr (range, 11.3 to 41.8); in the 4 patients with suspected recurrence, 9.5 (range, 4.4 to 11.8). The operative technique was changed in one respect; the distal 5 to 7.5 cm of the esophagus was skeletonized. In 14 patients, the mean PAOI-BAO +/- S.E. within 3 months of PGV was 1985 +/- 0.7 mEq/hr, and 13 of 14 values were less than 5 mEq/hr. One patient developed recurrent ulcer and required re-operation; this patient's value for PAO-BAO was 1.8 mEq/hr. The results show quantitatively that great differences in the completeness of PGV result from differences in the periesophageal dissection and emphasize its importance if optimal results are to be obtained and, especially, if the efficacy of the operation is to be judged.

Adolescent↗
PubMed1976

Double lumen esophagus due to reflux esophagitis with fibrous septom formation.

The unique endoscopic finding of a double lumen esophagus due to the development of a fibrous septum within an area of peptic reflux esophagitis is presented. The pathogenesis of this septum was felt to represent adherence to granulation tissue from opposing esophageal walls. This abnormality was easily managed by esophageal bouginage.

Esophageal Diseases↗
PubMed1976

Portal vein thrombosis resulting in portal hypertension in adults.

Attempting to elucidate the best way to treat adult patients with extrahepatic portal vein occlusive thrombosis, the experience with six such patients is analyzed. Portal vein thrombosis rarely occurs in adults but when it does, it frequently results in portal hypertension with its concomitant complications. Five patients had bleeding esophageal varices, two had massive refractory ascites. Their conventional liver function tests were not greatly altered. Thrombocytosis and history of thrombophlebitis were encountered in over half of the patients. Splenoportography is the best method to confirm the diagnosis preoperatively. In none of the six patients a decompressive portal systemic shunt could be performed although, it was attempted in five. Three patients survived. It appears that nonoperative management is the treatment of choice in these patients who can remain well for several years, however, when bleeding recurs gastric devascularization or even resective procedures are acceptable therapeutic alternatives.

Adult↗
PubMed1975

Correlation of lower esophageal sphincter pressure and serum gastrin level in man.

Resting lower esophageal sphincter pressures and fasting serum gastrin levels were measured in 35 consecutive patients. 28 of these patients were subdivided into Group I, which consisted of 9 patients with symptomatic gastroesophageal reflux and hiatus hernia, and Group II was further subdivided into Group IIA, 5 patients with hiatus hernias, and Group IIB, 14 patients without hiatus hernia. Mean LES pressures for Groups I, IIA, and IIB were 9.7, 36.8, and 25.6 cm H2O, and serum gastrin levels were 129, 74, and 116 pg/ml, respectively. Examination of these data as a whole or as subgroups failed to demonstrate a correlation between these two variables. The remaining 7 patients had abnormal sphincters (3 patients which scleroderma and 2 with achalasia) or abnormal serum gastrin levels (1 patient with pernicious anemia and 1 patient with antrectomy and Billroth II anastomosis). For these patients as well, no correlation between LES pressure and serum gastrin level was found. These results cast doubt on the hypothesis that endogenous gastrin is a major factor in the maintenance of resting LES pressure.

Adult↗