With an increase in illicit drug use in North America, more fetuses are exposed to cocaine, cannabinoids, alcohol, cigarettes, and opioids. Whereas the adverse fetal effects of some agents have been established (for example, ethanol), those of other compounds are still controversial (for example, cocaine, THC). Two important trends may hamper our understanding of the potential reproductive risks of recreational drugs: 1. The clustering of many other risk factors in the same women. 2. A tendency to publish studies showing adverse reproductive fetal effects while discouraging reports of no effects by drugs and chemicals. Although short-term research has addressed some of the immediate postnatal physical and behavioral performance of these babies, much more work is needed to address the difficult questions of long-term neurobehavioral outcome in babies exposed to recreational drug abuse in utero.

Female↗

PubMed1990

Distribution of saline following acute volume loading: postural effects.

The influence of posture on the transvascular partitioning of an acute isotonic saline load was studied in a large number of functionally nephrectomized anaesthetized dogs. In 10 supine dogs given Ringer's-lactate (7% body weight) over 30 min, there was significant protein efflux from the vascular space during the infusion interval accompanied by a 67% loss of infusate into the interstitial space. At the end of three hours, only 10.9% of the infusate remained within the plasma, representing 42% of the anticipated recovery. When animals were placed in their usual quadruped position, the acute saline load was accompanied by protein loss as previously, but there was in addition continuing protein loss into the interstitial space during the post-infusional period. At 3 h, only 5.1% of the infusate had been retained. Volume loading with dogs placed in the 45 degrees head-up tilt position produced zero net recovery of infusate and loss of original plasma so that at 3 h post-infusion, plasma volume had declined by 11% from control values. Tilting by itself for this time period had caused protein efflux without fluid loss. The application of lower body positive counter-pressure to dogs tilted up at 45 degrees improved the partitioning, so that instead of net loss, 13% of the expected volume remained within the vascular space. The provision of iso-oncotic colloid instead of saline prevented volume losses in supine but not tilted dogs. We conclude that the rapid infusion of isotonic solution is associated with augmented loss of protein into the interstitial space leading to diminished vascular retention of infusate.

Animals↗

PubMed1990

Vascular retention of saline following acute and subacute hemorrhage in dogs.

Acute hemorrhage is usually associated with compensatory mechanisms calculated to replenish the vascular compartment. In the present study, we studied the transvascular distribution of an isotonic saline load (7% body weight) delivered to supine anaesthetized dogs following acute (20-25 ml/kg blood removed on the morning of the study) or subacute (20-25 ml/kg blood removed 16-18 h before the study) hemorrhage. In 10 dogs subjected to subacute hemorrhage, plasma volume was unaltered from control values 3 h post-load, and 6/10 animals also lost original plasma volume. Only 5.8% of the anticipated volume was retained within the vascular space. The percentage of extracellular fluid (ECF) partitioned as plasma declined from 33 to 23% (p less than 0.05). In 6 dogs with acute hemorrhage treated the same way, plasma volume increased by 24% at 3 h post-loading and 59.8% of the available volume now remained intravascularly. The percentage of ECF partitioned as plasma declined from 30 to 26%, a change of only 13% compared to a decline of 30% observed for the subacute group. We conclude that a delay in replenishing the ECF following hemorrhage may profoundly alter the volume of infused isotonic saline retained within the vascular compartment.

Animals↗

PubMed1990

Vancomycin-induced red man syndrome.

A total of 11 cases of red man syndrome collected among 650 children who had received vancomycin in our hospital between 1986 and 1988 (estimated prevalence 1.6%) were retrospectively analyzed. These 11 children were compared with 11 age-matched children who received vancomycin in whom red man syndrome did not develop. Of the patients with red man syndrome, 73%, and of the patients with no reaction, 45.4% received vancomycin for penicillin-resistant Staphylococcus epidermidis-positive cultures, or because of history of penicillin allergy. No difference was observed in the dose per kilogram given to both groups (12.9 +/- 3.5 mg/kg per dose in those with red man syndrome vs 12.3 +/- 6.9 mg/kg per dose in control children. The duration (mean +/- standard deviation) of vancomycin infusion was 45.9 +/- 16.7 minutes (range 10 to 90 minutes) in patients with red man syndrome and 54.5 +/- 7.6 minutes (range 45 to 65 minutes) in the control group (P = .07). In the 5 children with red man syndrome rechallenged with vancomycin, slower infusion rates prevented or reduced the syndrome, which emphasized the fact that the rate of administration is the important determinant of red man syndrome in susceptible cases. Clinically, the syndrome developed at the end of the infusion in most patients, but appeared as early as 15 minutes after initiation of the infusion. It was mostly manifested as a flushed, erythematous rash on the face, neck, and around the ears. Less frequently, the rash was distributed all over the body. Pruritus was usually localized to the upper trunk but was also generalized (2 of 11 children).(ABSTRACT TRUNCATED AT 250 WORDS)

Body Weight↗

PubMed1990

Comparison of the effects of an isosmolar and hyperosmolar oral rehydrating solution on the hydration status, glycemia and ileal content composition of healthy neonatal calves.

Isosmolar oral rehydrating solutions (ORS) used to treat diarrheic calves are low in energy. In contrast, hyperosmolar ORS may have a dehydrating effect. This study was designed to compare the net water and glucose absorption from the small intestine of normal calves given isosmolar or hyperosmolar ORS. Six calves were used for the experiment. A reentrant ileal cannula was implanted surgically. Each calf was fed with either the isosmolar or the hyperosmolar solution. The next day, the second solution was given. Both contained chromium EDTA as a nonabsorbable marker. Changes in the hematocrit, total plasma protein, plasma osmolality, plasma glucose concentration, and ileal volume, osmolality, glucose content, and chromium concentration were monitored for 10 hours. The only statistically significant difference was in the post-feeding plasma glucose level: it peaked at the higher level (p less than 0.05) in calves fed the hyperosmolar solution. In normal calves, the hyperosmolar ORS had no effect on the hydration or on the small intestinal fluid composition.

Animals↗

PubMed1990

Methodological issues in studying the effect of the new oral chelator 1,2-dimethyl-3-hydroxypyrid-4-one (L1) on absorption of iron.

Although deferoxamine is currently the drug of choice for iron chelation, there is more and more evidence of its toxicity. As a replacement for deferoxamine, 1,2-dimethyl-3-hydroxypyrid-4-one (L1), a new oral iron chelator, is undergoing clinical studies in thalassemic patients. Iron handling in experimental acute iron intoxication is being studied in a multiphase study. Preliminary results suggest that the L1-iron complex is not absorbed from the gastrointestinal tract. Methodological issues in studying iron chelation in the context of acute iron intoxication are presented.

Administration, Oral↗

PubMed1990

Home-based palliative care for children--Part 1: The institution of a program.

To assess the necessity and feasibility of introducing a home-based palliative care program for children admitted to our neurosurgical unit and diagnosed as being terminally ill, we conducted an analysis of all such patients admitted to our unit over an 18-month period. Of a total of 30 patients, 22 (73.4%) had central nervous system tumors, 6 (20.0%) had myelomeningocele/hydrocephalus, and 2 (6.6%) had arteriovenous malformations. The mean duration +/- SEM of hospitalized days prior to death and the proportion of time spent hospitalized during the terminal phase of illness were 28.8 +/- 4.77 and 0.327 respectively, for the 23 patients who died and on whom adequate data were available. Sixteen (70.6%) of these 23 patients died in hospital. Nine (30.0%) of the total group of patients were studied prospectively during the last 6 months of this study to determine the extent of their symptoms and to ascertain whether it would be feasible for them to be managed at home. The most troublesome symptoms in this subgroup were feeding difficulties, gastrointestinal symptoms, breathing difficulty, and seizures. These symptoms were managed either by (a) medications administered orally or by feeding tube or rectally, or by (b) noninvasive procedures carried out by a nurse under the direction of the admitting neurosurgeon. This study suggests that prolonged hospitalization for children diagnosed as being terminally ill can be avoided by introducing a home-based palliative program with involvement from a nurse and a physician familiar with drug therapy for terminally ill children.

Adolescent↗

PubMed1990

Dietary assessment instruments for preschool children: reliability of parental responses to the 24-hour recall and a food frequency questionnaire.

Nutrient intakes of preschool-age children were assessed with a 24-hour dietary recall and a 3-month food frequency questionnaire (FFQ). Parents of 55 preschoolers (mean age = 4.25 +/- 0.59 years) completed the recall and FFQ on two occasions 1 week apart. The recalls and FFQs were analyzed for energy, cholesterol, protein, total carbohydrate, calcium, sodium, potassium, and saturated, polyunsaturated, and monounsaturated fats; each nutrient was expressed as raw value, value per kg body weight, and value per 1,000 kcal. Test-retest reliability estimates for the 24-hour recall indicated significant variability in reported total energy intake, but stable reports of intake were observed for one or all units of expression for polyunsaturated fats, cholesterol, protein, total carbohydrate, calcium, and potassium. The FFQ showed significant positive test-retest reliability estimates for all nutrients for all units of expression. Comparison of the recall and FFQ data showed similar percentages of intakes of energy from fat, carbohydrate, and protein and significant correlations for reported intakes of cholesterol, protein, calcium, and potassium. Comparison of the recall and FFQ data with recall data from a comparable cohort showed lower reported intakes for our sample, with the exception of protein, carbohydrate, calcium, and potassium. If validation studies are successful, the FFQ may be useful in epidemiological studies of preschoolers' intakes over extended periods. The recall may prove to be a useful tool in the assessment of day-to-day variations in macronutrient intakes.

Calcium, Dietary↗

PubMed1989