5%葡萄糖注射液和5%碳酸氢钠注射液配伍稳定性考察

目的:考察5%葡萄糖注射液和5%碳酸氢钠注射液配伍的稳定性。方法:模拟临床液体疗法用药情况,将5%葡萄糖注射液和5%碳酸氢钠注射液配制成不同配比的输液,在各个不同时间测定输液pH值、葡萄糖含量和5-羟甲基糠醛限量。结果:在实验时段内,pH值超过5%葡萄糖的规定范围,葡萄糖含量略有下降,5-羟甲基糠醛限量未见异常升高,紫外扫描未见5-羟甲基糠醛吸收峰增大。结论:5%葡萄糖注射液和5%碳酸氢钠注射液配伍使用,建议临用时配制,一旦配制应尽快用完。     

Antidotal Sodium Bicarbonate Therapy: Delayed QTc Prolongation and Cardiovascular Events

BackgroundSodium bicarbonate therapy (SBT) is currently indicated for the management of a variety of acute drug poisonings. However, SBT effects on serum potassium concentrations may lead to delayed QTc prolongation (DQTP), and subsequent risk of adverse cardiovascular events (ACVE), including death. Emergency department (ED)–based studies evaluating associations between SBT and ACVE are limited; thus, we aimed to investigate the association between antidotal SBT, ECG changes, and ACVE.MethodsThis was a secondary data analysis of a consecutive cohort of ED patients with acute drug overdose over 3 years. Demographic and clinical data as well as SBT bolus dosage and infusion duration were collected, and outcomes were compared with an unmatched consecutive cohort of patients with potential indications for SBT but who did not receive SBT. The primary outcome was the occurrence of ACVE, and secondary outcomes were delayed QTc (Bazett) prolongation (DQTP), and death. Propensity score and multivariable adjusted analyses were conducted to evaluate associations between adverse outcomes and SBT administration. Planned subgroup analysis was performed for salicylates, wide QRS (> 100 ms), and acidosis (pH < 7.2).ResultsOut of 2365 patients screened, 369 patients had potential indications for SBT, of whom 31 (8.4%) actually received SBT. In adjusted analyses, SBT was found to be a significant predictor of ACVE (aOR 9.35, CI 3.6–24.1), DQTP (aOR 126.7, CI 9.8–1646.2), and death (aOR 11.9, CI 2.4–58.9). Using a propensity score model, SBT administration was associated with ACVE (OR 5.07, CI 1.8–14.0). Associations between SBT and ACVE were maintained in subgroup analyses of specific indications for sodium channel blockade (OR 21.03, CI 7.16–61.77) and metabolic acidosis (OR: 6.42, 95% CI: 1.20, 34.19).ConclusionIn ED patients with acute drug overdose and potential indications for SBT, administration of SBT as part of routine clinical care was an independent, dose-dependent, predictor of ACVE, DQTP, and death. This study was not designed to determine whether the SBT or acute overdose itself was causative of ACVE; however, these data suggest that poisoned patients receiving antidotal SBT require close cardiovascular monitoring.     

肾功能不全合并高血压住院患者经药物摄入钠盐情况的调查

目的:调查肾功能不全合并高血压患者(未行血液透析)通过药物途径摄入钠盐的情况。方法:选取2012年10-12月我院肾内科慢性肾功能不全合并高血压住院患者84例,对住院医嘱及其出院医嘱的钠摄入情况进行统计分析。结果:84例患者人均用药18.99种,其中含钠药物2.31种,占用药品种的12.16%。共使用含钠药物14种,含钠量较高的为生理盐水、碳酸氢钠片、碳酸氢钠注射剂、葡萄糖氯化钠注射液、浓氯化钠注射剂。仅1例显示日均钠摄入量超过2 300 mg,77例患者人均每日钠摄入量为787.05 mg。结论:该类患者经药物途径摄入钠量不高。个别患者可能超过高血压患者日常摄盐量限定值,需要进一步控制日常饮食的钠盐摄入。     

Overview of the effects of Ringer's acetate solution and a new concept: renal ketogenesis during hepatic inflow occlusion

Developments in infusion therapy with sodium lactate administered with its isomer, and developments in acetate utilization, both as an infusate or a dialysate, have been previously described, as have the various effects of sodium acetate on cardiovascular function, metabolism and fluid replacement. Unfavorable effects of acetate infusate or dialysate, such as cardiovascular depression, have also been reported, and although the number of studies reporting favorable effects on cardiovascular metabolism is increasing, it is still a matter of controversy. It is clear, however, that acetate can be metabolized in the liver as well as in extrahepatic organs yielding bicarbonate, which can be utilized as an alkalizing agent. Recently, the authors reported new experimental findings that sodium acetate was metabolized to ketone bodies by the kidney during hepatic inflow occlusion. Ketone bodies attract considerable attention as energy substrates in the stress phase and in the reduced redox state. Administration of sodium acetate under such conditions may therefore contribute as substrate supply.     

透明帽辅助圈套器联合碳酸氢钠液注射治疗巨大胃石

目的评价内镜下碳酸氢钠液注射联合透明帽辅助下勒除器机械碎石治疗巨大植物性胃石症的有效性及安全性。方法 12例巨大植物性胃石症患者,采用内镜下碳酸氢钠液注射联合透明帽辅助下勒除器机械碎石治疗,统计治疗成功率、并发症发生率、胃石复发率及操作时间。结果 12例患者均一次性成功碎石取石,治疗成功率100%,无出血、穿孔及肠梗阻等严重并发症发生,平均操作时间42min,随访最长1年无胃石复发。结论内镜下碳酸氢钠液注射联合透明帽辅助下勒除器机械碎石治疗巨大植物性胃石症安全、方便、有效,复发率低,操作时间短,值得临床推广应用。     

细菌内毒素法检查碳酸氢钠注射液热原的研究

目的:研究用细菌内毒素法检查碳酸氢钠注射液的热原.方法:应用鲎试剂检查碳酸氢钠注射液中的热原,考察了碳酸氢钠注射液对细菌内毒素检查法的干扰行为.结果:碳酸氢钠注射液稀释2.5倍,对细菌内毒素检查法无干扰作用.结论:选用鲎试剂,细菌内毒素检查可代替碳酸氢钠注射液热原检查法.     

反相高效液相色谱法测定复方醋酸钠注射液中醋酸钠含量

目的建立测定复方醋酸钠注射液中醋酸钠含量的反相高效液相色谱法。方法采用ICsepIce-Coregel 87H3型色谱柱,流动相为0.005mol/L硫酸,流速为0.6mL/min,柱温60℃,检测波长210nm。结果醋酸钠质量浓度在1.0～3.0g/L范围内与峰面积线性关系较好,r=0.9999;平均加样回收率为100.18%,RSD=0.31%（n=6）;精密度试验的RSD=0.15%（n=6）;最低检测限为99.15ng。结论所用方法简单、灵敏、准确,可作为复方醋酸钠注射液中醋酸钠含量测定的方法。     

非PVC多层共挤输液膜与碳酸氢钠注射液的相容性

目的研究非PVC多层共挤输液膜与碳酸氢钠注射液的相容性。方法按生产工艺配制碳酸氢钠注射液,分装于非PVC多层共挤输液袋中,检测各项指标,并与玻璃瓶进行比较。结果用非PVC多层共挤输液袋包装的碳酸氢钠注射液中间体及成品长期室温放置条件下pH值明显升高。结论碳酸氢钠注射液不适用于非PVC多层共挤输液袋包装。     

A Literature Review of the Use of Sodium Bicarbonate for the Treatment of QRS Widening

Sodium bicarbonate is a well-known antidote for tricyclic antidepressant (TCA) poisoning. It has been used for over half a century to treat toxin-induced sodium channel blockade as evidenced by QRS widening on the electrocardiogram (ECG). The purpose of this review is to describe the literature regarding electrophysiological mechanisms and clinical use of this antidote after poisoning by tricyclic antidepressants and other agents. This article will also address the literature supporting an increased serum sodium concentration, alkalemia, or the combination of both as the responsible mechanism(s) for sodium bicarbonate’s antidotal properties. While sodium bicarbonate has been used as a treatment for cardiac sodium channel blockade for multiple other agents including citalopram, cocaine, flecainide, diphenhydramine, propoxyphene, and lamotrigine, it has uncertain efficacy with bupropion, propranolol, and taxine-containing plants.     

Successful Use of Hydroxocobalamin and Sodium Thiosulfate in Acute Cyanide Poisoning: A Case Report with Follow‐up

Hydroxocobalamin is an effective first‐line antidote used mainly in monotherapy of cyanide poisonings, while the opinions are different on the effects of its combination with sodium thiosulfate. A 58‐year‐old male committed a suicide attempt by ingesting of 1200–1500 mg of potassium cyanide; he was unconscious for 1–1.5 min. after ingestion with the episode of generalized seizures. On admission to the ICU, the patient was acidotic (pH 7.28; HCO₃ 14.0 mmol/L, base excess ?12.7 mmol/L, saturation O₂ 0.999) with high serum lactate (12.5 mmol/L). Hydroxocobalamin was administered 1.5 hr after ingestion in two subsequent intravenous infusions at a total dose of 7.5 g. The infusion was followed by continuous intravenous administration of 1 mL/hr/kg of 10% sodium thiosulfate at a total dose of 12 g. No complications and adverse reactions were registered. Serum lactate decreased to 0.6 mmol/L the same day, and arterial blood gases became normal (pH 7.49; HCO₃ 27.2 mmol/L, base excess 2.2 mmol/L, saturation O₂ 0.994). The follow‐up examination 5 months later revealed no damage of basal ganglia and cerebellum on magnetic resonance imaging. The neurological examination revealed no pathological findings. On the ocular coherence tomography, the retinal nerve fibres layer was normal. In visual evoked potentials, there was a normal evoked complex on the left eye and minor decrease in amplitude on the right eye. Combination of hydroxocobalamin and sodium thiosulfate can have a positive effect on the survival without long‐term neurological and visual sequelae in the cases of massive cyanide poisonings due to the possibility of a potentiation or synergism of hydroxocobalamin effects by sodium thiosulfate. This synergism can be explained by the different time‐points of action of two antidotes: the initial and immediate effect of hydroxocobalamin, followed by the delayed, but more persistent effect of sodium thiosulfate.     

Sodium polystyrene sulfonate induced intestinal necrosis; a case report

Background

Hyperkalemia is a commonly encountered medical problem. The treatment of hyperkalemia involves the use of pharmacological agents with different mechanism of actions. Sodium Polystyrene sulfonate (SPS) is a cation-exchange resin that exchanges sodium for potassium. In 2009, the United States Food and Drug Administration issued warning against the use of SPS with sorbitol due to risk of colonic necrosis. We present a case of SPS induced colonic necrosis in the absence of sorbitol and risk factors deemed to increase risk of colonic necrosis.

The effect of sodium bicarbonate on propranolol-induced cardiovascular toxicity in a canine model

STUDY OBJECTIVE: To evaluate the potential utility of sodium bicarbonate in an established model of acute propranolol toxicity. METHODS: Two minutes after the completion of a propranolol infusion (10 mg/kg), a bolus of 1.5 mEq/kg of sodium bicarbonate solution (1 mEq/mL) followed by an infusion of 1.5 mEq/kg over the next 26 minutes (n = 6) or an equivalent timing and volume of 5% dextrose solution (n = 6) was administered in each dog. Targeted cardiovascular parameters included heart rate, mean arterial pressure, left ventricular dP/dtmax, and QRS interval. RESULTS: Propranolol infusion significantly depressed heart rate (p < 0.0001), mean arterial pressure (p < 0.0001), dP/dtmax (p < 0.0001) and prolonged the QRS interval (p < 0.0001). Sodium bicarbonate failed to significantly improve these targeted parameters when compared to control animals. CONCLUSION: In this canine model of propranolol toxicity, intravenous sodium bicarbonate appears to be an ineffective single therapy. Furthermore, these results may suggest a different mechanism of sodium channel blockade for propanolol than that of type IA antiarrhythmic agents.     

Reversal of citalopram-induced junctional bradycardia with intravenous sodium bicarbonate

The cardiotoxicity of tricyclic antidepressants is a well-described phenomenon requiring serious consideration in patients who have taken an overdose. In patients who are at high risk for suicide attempts, selective serotonin reuptake inhibitors (SSRIs) were thought to constitute a safe alternative. However, evidence is accumulating that they, too, possess proarrhythmic properties, which must be reconciled in the setting of an overdose. An 82-year-old woman intentionally ingested citalopram 1.6 g. Several hours after presentation, she developed sinus arrest and junctional bradycardia that resolved after infusion of intravenous sodium bicarbonate solution. Thereafter, she demonstrated no further electrocardiographic abnormalities and was safely transferred to the psychiatry service without the need for a temporary transvenous pacemaker. The dramatic effect of the sodium bicarbonate on the arrhythmia represents a probable event according to the Naranjo probability scale. Intravenous sodium bicarbonate may serve as an effective antidote to SSRI-induced bradyarrhythmias.     

降低七叶皂苷钠输液微粒数的实验研究

目的观察注射用七叶皂苷钠与不同溶媒配伍后经过不同输液器的微粒变化,探索降低七叶皂苷钠输液微粒数的方法。方法应用不溶性微粒检测仪．分别检查注射用七叶皂苷钠与0．9％氯化钠注射液和10％葡萄糖注射液溶媒混合后输液中微粒数以及各输液通过不同输液器后微粒数的变化。结果注射用七叶皂苷钠与0．9％氯化钠注射液配伍的输液中微粒数增加大于其与10％葡萄糖注射液配伍的输液中微粒数：上述输液分别通过一次性使用精密输液器后输液中微粒数均明显减少;而通过一次性使用输液器后输液中微粒数均显著增加。结论选择10％葡萄糖注射液为注射用七叶皂苷钠溶媒,通过一次性使用精密输液器静脉滴注,可减少进入静脉微粒数,从而减少发生静脉炎。     

注射用美罗培南与丙戊酸钠的药物相互作用分析

目的探究注射用美罗培南对丙戊酸钠血药浓度的影响及机制。方法通过收集我院相关病例资料及查阅美罗培南与丙戊酸钠药物相互作用的相关文献报道,归纳总结美罗培南对丙戊酸钠血药浓度的影响及机制。结果本组共收集到23例注射用美罗培南与丙戊酸钠联合使用的病例,美罗培南使用后引起丙戊酸钠血药浓度明显降低(P<0.05),丙戊酸的血药浓度从(35.74±2.3)mg/L下降到(2.97±1.3)mg/L。其作用机制为合用美罗培南抑制丙戊酸钠的吸收,使丙戊酸钠向红细胞转运加强,抑制葡萄糖醛酸丙戊酸分解为游离型丙戊酸。结论在临床上要尽量避免美罗培南与丙戊酸钠联合使用,这两种药物的相互作用是不能通过改变丙戊酸钠的剂量而缓解的,临床上在使用丙戊酸钠时必须要用美罗培南时可改用卡马西平或苯妥英钠等药物替代。     

湿法混合制粒法制备碳酸氢钠片

目的研究以湿法混合制粒法制备碳酸氢钠片的工艺。方法采用淀粉、糊精、蔗糖粉为辅料,以不同配比、不同工艺制备碳酸氢钠片,并用正交设计筛选出了最佳制备工艺参数。结果经过片剂硬度测试证明,淀粉-糊精-蔗糖粉的配比为7∶1∶1,在制粒时加入5%的淀粉浆,压片时厚度控制为4.30mm时所压的片剂硬度最好。讨论A1B2C1配方及工艺得到的片剂硬度较好,适于生产,但没有考虑崩解时限、溶出度等指标。     

Comparison of a calixarene-based ion-selective electrode with two automated analyzers for the clinical determination of sodium in blood plasma

Neutral-carrier ion-selective electrodes based on methyl p-t-butylcalix[4]aryl acetate have been prepared that are responsive to sodium ions. The miniaturized catheter-type electrodes were obtained by dip-coating their porcelain tips in a PVC membrane cocktail. Examination of the general performance of the electrodes revealed excellent characteristics in terms of Nernstian response, selectivity, stability, reproducibility and response time. The results from the indirect potentiometric assessment of a large number of plasma samples with the electrodes showed a good correlation with the results from two automated analyzers (Technicon Smac 3, Hitachi 704) and with flame photometric data. Although inconsistencies were observed in the measurement of some plasma samples, the variance seemed to be method-dependent, and the overall performance of the electrodes showed promise as an alternative to the sodium glass electrode. Some factors influencing the standard potential of the measuring cell are discussed as a source of error.     

Effects of tight versus non tight control of metabolic acidosis on early renal function after kidney transplantation

Background

Recently, several studies have been conducted to determine the optimal strategy for intra-operative fluid replacement therapy in renal transplantation surgery. Since infusion of sodium bicarbonate as a buffer seems to be safer than other buffer compounds (lactate, gluconate, acetate)that indirectly convert into it within the liver, We hypothesized tight control of metabolic acidosis by infusion of sodium bicarbonate may improve early post-operative renal function in renal transplant recipients.

Methods

120 patients were randomly divided into two equal groups. In group A, bicarbonate was infused intra-operatively according to Base Excess (BE) measurements to achieve the normal values of BE (−5 to +5 mEq/L). In group B, infusion of bicarbonate was allowed only in case of severe metabolic acidosis (BE ≤ −15 mEq/L or bicarbonate ≤ 10 mEq/L or PH ≤ 7.15). Minute ventilation was adjusted to keep PaCO₂ within the normal range. Primary end-point was sampling of serum creatinine level in first, second, third and seventh post-operative days for statistical comparison between groups. Secondary objectives were comparison of cumulative urine volumes in the first 24 h of post-operative period and serum BUN levels which were obtained in first, second, third and seventh post-operative days.

Results

In group A, all of consecutive serum creatinine levels were significantly lower in comparison with group B. With regard to secondary outcomes, no significant difference between groups was observed.

Conclusion

Intra-operative tight control of metabolic acidosis by infusion of Sodium Bicarbonate in renal transplant recipients may improve early post-operative renal function.     

阿魏酸钠治疗肛周脓肿术后患者55例临床观察

目的观察在常规治疗的基础采用阿魏酸钠治疗肛周脓肿术后患者的临床疗效。方法将符合病例入选标准的110例肛周脓肿患者随机分为观察组、对照组,每组55例。2组患者均行手术治疗,其中低位脓肿行一次性切开术,高位脓肿行一次性切开挂线术。术后均给予抗生素、温热水熏洗、坐浴等对症治疗。观察组于术后第5天同时给予阿魏酸钠,0.2g+生理盐水250mL,静脉滴注,每日1次,连用15天。结果观察组治愈率为69.09%,总有效率为94.55%;对照组治愈率为36.36%,总有效率为80.00%。2组治愈率、总有效率相比有明显差异(P<0.05)。脓肿复发率、假性愈合率、创面愈合时间、术后肛瘘形成情况及住院时间等观察指标2组相比差异有统计学意义(P<0.05)。结论在常规治疗的基础采用阿魏酸钠治疗肛周脓肿术后患者临床疗效显著。