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LACTIC ACIDOSIS CANNOT BE USED TO EXPLAIN AN OSMOLAL GAP IN PATIENTS WITH POTENTIAL ETHYLENE GLYCOL TOXICITY. A CASE REPORT AND REVIEW OF THE LITERATURE. Joel M. Topf, Sean Jayakar Saint John Hospital and Medical Center, Detroit, Michigan, USA. The finding of an unexplained osmolal gap in the presence of an anion gap metabolic acidosis AGMA ; suggests ethylene glycol or methanol ingestion. In many hospitals specific assays for these toxic alcohols are not available in a timely manner and definitive therapy must be initiated based on clinical suspicion. Separating an explained from unexplained osmolal gap focuses on ruling out sepsis, ketoacidosis and lactic acidosis as the etiology for the osmolal gap. Though lactic acidosis can cause an osmolal gap with an AGMA, the lactic acid assay is unreliable during ethylene glycol intoxication. We report a case where a patient had an elevated osmolal gap 22 mOsm kg ; , severe metabolic acidosis pH 6.9 ; and an elevated anion gap 37 mmol L ; . His osmolal gap was completely explained by a lactic acid level of 27 mmol L. While this should rule out a toxic alcohol as the etiology of his osmolal gap and acidosis, subsequent lab results revealed an admission ethylene glycol level of 11 mg dL. We believe the elevated lactic acidosis was due to a previously documented artifact where the enzymatic lactic acid assay non-specifically mistakes glycolate for lactic acid. Ethylene glycol toxicity can cause artificially elevated lactic acid which can erroneously explain an osmolal gap. Lactic acid should not be used to explain an otherwise suspicious osmolal gap in patients where a toxic alcohol is a consideratio, for example, ibuprofen.
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Fig. 5. Therapeutic administration of NCX-1015 heals established colitis. NCX-1015 reverses colitis score a ; and MPO activity b ; in mice with established colitis. Data are mean SE of 8 mice. * , P 0.05 versus control ethanol-treated ; mice, and * , P 0.05 versus TNBS alone.
Table iiitotal daily isoptin sr dose recommended dosing intervals 180 mg once each morning with food 240 mg once each morning with food 360 mg 180 mg each morning plus 180 mg each evening, with food or 240 mg each morning plus 120 mg each evening, with food480 mg 240 mg each morning plus 240 mg each evening, with food - the antihypertensive effects of isoptin sr are evident within the first week of therapy and captopril.
When we analyze the buying habits of the enrolled clients, another critical facet of the program emerges: the average enrolled horse receives nearly $350 per year more veterinary care than un-enrolled horses with similar uses and demographics. Eight enrolled horses were compared to un-enrolled horses with similar use, housing and management over a four-year period ; . We believe the prepaid wellness programs cause clients to budget for their equine health care and pay for the services in the first part of the year, perhaps with their tax returns, and before other horse related bills mount up. When an enrolled horse is lame, ill, or injured, clients are better prepared to pay for the best possible care and choose treatments that might otherwise be out of reach.
The anti-virals norvir and kaletra, protease inhibitors for the treatment of hiv infection; lupron, also marketed as lucrin, and lupron depot used for the palliative treatment of advanced prostate cancer, treatment of endometriosis and central precocious puberty and for the preoperative treatment of patients with anemia caused by uterine fibroids; synthroid for the treatment of hypothyroidism; prevacid lansoprazole ; , a proton pump inhibitor for the short-term treatment of duodenal ulcers, gastric ulcers, and erosive esophagitis; various cardiovascular products, including loftyl, a vasoactive agent, mavik also marketed as goptin ; , isoptin and tarka for the treatment of hypertension, hytrin also marketed as hitrin and flotrin ; used for the treatment of hypertension and benign prostatic hyperplasia, candesartan sold under the trademarks blopress and tiadyl ; , an angiotension 2 antagonist; reductil also marketed as reductyl and reductal ; for the treatment of obesity; uprima for the treatment of erectile dysfunction; various forms of infant formulas and follow-on formulas, including similac advance, gain, and abbott grow; various adult medical nutritionals, including ensure, glucerna, and jevity; and a broad line of hospital products, including the anesthesia products sevoflurane sold outside of the united states primarily under the trademark sevorane and in a few other markets as ultane ; , isoflurane, and enflurane; specialty injectables such as calcijex and survanta; and electronic drug delivery systems sold in select international markets and diltiazem.
Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Parel, Mumbai - 400 012. Received : 24.11.2003; Accepted : 24.2.2004.
18 Laing SP, Swerdlow AJ, Slater SD, Burden AC, Morris A, Waugh NR, et al. Mortality from heart disease in a cohort of 23, 000 patients with insulin-treated diabetes. Diabetologia 2003; 46: 760-765 Laing SP, Swerdlow AJ, Carpenter LM, Slater SD, Burden AC, Botha JL, et al. Mortality from cerebrovascular disease in a cohort of 23 000 patients with insulin-treated diabetes. Stroke 2003; 34: 418-421 Colwell JA, Nesto RW. The platelet in diabetes: Focus on prevention of ischemic events. Diabetes Care 2003; 26: 2181-2188 Ferroni P, Basili S, Falco A, Davi G. Platelet activation in type 2 diabetes mellitus. J Thromb Haemost 2004; 2: 1282-1291 Ishii H, Umeda F, Nawata H. Platelet function in diabetes mellitus. Diabetes Metab Rev 1992; 8: 53-66 Vinik AI, Erbas T, Park TS, Nolan R, Pittenger GL. Platelet dysfunction in type 2 diabetes. Diabetes Care 2001; 24: 1476-1485 Yazbek N, Bapat A, Kleiman N. Platelet abnormalities in diabetes mellitus. Coron Artery Dis 2003; 14: 365-371 Winocour PD. Platelets, vascular disease, and diabetes mellitus. Can J Physiol Pharmacol 1994; 72: 295-303. Paton RP, Passa Ph. Platelets and diabetic vascular disease. Diabetes Metab 1983; 9: 306-312 Plutzky J, Viberti G, Haffner S. Atherosclerosis in type 2 diabetes mellitus and insulin resistance: Mechanistic links and therapeutic targets. J Diabetes Complications 2002; 16: 401-415 Porta M, Peters AM, Cousins SA, Cagliero E, FitzPatrick ML, Kohner EM. A study of platelet-relevant parameters in patients with diabetic microangiopathy. Diabetologia 1983; 25: 21-25 Colwell JA, Winocour PD, Halushka PV. Do platelets have anything to do with diabetic microvascular disease? Diabetes 1983; 32 Suppl 2: 14-19. 30 Gresele P, Guglielmini G, De Angelis M, Ciferri S, Ciofetta M, Falcinelli E, et al. Acute, short-term hyperglycemia enhances shear stress-induced platelet activation in patients with type II diabetes mellitus. J Coll Cardiol 2003; 41: 1013-1020 Assert R, Scherk G, Bumbure A, Pirags V, Schatz H, Pfeiffer AF. Regulation of protein kinase C by short term hyperglycaemia in human platelets in vivo and in vitro. Diabetologia 2001; 44: 188-195 Yngen M, Ostenson CG, Li N, Hjemdahl P, Wallen NH. Acute hyperglycemia increases soluble Pselectin in male patients with mild diabetes mellitus. Blood Coagul Fibrinolysis 2001; 12: 109-116 Gawaz M. 2001 ; Blood Platelets, pp. 1-41. Georg Thieme Verlag, Stuttgart, Germany. 34 Sobol AB, Watala C. The role of platelets in diabetes-related vascular complications. Diabetes Res Clin Pract 2000; 50: 1-16 Biondi-Zoccai GG, Abbate A, Liuzzo G, Biasucci LM. Atherothrombosis, inflammation, and diabetes. J Coll Cardiol 2003; 41: 1071-1077 Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med 1999; 340: 115-126. McEver RP. Adhesive interactions of leukocytes, platelets, and the vessel wall during hemostasis and inflammation. Thromb Haemost 2001; 86: 746-756 and doxazosin.
The distribution of sample characteristics is shown in Table 1. Slightly more than half 54% ; of the respondents were men. Ten percent of respondents were aged 15 to 19 years and 58% were aged 20 to 29 years. About half 51% ; were married, 38% were not married but had had a regular partner in the last 12 months, and 9% were not married and had not had a regular partner in the last 12 months. About 2% of respondents had never had sexual intercourse. On the basis of educational level, the sample had relatively high SES: 51% of respon.
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Major driver in the increasing cost of PEIA coverage. Since 1997, PEIA's and more of PEIA's budget. Specifically, single source brand-name drugs are driving this trend. It was in Plan Year 2000 that PEIA first implemented the three-tiered copayments for prescription drugs, the plan where you pay $5 for generics, $15 for preferred brand-name drugs and even more for non-preferred brandname drugs. The non-preferred drug copay has changed several times -- $40 and catapres.
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BOARD ACTION: Dr. Bowden made the motion that the Arkansas State Board of Pharmacy approves the National Institute for Standards in Pharmacist Credentialing NISPC ; as the disease state management credentialing organization until the October 2005 meeting of the State Board of Pharmacy. Dr. Newsome seconded the motion. The vote for the motion was unanimous. Ms. Lincourt presented the Board with a professional meetings schedule for 2004-2005. She asked the Board members to rank the meetings in the order they wanted to attend, and to return their schedule to her as soon as possible. Ms. Lincourt also explained to the Board that the current statutes do not require wholesale distributors of legend devices to be licensed by the Arkansas State Board of Pharmacy. She said a simple addition to the wholesale distributor statute would take care of the matter. BOARD ACTION: Dr. Autry made the motion to add legend devices to the wholesale distributor statute. Mr. Holiman seconded the motion. The vote for the motion was unanimous. Dr. Campbell discussed the procedures for criminal background checks in the office. He said the intent of the regulation was to screen for people who have had felony convictions with regard to controlled substances, but the regulation includes many other convictions. He explained that if the background check comes back positive for any conviction listed in the regulation that there is a procedure for the applicant to request a waiver. Dr. Campbell also explained that the Executive Director and staff have the ability to waive the offense and allow the technician to go to work. He said if the application is denied, the applicant has the ability to appear before the Board. Dr. Campbell asked the Board for their opinion on what type of convictions he should deny. The Board directed Dr. Campbell and staff to look at each conviction separately to decide whether or not to grant a license. They also said that any conviction which pertains to a controlled substance violation must appear before the Board in an informal hearing if a waiver is requested. Dr. Campbell said that a criminal background check, conducted on an applicant that just completed his first year of pharmacy school, revealed two DWI convictions within a six-month time period. He told the Board that he referred him to the Pharmacy Support Group and he has since signed a contract with them. Dr. Campbell told them that the student would need his intern license to enroll in his second year of pharmacy school and asked for direction from the Board. The Board instructed the staff to issue the student's intern license. Ronnie Norris discussed the Compounding Committee meeting with the Board. He reminded the Board that the committee was formed to address specific language regarding restrictions on compounding commercially available products. He said there have been discussions with DEA concerning the dispensing of controlled substances pursuant to a valid prescription to a physician's office rather than the patient. Dr. Norris told the Board that DEA was asked if a pharmacist could fill a patient specific prescription and give it to the doctor to administer, and DEA said a controlled substance had to go to the ultimate user not a doctor's office. The committee recommended that any patient specific prescription for a controlled substance must be delivered to the patient or an immediate family member in accordance with DEA, for example, idoptin sr 240 mg.
Comparison of Nine Months Ended September 30, 2001 to Nine Months Ended September 30, 2000 General Most of the factors described above relating to the comparison of the results of the third quarter of 2001 and 2000 also impacted the comparison of the first nine months of 2001 compared to the first nine months of 2000. However, the comparative results of the nine month periods were also significantly influenced by the inclusion of the results of operations of Novopharm Limited, which was acquired in April 2000, for the full nine months of 2001, as compared to only six months in the first nine months of 2000. The following table sets forth certain financial data presented as a percentage of sales and the percentage change, for the periods indicated, excluding for purposes of comparison, a one-time charge of $35.7 million which was recorded in the second quarter of 2000 with respect to acquisition of R&D in process resulting mainly from the acquisition of Novopharm: Period to Period Percentage Change 22.6% 24.9 34.7 ; 12.0 ; 47.1 57.4 and cefaclor.
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Expression of Isoflavonoid Pathway Genes as a Consequence of IOMT Overexpression These data suggest that increased production of 4 -O-methylated isoflavonoids and the resulting disease resistance in IOMT-overexpressing plants might be the direct result of increased concentrations of IOMT and therefore point to a direct involvement of IOMT in the synthesis of these compounds. However, because the 4 -O-methylated compounds are stress-induced phytoalexins in alfalfa, it is possible that lines with increased IOMT activity have some kind of metabolic stress that leads to increased phytoalexin production independent of flux through IOMT. This is unlikely, however, in view of the lack of detectable phytoalexins in unelicited or uninfected IOMT-overexpressing plants Figures 4 and 5 ; . To further rule out this possibility and to determine whether other enzymes of the isoflavonoid pathway might be modulated after expression of IOMT, we examined the amounts of transcripts encoding eight of the enzymes involved in the conversion of phenylalanine to medicarpin in and cefuroxime.
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| Isoptin ointmentTitle: IEO trial n. S65 500, ELIOT Intraoperative Radiotherapy with Electrons ; in breast cancer. Aims: This randomised trial compares intraoperative RT 21 Gy single dose ; with standard external RT up to total dose of 60 Gy women with unifocal breast carcinoma of maximum diameter 2.5 cm. Eligibility: Patients older than 48 years with invasive breast carcinoma and unifocal tumour diameter up to 2.5 cm are candidates for this trial; exclusion criteria are previous diagnosis of malignancy in medical history, multi-centric or multi-focal disease in breast, and major contraindications to radiotherapy. Accrual: Target accrual is 824 patients. Up to 9 February 2005, 766 patients had been enrolled: 382 received ELIOT and 384 external radiotherapy. Endpoints: The main endpoint of this trial is local control of disease by ELIOT, by determination of the incidence of local relapse. Overall survival and quality of life are secondary endpoints.
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