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Biomedical subjects

J F Dasta

Publications and source records attributed to J F Dasta.

69 records · Page 4Linked to original sources
PubMed1981

Diazepam infusion in tetanus: correlation of drug levels with effect.

A patient with muscle spasms and rigidity associated with tetanus was successfully treated with a continuous infusion of diazepam. This beneficial response was associated with a minimal serum diazepam concentration of 500 ng/ml. The major metabolite of diazepam, DMD, did not appear to exert substantial activity. Guidelines for dosing diazepam are provided.

Adult↗
PubMed1979

Isoniazid-induced fever.

A 56-year-old man was started on therapy with isoniazid after exhibiting a positive reaction to an intradermal injection of intermediate-strength purified protein derivative of tuberculin. After the first dose and each of the following three doses, nausea, vomiting, chills, and an elevated body temperature ranging from 38 degrees C (100.4 degrees F) to 40 degrees C (104. degrees F) occurred. There was no evidence of a hypersensitivity reaction to isoniazid, such as cutaneous rash, eosinophilia, elevated concentration of IgE, and abnormal results on tests of hepatic function. Following discontinuance of therapy with isoniazid, the temperature returned to normal. This experience illustrates the potential of isoniazid to cause febrile reactions, a situation that could be misdiagnosed as an infectious process.

Carcinoma, Squamous Cell↗
PubMed1978

Paraquat poisoning: a review.

The pathophysiology, symptoms and treatment of paraquat intoxication, primarily from oral ingestion, and the pharmacology and pharmacokinetics of paraquat are reviewed. Toxicity has occurred after topical application, oral ingestion or inhalation of paraquat. Systemic toxicity has not been reported from smoking of paraquat-contaminated marijuana but heavy abusers of contaminated marijuana may experience coughing, hemoptysis and mouth irritation. Following ingestion of 30 mg/kg or 50 ml of a 21% (w/w) solution of paraquat (as the base), hepatic, cardiac or renal failure or death may occur. Smaller doses (greater than or equal to 4 mg/kg of paraquat base) may cause respiratory distress, renal dysfunction or, occasionally, jaundice or adrenal cortical necrosis. When paraquat ingestion is suspected, the drug should be removed immediately from the gastrointestinal tract by gastric lavage or by whole-gut irrigation. Adsorbents such as Fuller's earth, bentonite or activated charcoal may be used during gastric lavage. Combined use of forced diuresis (with furosemide, mannitol and i.v. dextrose in water or normal saline), hemodialysis or hemoperfusion is recommended until the compound cannot be detected in body fluids or the dialysate. Immediate and effective treatment is necessary to prevent systemic toxicity or death from paraquat intoxication.

Cannabis↗
PubMedDate not supplied

Pharmacology and therapeutic use of low-dose dopamine.

The renal pharmacologic effects of intravenous dopamine in doses of 0.5-3.0 micrograms/kg/min include increases in renal blood flow, glomerular filtration rate, solute excretion, and urine flow. Clinical studies revealed that low-dose dopamine can reverse oliguria, but these studies were poorly controlled, were confounded by the use of other diuretics, had small patient populations, and often did not evaluate mortality or long-term renal function. When used in low doses, side effects are rarely seen. Because of dopamine's effect on hepatic and renal function, changes in drug clearance may occur. Low-dose dopamine may be considered in the early course of oliguric patients; however, specific advantages over other diuretic therapy have not been established.

Anuria↗
PubMedDate not supplied

Effect of haloperidol on dopamine-induced increase in renal blood flow.

Increasing renal blood flow (RBF) by the administration of low-dose dopamine is one mechanism to increase urine output in oliguric patients. This response is mediated in part by stimulation of dopaminergic receptors in the kidney, which could be attenuated by the dopamine blocker haloperidol. We evaluated this interaction by administering both drugs in clinically used doses to six anesthetized mongrel dogs. A dopamine regimen of 2.5 micrograms/kg/min significantly increased RBF along with cardiac output and stroke volume. Simultaneous administration of haloperidol 50 micrograms/kg iv did not influence the ability of low-dose dopamine to increase RBF. Although haloperidol is an antagonist of dopaminergic receptors, the increase in RBF associated with low-dose dopamine is maintained when intravenous haloperidol is concurrently administered to dogs.

Animals↗
PubMedDate not supplied

Serum aldosterone concentrations and urine output in oliguric intensive care unit patients receiving low-dose dopamine.

OBJECTIVE: To determine whether the diuretic and natriuretic effects of low-dose dopamine (2.5 micrograms/kg/min) are associated with changes in serum aldosterone concentration. DESIGN: Prospective clinical study. SETTING: Surgical intensive care unit (SICU) of a university hospital. PARTICIPANTS: Oliguric (urine output < 0.5 mL/kg/h) SICU patients. All patients were resuscitated to pulmonary artery occlusion pressure > 10 mm Hg, mean arterial pressure > 65 mm Hg, and cardiac index > 2.5 L/min/m2. Patients with a serum creatinine concentration > 176.8 mumol/L (2.0 mg/dL), those who received diuretics within 12 hours prior to entry into the study, and renal transplant recipients were excluded. MAIN OUTCOME MEASURES: Hourly urine output (mean +/- SD) was recorded 2 hours before and for 6 hours after the initiation of low-dose dopamine. Urine sodium and serum aldosterone concentrations were obtained prior to and 6 hours after the start of low-dose dopamine. RESULTS: Fifteen patients were enrolled in the study. Urine output (mean +/- SD) increased from 0.31 +/- 0.11 mL/kg/h before to 0.80 +/- 0.34 mL/kg/h following low-dose dopamine (p < 0.01). Urine sodium concentrations increased from 46 +/- 32 mmol/L baseline to 72 +/- 53 mmol/L following low-dose dopamine (p < 0.05), and serum aldosterone concentrations decreased from 415.82 +/- 341.48 pmol/L prior to low-dose dopamine infusion to 256.04 +/- 204.17 pmol/L (p < 0.05). Cardiac output, pulmonary artery occlusion pressure, mean arterial pressure, and heart rate did not change. CONCLUSIONS: Low-dose dopamine significantly increases urine output and urine sodium excretion in oliguric, critically ill, surgical patients, and is associated with a decrease in serum aldosterone concentration. The diuretic and natriuretic effects of low-dose dopamine may be, in part, related to a dopamine-mediated inhibition of aldosterone secretion.

Adult↗
PubMedDate not supplied

Defining and achieving optimum therapeutic goals in critically ill patients.

Patients who are critically ill with sepsis, shock, respiratory failure, trauma, or major surgical procedures may have reduced morbidity and mortality when hemodynamic and oxygen transport variables are augmented to values higher than those traditionally considered normal. Lactate production and suboptimum oxygen transport values are associated with anaerobic metabolism and insufficient tissue oxygenation. Since lactate can be a marker of inadequate tissue oxygenation, serial lactate measurements may be useful in individualizing therapy to reverse tissue hypoxia. Optimum hemodynamic and oxygen transport values are highly individual, and no accepted method has been established for guiding therapy. These values, together with plasma lactate concentrations, may assist in individualizing therapy in critically ill patients. No consensus can be reached at this time as to which specific therapeutic end points are optimal, how to achieve these end points, and which subset of patients will benefit from this therapy.

Bacterial Infections↗