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JPEN. Journal of Parenteral and Enteral... May 2023Drug administration through feeding tubes presents many challenges to the healthcare provider. There is little information available on medications than can be delivered... (Review)
Review
BACKGROUND
Drug administration through feeding tubes presents many challenges to the healthcare provider. There is little information available on medications than can be delivered safely when crushed and what efforts can be implemented to minimize clogging the feeding tube. Our institution requested a comprehensive examination of all oral medications for the feeding tube route.
METHODS
This report is a synopsis of the physical evaluation of 323 different oral medications for their appropriateness for feeding tube administration with distal site in either the stomach or jejunum. A worksheet was created for each medication. This document contained a review of the chemical and physical properties that would contribute to delivery of the medication. Each medication was then studied for the degree of disintegration, pH, osmolality, and potential to form clogs. For drugs that needed to be crushed, the volume of water needed to dissolve the drug, time for that process, and volume needed to rinse the tube after administration was also studied.
RESULTS
The results of this review are summarized in a table and based on a composite of the documents cited, tests conducted, and author's judgements based all the data collected. Thirty-six medications were identified as inappropriate for feeding tube administration, and an additional 46 medications were identified as inappropriate for direct jejunal administration.
CONCLUSION
The information produced by this study will enable clinicians to make informed choices in selecting, compounding, and rinsing medications through feeding tubes. Using the template provided, they will be able to evaluate a drug not studied here for potential issues in feeding tube administration.
Topics: Humans; Enteral Nutrition; Intubation, Gastrointestinal; Pharmaceutical Preparations; Osmolar Concentration; Health Personnel; Administration, Oral
PubMed: 36847617
DOI: 10.1002/jpen.2490 -
The Korean Journal of Internal Medicine May 2023Hypernatremia is an occasionally encountered electrolyte disorder, which may lead to fatal consequences under improper management. Hypernatremia is a disorder of the... (Review)
Review
Hypernatremia is an occasionally encountered electrolyte disorder, which may lead to fatal consequences under improper management. Hypernatremia is a disorder of the homeostatic status regarding body water and sodium contents. This imbalance is the basis for the diagnostic approach to hypernatremia. We summarize the eight diagnostic steps of the traditional approach and introduce new biomarkers: exclude pseudohypernatremia, confirm glucose-corrected sodium concentrations, determine the extracellular volume status, measure urine sodium levels, measure urine volume and osmolality, check ongoing urinary electrolyte free water clearance, determine arginine vasopressin/copeptin levels, and assess other electrolyte disorders. Moreover, we suggest six steps to manage hypernatremia by replacing water deficits, ongoing water losses, and insensible water losses: identify underlying causes, distinguish between acute and chronic hypernatremia, determine the amount and rate of water administration, select the type of replacement solution, adjust the treatment schedule, and consider additional therapy for diabetes insipidus. Physicians may apply some of these steps to all patients with hypernatremia, and can also adapt the regimens for specific causes or situations.
Topics: Humans; Adult; Hypernatremia; Sodium; Osmolar Concentration; Body Water; Water
PubMed: 36578134
DOI: 10.3904/kjim.2022.346 -
Advances in Physiology Education Dec 2018Understanding osmolarity and tonicity is one of the more challenging endeavors undertaken by students of the natural sciences. We asked students who completed a course...
Understanding osmolarity and tonicity is one of the more challenging endeavors undertaken by students of the natural sciences. We asked students who completed a course in animal physiology to submit an essay explaining what they found most perplexing about this subject, and what in-class activities proved most useful to them. Students had difficulty distinguishing osmolarity from tonicity and determining tonicity based on the solution's composition. The most useful activities were questions requiring simultaneous consideration of both osmolarity and tonicity. Problems that require calculating osmotic concentration and the volumes of body fluid compartments after administration or loss of various solutions emphasize the significance of osmolarity and tonicity in the context of systemic homeostasis and clinical medicine. We hope that our approach to teaching osmolarity and tonicity will prove useful to physiology lecturers who are looking for new ways of introducing this complicated topic to their health professions students.
Topics: Animals; Cell Size; Humans; Learning; Osmolar Concentration; Osmosis; Physiology; Students, Health Occupations; Teaching
PubMed: 30303411
DOI: 10.1152/advan.00094.2018 -
Clinical Chemistry and Laboratory... Jul 2023Detection of hemoglobin (Hb) and red blood cells in urine (hematuria) is characterized by a large number of pitfalls. Clinicians and laboratory specialists must be... (Review)
Review
Detection of hemoglobin (Hb) and red blood cells in urine (hematuria) is characterized by a large number of pitfalls. Clinicians and laboratory specialists must be aware of these pitfalls since they often lead to medical overconsumption or incorrect diagnosis. Pre-analytical issues (use of vacuum tubes or urine tubes containing preservatives) can affect test results. In routine clinical laboratories, hematuria can be assayed using either chemical (test strips) or particle-counting techniques. In cases of doubtful results, Munchausen syndrome or adulteration of the urine specimen should be excluded. Pigmenturia (caused by the presence of dyes, urinary metabolites such as porphyrins and homogentisic acid, and certain drugs in the urine) can be easily confused with hematuria. The peroxidase activity (test strip) can be positively affected by the presence of non-Hb peroxidases (e.g. myoglobin, semen peroxidases, bacterial, and vegetable peroxidases). Urinary pH, haptoglobin concentration, and urine osmolality may affect specific peroxidase activity. The implementation of expert systems may be helpful in detecting preanalytical and analytical errors in the assessment of hematuria. Correcting for dilution using osmolality, density, or conductivity may be useful for heavily concentrated or diluted urine samples.
Topics: Humans; Hematuria; Peroxidase; Hemoglobins; Erythrocytes; Osmolar Concentration
PubMed: 37079906
DOI: 10.1515/cclm-2023-0260 -
Clinical & Experimental Optometry Jan 2012The tear film is a nourishing, lubricating and protecting layer that bathes the ocular surface. It is continuously replenished through cycles of production and... (Review)
Review
The tear film is a nourishing, lubricating and protecting layer that bathes the ocular surface. It is continuously replenished through cycles of production and elimination via evaporation, absorption and drainage. These processes are often referred to as tear film dynamics. Osmolality is an objective clinical measurement that provides insight into the balance of these complex tear film dynamics. Balanced tear production and elimination is vital for tear film integrity, stability and normal osmolality. Imbalances cause alterations of the tear film structure and composition, ultimately leading to tear film instability and measurable tear film hyperosmolality. Elevated tear film osmolality is considered a core mechanism in dry eye, forming the basis of dry eye symptoms and leading to ocular surface damage. Despite its immense potential in the diagnosis of dry eye, tear film osmolality is not commonly assessed. This review will focus on the current knowledge of tear film dynamics and tear film osmolality.
Topics: Dry Eye Syndromes; Humans; Osmolar Concentration; Tears
PubMed: 22022802
DOI: 10.1111/j.1444-0938.2011.00634.x -
Physiology & Behavior Dec 2015Regulation of appropriate osmolality of body fluid is critical for survival, yet there are sex differences in compensatory responses to osmotic challenges. Few studies... (Review)
Review
Regulation of appropriate osmolality of body fluid is critical for survival, yet there are sex differences in compensatory responses to osmotic challenges. Few studies have focused on the role of sex hormones such as estradiol in behavioral responses to increases or decreases in systemic osmolality, and even fewer studies have investigated whether central actions of estrogens contribute to these responses. This overview integrates findings from a series of ongoing and completed experiments conducted in my laboratory to assess estradiol effects on water and NaCl intake in response to osmotic challenges, and on activity in central pathways that mediate such responses.
Topics: Animals; Brain; Drinking; Eating; Estradiol; Humans; Osmolar Concentration; Sodium, Dietary
PubMed: 26074202
DOI: 10.1016/j.physbeh.2015.06.017 -
Andrology Jan 2022Terminally differentiated mammalian sperm are exposed to gradients of viscosity, pH, and osmolality both in the male and female reproductive tract during their perilous... (Review)
Review
BACKGROUND
Terminally differentiated mammalian sperm are exposed to gradients of viscosity, pH, and osmolality both in the male and female reproductive tract during their perilous journey to quest the ovum. The complex physicochemical factors play an integral role in preparing sperm for the fertilization process.
OBJECTIVES
To elucidate the influence of the reproductive tract microenvironment especially viscosity, pH, and osmolality in regulating sperm functional and fertilization competence.
MATERIALS AND METHODS
The data used in this review were collected from the research papers and online databases focusing on the influence of viscosity, pH, and osmolality on sperm function.
DISCUSSION
The gradients of viscosity, pH, and osmolality exist across various segments of the male and female reproductive tract. The changes in the viscosity create a physical barrier, pH aid in capacitation and hyperactivation, and the osmotic stress selects a progressive sperm subpopulation for accomplishing fertilization. The sperm function tests are developed based on the concept that the male genotype is the major contributor to the reproductive outcome. However, recent studies demonstrate the significance of sperm genotype-environment interactions that are essentially contributing to reproductive success. Hence, it is imperative to assess the impact of physicochemical stresses and the adaptive ability of the terminally differentiated sperm, which in turn would improve the outcome of the assisted reproductive technologies and male fertility assessment.
CONCLUSION
Elucidating the influence of the reproductive tract microenvironment on sperm function provides newer insights into the procedures that need to be adopted for selecting fertile males for breeding, and ejaculates for the assisted reproductive technologies.
Topics: Animals; Cellular Microenvironment; Female; Fertility; Genitalia; Humans; Hydrogen-Ion Concentration; Male; Osmolar Concentration; Sperm-Ovum Interactions; Spermatozoa; Viscosity
PubMed: 34420258
DOI: 10.1111/andr.13102 -
The Journal of Physiology Dec 19741. The effects of 0.45% saline infusions into the portal vein of conscious and anaesthetized dogs have been compared with similar infusions through a systemic vein.2....
1. The effects of 0.45% saline infusions into the portal vein of conscious and anaesthetized dogs have been compared with similar infusions through a systemic vein.2. Measurements were made of plasma and urinary osmolality, sodium, potassium and chloride concentrations and urine flows; osmolal clearances, free water clearances, the percentage of the infused loads excreted at given times, and rates of sodium and potassium excretion in the urine, were calculated.3. In the conscious and anaesthetized series of experiments no significant differences were found between the portal and systemic routes of infusion.4. For both the portal and systemic routes of infusion there was a significantly smaller diuretic response to the saline infusion in anaesthetized as compared with conscious animals.5. These results do not support the concept of hepatic osmoreceptors occurring in the dog.
Topics: Animals; Chlorides; Consciousness; Diuresis; Dogs; Female; Injections, Intravenous; Liver; Osmolar Concentration; Osmotic Pressure; Portal Vein; Potassium; Sensory Receptor Cells; Sodium; Sodium Chloride; Unconsciousness
PubMed: 4449080
DOI: 10.1113/jphysiol.1974.sp010776 -
Fluids and Barriers of the CNS Jun 2022The etiology of idiopathic normal pressure hydrocephalus (iNPH) is currently unknown. With no visible obstructions, altered cerebrospinal fluid (CSF) dynamics may...
BACKGROUND
The etiology of idiopathic normal pressure hydrocephalus (iNPH) is currently unknown. With no visible obstructions, altered cerebrospinal fluid (CSF) dynamics may explain the accumulation of ventricular fluid. We hypothesized that elevated osmolality in the CSF of iNPH patients could potentiate formation of ventricular fluid and thereby cause the disease progression and/or predict the surgical outcome. To address this hypothesis, we determined the lumbar and ventricular CSF osmolality of iNPH patients at different disease stages and compared with lumbar CSF samples obtained from control subjects.
METHODS
The osmolality of CSF was determined on a total of 35 iNPH patients at diagnosis and at the subsequent treatment with shunt surgery (n = 20) and compared with the CSF osmolality from 20 control subjects. Simultaneously collected lumbar and ventricular CSF samples from experimental pigs were used to evaluate the compatibility between CSF from different compartments.
RESULTS
We found no evidence of increased osmolality in the CSF of iNPH patients upon diagnosis or at the time of shunt treatment months after the diagnosis, compared with control individuals. CSF tapped from the lumbar space could be used as a read-out for ventricular CSF osmolality, as these were similar in both the patient group and in experimental pigs. We further observed no correlation between the CSF osmolality in iNPH patients and their responsiveness to shunt surgeries.
CONCLUSIONS
The osmolality of lumbar CSF is a reliable reflection of the ventricular CSF osmolality, and is not elevated in iNPH patients. iNPH therefore does not appear to arise as a function of osmotic imbalances in the CSF system and CSF osmolality cannot serve as a biomarker for iNPH or as a predictive tool for shunt responsiveness.
Topics: Animals; Biomarkers; Cerebrospinal Fluid Shunts; Humans; Hydrocephalus, Normal Pressure; Osmolar Concentration; Swine; Treatment Outcome
PubMed: 35761330
DOI: 10.1186/s12987-022-00349-5 -
Deutsches Arzteblatt International Oct 2023Hydration disturbances are common in old age: the reported prevalence of dehydration in elderly patients ranges from 19% to 89%, depending on the definition and the... (Review)
Review
BACKGROUND
Hydration disturbances are common in old age: the reported prevalence of dehydration in elderly patients ranges from 19% to 89%, depending on the definition and the population in question. However, the clinical assessment of patients' hydration status is difficult. In this review, we discuss the diagnostic value of currently used methods that may or may not be suitable for assessing older patients' hydration status.
METHODS
We conducted a selective literature search for relevant studies concerning patients aged 65 and above. Of the 355 articles retrieved by the initial search, a multistep selection process yielded 30 that were suitable for inclusion in this review.
RESULTS
107 different methods for the diagnostic assessment of dehydration in older persons were evaluated on the basis of the reviewed publications. High diagnostic value, especially for the determination of hyperosmolar dehydration, was found for serum osmolality, serum sodium concentration, inferior vena cava ultrasonography, a history (from the patient or another informant) of not drinking between meals, and axillary dryness. On the other hand, a variety of clinical signs such as a positive skin turgor test, sunken eyes, dry mouth, tachycardia, orthostatic dysregulation, and dark urine were found to be of inadequate diagnostic value.
CONCLUSION
Only five of the 107 methods considered appear to be suitable for determining that a patient is dehydrated. Thus, the available scientific evidence indicates that all clinicians should critically reconsider their own techniques for assessing hydration status in elderly patients. To optimize the clinical assessment of patients' hydration status, there seems to be a need for the rejection of unsuitable methods in favor of either newly developed criteria or of a combination of the best criteria already in use.
Topics: Aged; Humans; Aged, 80 and over; Dehydration; Osmolar Concentration
PubMed: 37583084
DOI: 10.3238/arztebl.m2023.0182