Role of muscle in CO2 production after oral glucose administration in man

A significant increase in CO2 production, reflecting carbohydrate oxidation and/or fat synthesis, is observed in normal subjects after the ingestion of glucose. The anatomic site(s) of this CO2 production has not yet been localized, although liver and muscle are logical considerations. To assess the contribution of skeletal muscle to this process, we measured whole-body and forearm CO2 flux in normal, postabsorptive subjects after the ingestion of 100 g of glucose and calculated their total muscle CO2 production. In the basal state, muscle accounted for 19% of total CO2 production, and, after glucose administration, muscle CO2 production did not change significantly. Thus, muscle is not the principal site of the observed increase in CO2 production.     

Blood glucose response after oral lactulose intake in type 2 diabetic individuals

BACKGROUNDLactulose is approved for the symptomatic treatment of constipation, a gastrointestinal (GI) complication common in individuals with diabetes. Lactulose products contain carbohydrate impurities (e.g., lactose, fructose, galactose), which occur during the lactulose manufacturing process. These impurities may affect the blood glucose levels of individuals with type 2 diabetes mellitus (T2DM) using lactulose for the treatment of mild constipation. A previous study in healthy subjects revealed no increase in blood glucose levels after oral lactulose intake. However, it is still unclear whether the intake of lactulose increases blood glucose levels in individuals with diabetes.AIMTo evaluate the blood glucose profile after oral lactulose intake in mildly constipated, non-insulin-dependent subjects with T2DM in an outpatient setting.METHODSThis prospective, double-blind, randomized, controlled, single-center trial was conducted at the Clinical Research Center at the Medical University of Graz, Austria, in 24 adult Caucasian mildly constipated, non-insulin-dependent subjects with T2DM. Eligible subjects were randomized and assigned to one of six treatment sequences, each consisting of four treatments stratified by sex using an incomplete block design. Subjects received a single dose of 20 g or 30 g lactulose (crystal and liquid formulation), water as negative control or 30 g glucose as positive control. Capillary blood glucose concentrations were measured over a period of 180 min post dose. The primary endpoint was the baseline-corrected area under the curve of blood glucose concentrations over the complete assessment period [AUC_{baseline_c (0-180 min)}]. Quantitative comparisons were performed for both lactulose doses and formulations vs water for the equal lactulose dose vs glucose, as well as for liquid lactulose vs crystal lactulose. Safety parameters included GI tolerability, which was assessed at 180 min and 24 h post dose, and adverse events occurring up to 24 h post dose.RESULTSIn 24 randomized and analyzed subjects blood glucose concentration-time curves after intake of 20 g and 30 g lactulose were almost identical to those after water intake for both lactulose formulations despite the different amounts of carbohydrate impurities (≤ 3.0% for crystals and approx. 30% for liquid). The primary endpoint [AUC_{baseline_c (0-180 min)}] was not significantly different between lactulose and water regardless of lactulose dose and formulation. Also with regard to all secondary endpoints lactulose formulations showed comparable results to water with one exception concerning maximum glucose level. A minor increase in maximum blood glucose was observed after the 30 g dose, liquid lactulose, in comparison to water with a mean treatment difference of 0.63 mmol/L (95% confidence intervals: 0.19, 1.07). Intake of 30 g glucose significantly increased all blood glucose endpoints vs 30 g liquid and crystal lactulose, respectively (all P < 0.0001). No differences in blood glucose response were observed between the different lactulose formulations. As expected, lactulose increased the number of bowel movements and was generally well tolerated. Subjects experienced only mild to moderate GI symptoms due to the laxative action of lactulose.CONCLUSIONBlood glucose AUC_{baseline_c (0-180 min)} levels in mildly constipated, non-insulin dependent subjects with T2DM are not affected by the carbohydrate impurities contained in 20 g and 30 g crystal or liquid lactulose formulations.     

非糖尿病终末期肾病患者血液透析期间血糖变化

目的 探讨非糖尿病终末期肾病患者血液透析过程中血糖变化并分析其原因.方法 选取我院非糖尿病终末期肾病血液透析患者20例,其中非进食组11例,进食组9例(于透析1.5～2h进食).测定患者血液透析0、0.5、1.0、2.0、4.Oh时血糖浓度.收集患者透析废液,检测其中葡萄糖含量.结果 20例患者均未出现低血糖反应,其中非进食组2例患者出现无症状低血糖.进食组血糖呈逐渐增高趋势,而非进食组血糖呈逐渐降低趋势.进食组透析废液中葡萄糖丢失量为(17.70±6.33)g,非进食组透析废液葡萄糖丢失量为(15.43±8.52)g,两组比较差异无统计学意义.结论 非糖尿病肾病血液透析期间有低血糖发生风险,血液透析中葡萄糖丢失是其主要原因,建议非糖尿肾病血液透析患者使用含糖透析液,以减少低血糖发生风险.     

普萘洛尔治疗婴儿血管瘤的护理

目的 探讨普萘洛尔治疗婴儿血管瘤的效果及护理.方法 对8例血管瘤婴儿采用普萘洛尔口服治疗,服药期间观察药物不良反应并进行对症支持治疗护理.结果 仅2例心率略有减慢,其余未发现严重的不良反应.服药24 h,所有婴儿瘤体张力均有不同程度减小,颜色开始变淡,服药5～7 d瘤体变化最显著.结论 口服小剂量普萘洛尔治疗婴幼儿血管...     

Blood glucose level as an aid in the diagnosis of septicaemia

Although burn wound sepsis is primarily managed with topical antibacterials and excision-débridement of necrotic tissue, true septicaemia with bloodstream invasion requires systemic antibiotics. Multiple and broad spectrum antibiotics have been associated with fungal infection and emergence of resistant organisms in the burned patient. Therefore, it is beneficial to use a specific bactericidal drug whenever possible.In a series of 214 patients with septicaemia, the mean glucose level in patients with Gram-positive organisms was 165 mg per cent compared to 101 mg per cent for patients with Gram-negative organisms. In non-diabetic patients, the difference was also marked-138 mg per cent in the Gram-positive septicaemias and 97·5 mg per cent in the Gram-negative septicaemias. Of all the patients with septicaemia having a blood glucose of <110 mg per cent, over 80 per cent showed Gram-negative organisms in their blood cultures. Of all those whose blood glucose concentration was > 130 mg per cent, over 80 per cent showed Gram-positive organisms in the cultures.For the past three years, blood glucose levels have been drawn each time the patient's temperature is greater than 38·5 °C (101·3 °F) at the time blood cultures were drawn. This has allowed the burn team to gain additional information prior to culture results. Using these guidelines, the blood glucose level has predicted the type of organism in 4 out of 5 of cases of septicaemia. Therefore, if the diagnosis of septicaemia is made and antibiotics are felt indicated, a Gram-negative bactericidal antimicrobial is administered if the glucose is < 110 mg per cent until blood culture results are available. If the glucose is > 130 mg per cent, a Gram-positive bactericidal antimicrobial agent is instituted. This has allowed us to decrease the number of antibiotics used and to decrease the spectrum of antimicrobials in our facility.     

The metabolic effects of oral L-carnitine administration in infants receiving total parenteral nutrition with fat

beta-Oxidation, an important pathway in the metabolism of free fatty acids, occurs within the mitochondria in mammals. L-Carnitine is an essential cofactor in the transfer of long-chain fatty acids across the inner mitochondrial membrane. Maintenance of normal carnitine concentrations in whole blood and tissues, either through diet or biosynthesis, would appear necessary for adequate utilization of fat as an energy source. Infants, especially premature ones, without an exogenous dietary source of carnitine, have decreased plasma carnitine levels compared with infants receiving carnitine-supplemented feedings. To determine the importance of carnitine supplementation in a total parenteral nutrition program in infants in which a fat emulsion serves as a major calorie source, the following study was undertaken. Twelve infants receiving total parenteral nutrition (TPN) with fat for seven days were divided into two treatment groups. Group 1 was orally supplemented for seven days with carnitine (70 mumol/l/kg/24 h in 24 mL of 5% dextrose), while the second group received seven days of placebo supplementation (dextrose 5%, 24 cc/24 h). Plasma carnitine levels in the carnitine-supplemented group were significantly higher (29 +/- 8 nmol/mL) than in the control group (12.4 +/- 3.5 nmol/mL) after seven days of treatment. However, clearance of serum triglycerides and free fatty acids was not significantly different between the two groups. Baseline triglyceride levels in the carnitine-supplemented group were 96 +/- 42 mg/dL, increased to 242 +/- 101 mg/dL after the lipid challenge and decreased to 121 +/- 47 mg/dL two hours after the lipid infusion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Efficacy of erythropoietin administration in the treatment of anemia immediately after renal transplantation

Anemia negatively impacts cardiovascular comorbidity and hospitalization. In animals, recombinant erythropoietin (RhuEPO) leads to faster recovery after acute tubular necrosis. This study evaluates the effect of RhuEPO (Recormon, Hoffman-La Roche, Basel, Switzerland) on the correction of anemia and kidney function after renal transplantation. Patients receiving a renal transplant were randomized to receive or not receive RhuEPO 100 U/kg three times per week if the hemoglobin (Hb) level was less than 12.5 g/dL. The time to reach an Hb level greater than 12.5 g/dL was 66.5+/-14.5 days versus 52.6+/-23.7 days in the non-EPO and EPO groups, respectively (P=0.05). After 3 months, Hb levels were not different between the non-EPO and EPO groups (12.6+/-1.5 g/dL vs. 12.0+/-1.5 g/dL, respectively), although there was a higher increase in the EPO group (4.1+/-1.1 g/dL vs. 3.2+/-1.1 g/dL, P=0.02). In a Cox regression analysis, EPO use (relative risk 7.2, P=0.004) and dose (relative risk=0.63, P=0.04) were retained as independent variables predicting the time to reach an Hb level greater than 12.5 g/dL. In the EPO group, 14 of 22 patients reached the target Hb level of more than 12.5 g/dL versus 12 of 18 patients in the non-EPO group (P=not significant). Serum creatinine levels were not different between groups. RhuEPO in the immediate posttransplantation period seems to have no relevant clinical impact on the correction of anemia. There was no difference in the evolution of serum creatinine levels. In view of the cost, the use of RhuEpo in the posttransplantation period should be limited to high-risk patients.     

Effects of intravenous and oral glucose administration on insulin action in human fat cells

The effects of various forms of glucose administration on insulin action were investigated in isolated human fat cells. Subcutaneous (s.c.) adipose tissue was obtained before and (1) 30 min (eight subjects) and 60 min (seven subjects) after an intravenous (i.v.) glucose load, and (2) after a 60-min continuous i.v. glucose infusion (five subjects). In addition, five subjects were reinvestigated before and 60 min after oral glucose ingestion. Lipolysis (glycerol release) and insulin receptor binding were determined. After all forms of i.v. glucose administration, adipocyte insulin binding was significantly reduced by 20% owing to a decrease in the high-affinity binding, whereas the concentrations of insulin producing the half-maximum inhibitions of basal and isoprenaline-induced rates of glycerol release were unaltered. Sixty minutes after oral glucose ingestion, insulin sensitivity increased 7-30-fold (P less than 0.05-0.01) and high-affinity insulin binding increased by 25% (P less than 0.05). The maximum insulin-induced inhibitions of basal and isoprenaline-stimulated lipolysis were not altered after oral or i.v. glucose. The plasma level of glycerol was markedly and rapidly reduced after oral glucose, but the fall was slow and less pronounced after i.v. glucose. It is concluded that oral, but not i.v., glucose administration mediates a rapid increase in the antilipolytic potency of insulin in human fat cells in vitro. This may explain why antilipolysis in vivo is more pronounced after oral than after i.v. glucose challenge.(ABSTRACT TRUNCATED AT 250 WORDS)     

Early bioavailability of paracetamol after oral or intravenous administration

BACKGROUND: Paracetamol is a peripherally acting analgesic commonly used in multimodal post-operative pain management to reduce the need for more potent analgesics with their unwanted side-effects. The dose and optimal galenical form for achieving analgesic concentrations is not well defined. The primary aim of this pilot project was to study the early bioavailability for two fixed doses of orally administrated paracetamol and one dose of intravenous propacetamol, all of which were given after minor surgery. METHODS: Thirty-five patients undergoing day surgery were divided into five groups, seven patients each. Groups received either 1 g of an ordinary paracetamol tablet, 2 g of an ordinary paracetamol tablet, 1 g of a bicarbonate paracetamol tablet, 2 g of a bicarbonate paracetamol tablet or 2 g intravenously of prodrug propacetamol. We studied the plasma concentration of paracetamol during the first 80 min after administration. RESULTS: Within 40 min, intravenous propacetamol gave a median plasma paracetamol concentration of 85 micromol/l (range 65-161) and decreased thereafter. After oral administration, median plasma paracetamol concentration increased with increasing dose and time, but there were huge inter-individual differences at all time points studied. At 80 min after oral paracetamol the median plasma concentrations were 36 and 129 micromol/l for the 1- and 2-g groups, respectively, with an overall range between 0 and 306 micromol/l. CONCLUSION: Oral administration of paracetamol as part of multimodal pain management immediately post-operatively resulted in a huge and unpredictable variation in plasma concentration compared with the intravenous administration.     

Ofloxacin concentration in human benign prostatic tissue after oral administration

The penetration of ofloxacin (OFLX) into prostatic tissue was examined on 11 patients with benign prostatic hypertrophy. OFLX was administered orally in a dose of 200 mg, three times one day before and twice on the day of operation. The blood sample was taken 30 minutes before operation and prostatic tissue specimens were collected during operation. The mean concentration of OFLX in prostatic tissue was 5.51 +/- 1.79 micrograms/g (mean +/- SD) and 5.36 +/- 1.28 micrograms/ml in serum. The mean ratio of these concentrations was 1.06 +/- 0.31 (range 0.55-1.54). These findings indicate that OFLX will be valuable against bacterial prostatitis.