Unexpectedly high plasma fentanyl levels after epidural use.
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Biomedical subjects
Publications and source records attributed to R A Moore.
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Cortisol to creatinine ratios in overnight urine samples, urinary glucose excretion, and plasma glucose concentrations were determined in 43 diabetic inpatients. All initially had normal cortisol to creatinine ratios (less than 55 x 10(-6)) and were initially treated by increasing their long-acting insulin component. Nine patients in whom this ratio became raised then had their long-acting insulin component reduced until their fasting plasma glucose concentration was 4-7 mol/l (72-126 mg/100 ml). The 34 patients who had never had a raised ratio were treated by increasing their long-acting insulin component until their fasting plasma glucose concentration was in the range 4-7 mmol/l. All the raised cortisol to creatinine ratios were clearly separate from the other values. A mean reduction in total insulin dose of 23% and in long-acting insulin dose of 53% was achieved, abolishing presumptive nocturnal hypoglycaemia by reducing the ratio to normal and dramatically improving diabetic control. Although there was no definite evidence that the patients who had raised cortisol to creatinine ratios had suffered from nocturnal hypoglycemia, these results strongly support the view that a raised ratio indicates an otherwise unrecognised episode of this condition.
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Antisera to buprenorphine were obtained in rabbits immunised with 3-0-carboxymethylbuprenorphine and N-hemisuccinyl-norbuprenorphine conjugated to bovine serum albumin. Using the latter antiserum and tritium labelled buprenorphine a radioimmunoassay have good accuracy and precision was developed for concentrations as low as 50 picograms in 1 ml of plasma. The N-hemisuccinyl antiserum crossreacted with norbuprenorphine, and the 3-0-glucuronide conjugate with the 3-0-carboxymethyl antiserum. Cross-reactivity of both antisera to other pharmacologically related compounds was negligible. The assay was employed to determine plasma buprenorphine concentration following its parenteral administration to dog and man.
Significant diurnal variations in levels of total plasma cholesterol, HDL cholesterol and LDL cholesterol were found in the majority of 12 normals, 13 maturity onset and 14 insulin requiring diabetics. The variations in total cholesterol and its lipoprotein subfraction were more marked in diabetics. These variations were not correlated in either diabetic group with glucose control as assessed by the level of glycosylated haemoglobin. The significance of the diurnal changes in total plasma cholesterol and the lipoprotein subfractions in relation to arteriovascular disease is discussed.
The analgesic, respiratory and hormonal effects of two doses of buprenorphine were studied during and after operation in 20 patients undergoing total hip replacement. The drug provided analgesia of long duration. The analesic and hormonal effects of the drug were greater after i.m. than after i.v. administration. The postoperative analgesic requirement of women was less than that of men. The pharmacodynamic differences shown between the sexes and between the two routes of administration are discussed in relation to the pharmacokinetics of the drug.
A case of propoxyphene hydrochloride (Darvon) poisoning was unresponsive to therapeutic doses of naloxone hydrochloride in a 2 1/2-year-old girl. Following prolonged coma and artificial ventilation for three hours, the patient responded immediately to the intravenous administration of 2 mg of naloxone hydrochloride, which is 20 times the manufacturer's recommended dosage. Naloxone is the agent of choice in reversing the effects of narcotics and synthetic opiate derivatives, such as propoxyphene and pentazocine. The manufacturer's present recommended dosage may not be sufficient to reverse the effects of large narcotic ingestions. We therefore recommend that if there is no response within two minutes of the initial 0.01 mg/kg dosage of naloxone hydrochloride, a second dose 0.1 mg/kg (ten times the manufacturer's suggested dose) be given.
Fourteen patients with established maturity-onset diabetes were treated as outpatients with a high-carbohydrate-(about 60% of total daily energy requirements)-modified fat diet (ratio of polyunsaturated fatty acids to other fatty acids greater than or equal to 1:1) for six weeks. Commercially available and acceptable cereal foods and tuberous vegetables high in both digestible and non-digestible carbohydrates were used. Simple sugars were restricted. Compared with their usual, low-carbohydrate diabetic diet this diet resulted in a fall in basal plasma glucose concentration (average of values measured at 0300, 0500, and 0700), mean preprandial plasma glucose concentration (average of values measured at 0800, 1230, and 1730), and percentage of glycosylated haemoglobin. Modifying dietary fat also decreased the fasting plasma cholesterol concentration. The findings suggest that it is no longer justifiable to prescribe a low-carbohydrate diet for maturity-onset diabetes.
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Eleven unfit bank executives in sedentary employment exercised daily for 10 weeks according to the Canadian Air-Force 5BX Exercise Programme. Over this period no changes were observed in the glucose or insulin responses to a standard breakfast or to intravenous glucose, or in the glucose response to intravenous insulin. There was a significant reduction in high-density-lipoprotein cholesterol, but total plasma triglyceride and cholesterol levels were unaffected by exercise.
The management of acute conjunctivitis need not be confusing. In the newborn period the common etiologic agents are chemical, TRIC, and bacterial. The latter two causes are effectively treated with sulfacetamide ophthalmic preparations. Dacryostenosis should be suspected in any child with recurrent conjunctivitis in the first six months of life. With older children the major causes can be classified as viral, allergic, foreign bodies, and bacterial. Bacterial conjunctivitis almost always responds to sulfacetamide ophthalmic preparations.
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We describe an autopsy-proven case of central pontine myelinolysis (CPM) with premortem computerized tomographic (CT) visualization of the lesion on two scans, performed with an interval of 2 weeks. This case demonstrates the capability of CT to support the clinical diagnosis of central pontine myelinolysis. Identification of the condition should facilitate prompt initiation of aggressive supportive care.
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