Acebutolol-induced ventricular tachycardia reversed with sodium bicarbonate.

BACKGROUND: Acebutolol is a unique beta blocker that possesses cardioselectivity, partial agonist activity, and membrane stabilizing activity. Sodium bicarbonate is used to reverse the cardiotoxic effects of other drugs with membrane stabilizing activity. There have been no reported cases of acebutolol-induced ventricular dysrhythmias treated successfully with bolus sodium bicarbonate. CASE PRESENTATION: A 48-year-old man ingested approximately 6.4 g of acebutolol with ethanol (blood ethanol 61 mmol/L). There were no other coingestants identified. One hour after presentation, the patient had a cardiac arrest with the monitor showing ventricular tachycardia. Sodium bicarbonate 50 mEq intravenous push converted the patient to sinus rhythm and the blood pressure improved to 129/90 mm Hg. CONCLUSION: This case demonstrates a temporal relationship between bolus sodium bicarbonate administration and the termination of acebutolol-induced ventricular tachycardia.     

Effect of sodium bicarbonate in rats acutely poisoned with dichlorvos

The development of effective antidotes against organophosphates such as dichlorvos has been a persistent challenge over the past decades. Therapy of organophosphate poisoning is based on the administration of atropine and oxime as standard antidotes. The present study was undertaken to evaluate the ability of sodium bicarbonate to improve protective effects of standard antidotes in rats poisoned with dichlorvos. The aim of this experiment was to establish the correlation between protective effects and biochemical parameters relevant for acid-base status. In order to examine the protective effect of both standard antidotes and their combinations, groups of experimental animals were poisoned subcutaneously with increasing doses of dichlorvos. Immediately thereafter, rats were treated with atropine 10 mg/kg intramuscularly, oximes 10 mg/kg intramuscularly and sodium bicarbonate 3 mmol/kg intraperitoneally. These antidotes were administered either as single doses or in combinations. In the biochemical part of the experiments, rats were poisoned with dichlorvos 1.3 LD(50) (10.64 mg/kg) subcutaneously and immediately thereafter treated with atropine 10 mg/kg intramuscularly, oximes (trimedoxime or obidoxime) 10 mg/kg intramuscularly and sodium bicarbonate 3 mmol/kg intraperitoneally either as single doses or in combinations. Parameters relevant for acid-base status were measured 10 minutes after the administration of antidotes. The results of our study indicate that addition of sodium bicarbonate to standard antidotes significantly improves protective effects of atropine, obidoxime and trimedoxime. Correlation between protection and biochemical outcome is clearly evident when sodium bicarbonate is being added to atropine.     

Solution stability of cephradine neutralized with arginine or sodium bicarbonate

The solution stability of two formulations of cephradine--one using L-arginine and the other sodium carbonate as the neutralizer--was studied. Solutions of each formulation of 1% cephradine were prepared in the following diluents: 0.9% sodium chloride injection, lactated Ringer's injection, Ringer's injection, Normosol-R injection, 5% dextrose injection, and sterile water for injection; 5 and 25% solutions were made with sterile water for injection. All solutions were maintained at 25 degrees C, and at least five samples of each were assayed at various time intervals. Assay methods were HPLC, hydroxylamine colorimetric assay, microbiological agar diffusion, and iodometric analysis. By all assay methods, degradation rates of 1% solutions were lower for the arginine-neutralized product than for the one neutralized with sodium carbonate. This may be attributable to the lower pH values of solutions of the formulation with arginine, because one mechanism of degradation is pH-dependent. At concentrations of 5%, the difference in cephradine stability between the two formulations was minimal. At the 25% concentration, the formulations containing sodium carbonate were more stable. At these higher concentrations, the effect of pH is less important because degradation occurs by a combination of mechanisms. The 1% cephradine-arginine formulation was more stable than the same strength cephradine-sodium carbonate formulation in all the i.v. diluents studied. At 5 and 25% cephradine concentrations, the differences in stability between the two formulations were not substantial.     

654-2和碳酸氢钠不同给药法减少静滴红霉素副作用的观察

红霉素静滴应用时可引起胃肠道平滑肌及血管平滑肌痉挛,出现腹泻、恶心、呕吐、胃痛等副作用,在儿科的应用受到较多限制。近年来,有文献[1,2]报道在红霉素静滴液中加入适量的碳酸氢钠和654-2注射液可起到明显抑制其不良反应和增加抗菌作用的效果,但我们在实际应用中仍感到不满意,而采用在红霉素静滴液中同时加入适量的654鄄2注射液和5%的碳酸氢钠注射液的方法,收到满意效果,现报告如下。1资料和方法1.1临床资料选自本院儿科2000年1月至2003年3月期间因患肺部支原体感染住院治疗的患儿或因头孢菌素、青霉素类药物过敏而需选用红霉素治疗的患…     

碳酸氢钠注射液中细菌内毒素的含量测定

目的:对碳酸氢钠注射液进行细菌内毒素检测,建立检测碳酸氢钠注射液细菌内毒素的实验方法。方法:采用2005年版中国药典细菌内毒素检查法,用盐酸对碳酸氢钠注射液的 pH 值进行调整,在 pH>7和 pH<7两种条件下,对样品进行4倍稀释,分别用凝胶法和动态浊度法对样品中的内毒素进行测定。结果:当样品的 pH>7时,凝胶法和动态浊度法均存在干扰,凝胶法为抑制,动态浊度法为增强;当样品的 pH<7时,凝胶法和动态浊度法均无干扰,实验方法成立。结论:用凝胶法和动态浊度法检测碳酸氢钠注射液中的细菌内毒素是可行的。动态浊度定量法较凝胶法具有方便、快捷、定量、可以观察动态反应过程、利于分析干扰情况等优势。     

细菌内毒素法检查碳酸氢钠注射液的探讨

目的建立碳酸氢钠注射液细菌内毒素检查方法。方法参照《中国药典》2005年版（二部）附录细菌内毒素检查法及其指导原则进行试验。结果干扰实验表明供试品稀释4倍可消除干扰。结论碳酸氢钠注射液细菌内毒素检查法可代替家兔法热原检查。     

联合应用碳酸氢钠和N-乙酰半胱氨酸预防造影剂肾病临床研究

目的探讨联合应用碳酸氢钠和N．乙酰半胱氨酸对’肾功能不良患者造影剂肾病的预防作用。方法将行冠状动脉介入治疗的140例肾功能不全（肌酐≥177μmol／L）冠心病患者随机分为2组i0．9％氯化钠溶液＋N-乙酰半胱氨酸组（n：68）造影前后12h静脉滴注0．9％氯化钠溶液;碳酸氢钠＋N-乙酰半胱氨酸组（n=72）于造影前lh、造影过程中及造影后6h连续静脉滴注1．5％碳酸氢钠。2组均于造影前、后24h,2次／d,口服N-乙酰半胱氨酸泡腾片1200mg;造影前后48h检测患者血尿素、肌酐水平。血清肌酐水平比造影前升高i〉25％,或是血肌酐升高≥44μmol／L,并除外其他原因所致者诊断为造影剂肾病。结果0．9％氯化钠溶液＋N-乙酰半胱氨酸组出现造影剂肾病7例;而碳酸氢钠＋N-乙酰半胱氨酸组发生造影剂肾病1例,明显低于0．9％氯化钠溶液＋N-乙酰半胱氨酸组（P〈0．05）。结论碳酸氢钠＋N-乙酰半胱氨酸对造影剂肾病有良好的预防作用,明显优于临床常规使用的0．9％氯化钠溶液＋N-乙酰半胱氨酸治疗方案。     

Reversal of bradykinin-induced reflex tachycardia to bradycardia by captopril; evidence for prostacyclin involvement

In conscious male New Zealand rabbits, bradykinin caused dose-dependent (0.03-1 microgram/kg i.v.) hypotension and reflex tachycardia. After inhibition of angiotensin converting enzyme (ACE, also known as kininase II) with captopril (1 mg/kg i.v.), the hypotensive effect of bradykinin was enhanced in magnitude and duration but the normally observed tachycardia was reversed to bradycardia. In rabbits treated with indomethacin to inhibit cyclooxygenase and then given captopril, the bradycardia to bradykinin reverted to tachycardia whereas the magnitude of the initial hypotensive effect was unchanged. However, inhibition of thromboxane synthetase with SQ 80,338 (1-[3-phenyl-2-propenyl]-1H-imidazole) was without effect on either bradykinin-induced hypotension or bradycardia in captopril treated rabbits. Infusion of nicotine to inhibit prostacyclin synthetase completely reversed the bradycardia induced by bradykinin in captopril-treated rabbits, an effect unrelated to ganglion blockade by nicotine since mecamylamine had no effect on the actions of bradykinin. beta-Adrenoceptor blockade with nadolol did not modify the bradycardia caused by bradykinin in captopril-treated rabbits whereas atropine methylnitrate caused a marked reduction. Captopril had no inhibitory effect on reflex tachycardia caused by nitroglycerin or acetylcholine and only reduced that caused by eledoisin. Hypotension and bradycardia resulted from giving rabbits prostacyclin (100 microgram/kg i.v.). These results suggest that the bradycardia observed in conscious rabbits to bradykinin after captopril treatment is the result of an increase in circulating bradykinin due to ACE (kininase II) inhibition leading to a vago-vagal reflex induced by the synthesis of prostaglandins, probably prostacyclin.     

Preliminary results of gentamycin combined with sodium bicarbonate for prevention of irinotecan-induced diarrhea

The aim of this paper was to observe the clinical effect of gentamycin combined with sodium bicarbonate for the prevention of irinotecan-induced diarrhea. A total of 98 patients with stage IV cancers were recruited and divided into a prevention group (52 patients) and a control group (46 patients). All patients received the chemotherapy including irinotecan. The prevention group received gentamycin and sodium bicarbonate before the use of irinotecan for 4 days; the control group did not receive any prevention. The use of gentamycin and sodium bicarbonate resulted in significantly higher stool pH (P<0.001), while the incidence of diarrhea by irinotecan was reduced (prevention group 13.70% versus control group 34.83%; P<0.001). Gentamycin combined with sodium bicarbonate appears to be useful in preventing the diarrhea induced by irinotecan and reducing the dosage of loperamide and fluid replacement.     

碳酸氢钠联合卡泊芬净治疗真菌性肺炎的疗效观察

目的探讨碳酸氢钠注射液联合注射用醋酸卡泊芬净治疗真菌性肺炎的临床疗效。方法选取2017年2月—2018年2月在南京大学医学院附属南京鼓楼医院集团宿迁市人民医院治疗的真菌性肺炎患者78例,根据用药方案的不同分为对照组(39例)和治疗组(39例)。对照组患者静脉滴注注射用醋酸卡泊芬净,首日剂量70 mg加入250 m L生理盐水,之后减至50 mg/d;治疗组在对照组基础上气道内持续泵注2.5%碳酸氢钠注射液2~5 m L/h。两组均经过7 d治疗。观察两组患者临床疗效,同时比较治疗前后两组患者临床症状改善情况、动脉血二氧化碳分压(p CO_2)和动脉血氧分压(p O_2)值及真菌清除率。结果治疗后,对照组临床有效率为82.05%,显著低于治疗组的97.44%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组患者的体温恢复时间、咳嗽消退时间和肺部湿罗音消退时间均显著短于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者p CO_2明显降低(P0.05),p O_2明显升高(P0.05),且治疗后治疗组患者p CO_2和p O_2值明显优于对照组(P0.05)。治疗后,对照组的真菌清除率为71.79%,显著低于治疗组的92.31%,两组患者比较差异具有统计学意义(P0.05)。结论碳酸氢钠注射液联合注射用醋酸卡泊芬净治疗真菌性肺炎可有效改善患者临床症状,提高真菌清除率,具有一定的临床推广应用价值。     

Compatibility of imipenem-cilastatin sodium with commonly used intravenous solutions

The stability of imipenem-cilastatin sodium (Primaxin, Merck Sharp & Dohme) in various intravenous fluids was determined after storage at 4 degrees C or 25 degrees C and after freezing. Samples of imipenem-cilastatin sodium were constituted with 100 mL of each of 17 i.v. fluids to concentrations of 2.5 mg/mL or 5.0 mg/mL of each drug component and stored in glass infusion bottles at constant room temperature (25 degrees C) or constant refrigerated temperature (4 degrees C). The concentration of each solution was determined immediately after constitution by a stability-indicating high-performance liquid chromatographic assay; the concentrations of both drugs were monitored in each i.v. fluid until the time that the concentration of either imipenem or cilastatin decreased to less than 90% of the initial concentration (t90). The exact value of t90 was determined for each solution by linear regression. The solutions were also assessed for changes in pH or color. Cilastatin sodium was more stable in all 17 i.v. fluids than imipenem. The stability of imipenem was dependent on the concentration of that drug in solution; solutions of imipenem 2.5 mg/mL were more stable than solutions of imipenem 5.0 mg/mL. The values of t90 for imipenem in solutions stored at 4 degrees C were greater than the values for solutions stored at 25 degrees C. Imipenem was most stable in 0.9% sodium chloride injection. The pH values of the solutions generally decreased during the study period.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cefoxitin sodium compatibility with intravenous infusions and additives.

The compatibility and stability of cefoxitin sodium in solution with a series of frequently used intravenous infusion fluids and injectable additives were studied. Cefoxitin sodium's stability in various solutions was measured by ultraviolet spectrophotometry, iodometry, thin-layer chromatography, high-pressure liquid chromatography, ion-exchange chromatography and microbiological assay. Cefoxitin sodium was shown to maintain 90% of its initial concentration in aqueous solution for 40 hours at room temperature (25 C) and about 30 days at 5 C. The stability of cefoxitin sodium in common i.v. infusion fluids was independent of the concentrations (1 mg/ml to 400 mg/ml) and containers used, and was retained after 30 weeks storage at -20 C. Similar stability patterns were demonstrated for cefoxitin sodium in protein hydrolysate solutions and multivitamin formulations. Cefoxitin sodium was chemically and visually compatible with amikacin sulfate, gentamicin sulfate, kanamycin sulfate and tobramycin sulfate when admixed with normal saline or 5% dextrose in water injections. Cefoxitin sodium (397 mg/ml) in 0.5% lidocaine hydrochloride was stable after 26 weeks of storage at -20 C. Sodium cefoxitin is compatible with a wide variety of commonly used infusion solutions. Its stability is independent of concentration or pH within the ranges studied, and of types of common containers.     

Oral bioavailability of pantoprazole suspended in sodium bicarbonate solution.

The bioavailability of pantoprazole when administered as a suspension in sodium bicarbonate solution and as the oral tablet was studied. In an open-label, randomized, two-period crossover study, healthy fasting subjects received either one enteric-coated 40-mg pantoprazole tablet by mouth with 240 mL of water or 20 mL of a suspension prepared from one crushed pantoprazole tablet and 840 mg of sodium bicarbonate solution and administered via a nasogastric tube. Treatments were separated by a 48-hour washout period. Blood samples were collected at intervals up to 24 hours after drug administration for measurement of pantoprazole concentration by high-performance liquid chromatography (HPLC) and estimation of pharmacokinetic values. A separate study was conducted to determine pantoprazole's stability in the suspension for up to three months at 25, 5, and -20 degrees C; concentrations were measured by HPLC. Twelve subjects completed the study. The suspension yielded pantoprazole Cmax values similar to those of the tablet formulation, but the drug was 25% less bioavailable. There was no lag time for the suspension. The suspension was stable for up to two weeks at 5 degrees C and up to three months at -20 degrees C. A suspension of pantoprazole in sodium bicarbonate solution yielded a Cmax similar to that of the tablet formulation, and the drug was quickly absorbed. However, bio-availability was slightly lower with the suspension than with the tablet.     

碳酸氢钠雾化吸入治疗支气管哮喘的疗效观察

目的观察碳酸氢钠雾化吸入在儿童支气管哮喘治疗中的作用。方法支气管哮喘急性发作患儿128例,随机分为观察组和对照组。对照组给予常规抗感染和激素、支气管扩张剂雾化吸入治疗,观察组在对照组基础上加用碳酸氢钠雾化吸入治疗。观察患儿治疗前后治疗效果以及外周血白细胞介素－6（IL-6）、白细胞介素-8（IL-8）和肿瘤坏死因子－α（TNF－α）等的水平的变化。结果观察组显效率（59．4％）和总有效率（95．3％）均优于对照组（40．6％,82．8％）,差异均有统计学意义（均P〈0．05）。观察组患儿症状和体征消失时间以及平均住院时间均显著短于对照组。两组患儿治疗后IL-6、IL－8和TNF－α等的水平均较治疗前显著降低,观察组降低更为显著,差异均有统计学意义（均P〈0．05）。结论碳酸氢钠雾化吸入治疗支气管哮喘可显著改善患儿症状和体征、缩短病程,并降低炎性因子的水平。     

Effects of tromethamine and sodium bicarbonate buffers during cardiac resuscitation

The effects on cardiac resuscitability of iso-osmolal solutions of tris-hydroxymethyl-aminomethane (tromethamine), sodium bicarbonate (NaHCO3) and sodium chloride placebo were compared in 30 domestic pigs using a well-established model of electrically induced cardiac arrest and resuscitation. We hypothesized that a carbon dioxide (CO2) consuming buffer like tromethamine would reduce and sodium bicarbonate would increase the respiratory acidosis of mixed venous blood, which had recently been demonstrated in our laboratory, Tromethamine did decrease and sodium bicarbonate did increase both arterial and mixed venous CO2 during cardiopulmonary resuscitation (CPR). Both concentrations of end-tidal CO2 and coronary venous PCO2 were significantly lower after tromethamine than after bicarbonate. However, tromethamine produced an unexpected vasodilator effect with reduction of mean aortic and coronary perfusion pressures to levels that are known to reduce resuscitability and survival independently of its buffer action. Neither resuscitability nor survival was altered by bicarbonate therapy in comparison with sodium chloride placebo.