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Phukpattanachai K, Praditseree N, Skjolaas S, Klaychaiya S, Trongtrakul K. Accuracy of pH strip testing and pH liquid testing versus standard pH meter of gastric contents in critically ill patients: a diagnostic accuracy study. BMJ Open 2024; 14:e081830. [PMID: 39013655 PMCID: PMC11253741 DOI: 10.1136/bmjopen-2023-081830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 06/19/2024] [Indexed: 07/18/2024] Open
Abstract
OBJECTIVE The utilisation of pH level measurements from gastric contents may indicate the preferred tip position of a nasogastric tube or monitor the efficacy of stress ulcer prophylaxis in critically ill patients. We aimed to determine the accuracy of pH strip (pHS) tests and pH liquid (pHL) tests compared with the standard pH meter (pHM). DESIGN Diagnostic accuracy study. SETTING Gastric contents from medically critically ill patients. PARTICIPANTS In total, 113 gastric samples were collected from 27 critically ill patients. OUTCOME MEASURE The level of pH measured by pHM, pHS and pHL. RESULTS The pH values measured by pHM, pHS and pHL were 5.83 (IQR 5.12-6.61), 5.50 (IQR 5.00-6.00) and 5.75 (IQR 5.25-6.25), respectively. The pHS test showed greater accuracy, exhibiting a more positive correlation with the standard pHM measurement than the pHL test, with Y=0.95*X+0.56; rho=0.91, p<0.001, and Y=1.09*X - 0.72; rho=0.75, p<0.001, respectively. However, the pHS test demonstrated less agreement with the pHM than the pHL test, with biases of -0.27 versus 0.18, respectively. Noticeably, a slight variation in pHL from the standard pH values was found when we measured gastric contents with a pH lower than 5. CONCLUSION Both the pHS and pHL methods were good options for measuring gastric pH in critically ill patients. However, it was advisable to find alternative approaches to the pHL testing method when anticipated gastric acidity levels fall below 5. TRIAL REGISTRATION NUMBER TCTR20220530004.
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Affiliation(s)
| | | | - Smith Skjolaas
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Konlawij Trongtrakul
- Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Wise JC, Hughes KJ, Edwards S, Jacobson GA, Narkowicz CK, Raidal SL. Pharmacokinetic and pharmacodynamic effects of 2 registered omeprazole preparations and varying dose rates in horses. J Vet Intern Med 2020; 35:620-631. [PMID: 33340169 PMCID: PMC7848319 DOI: 10.1111/jvim.15971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/02/2020] [Accepted: 11/10/2020] [Indexed: 12/02/2022] Open
Abstract
Background Omeprazole preparations vary in bioavailability in horses. Hypothesis/Objectives To characterize the pharmacokinetics and pharmacodynamics of an existing enteric‐coated oral omeprazole paste (REF) and a novel, in‐feed, enteric‐coated dry granule preparation (NOV). Animals Twelve Standardbred/Thoroughbred mares free from clinical disease. Methods A prospective, blinded randomized interventional study was trial, conducted in 3 parts: (a) bioavailability study, (b) dose titration study, and (c) comparative clinical pharmacodynamic study, each using a blocked crossover design. Results Consistent with the larger dose administered, Cmax (median, 1032 ng/mL; range, 576‐1766) and AUC0‐24 (median, 63.9 μg/mL*min; range, 42.4‐152.4) were greater after single oral administration of NOV than REF (282.7 ng/mL; range, 94.8‐390.2, and 319 23.8 μg/mL*min; range, 8.2‐42.3, respectively; both P = .004). No differences were observed between products for absolute oral bioavailability (NOV 55% range, 15‐88; REF 17% range, 10‐77; P = .25). Treatment with both preparations was associated with reduced gastric squamous ulcer scores and increased pH of gastric fluid. Bioequivalence was demonstrated for pharmacodynamic measures with the exception of % time pH <4, despite differences in dose rate and subsequent plasma omeprazole concentrations. Conclusions and Clinical Importance The findings of this study indicate that the NOV product would be a suitable alternative to the reference product, and confirm that plasma concentrations of omeprazole and omeprazole dose do not predict drug pharmacodynamics in horses.
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Affiliation(s)
- Jessica C Wise
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Kristopher J Hughes
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Scott Edwards
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Glenn A Jacobson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Christian K Narkowicz
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Sharanne L Raidal
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
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Variability in measuring pH using litmus paper and the relevance in ocular chemical injury. Eye (Lond) 2019; 34:2133-2134. [PMID: 31848458 DOI: 10.1038/s41433-019-0737-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/29/2019] [Indexed: 11/09/2022] Open
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Metheny NA, Gunn EM, Rubbelke CS, Quillen TF, Ezekiel UR, Meert KL. Effect of pH Test-Strip Characteristics on Accuracy of Readings. Crit Care Nurse 2018; 37:50-58. [PMID: 28572101 DOI: 10.4037/ccn2017199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Little is known about characteristics of colorimetric pH test strips that are most likely to be associated with accurate interpretations in clinical situations. OBJECTIVES To compare the accuracy of 4 pH test strips with varying characteristics (ie, multiple vs single colorimetric squares per calibration, and differing calibration units [1.0 vs 0.5]). METHODS A convenience sample of 100 upper-level nursing students with normal color vision was recruited to evaluate the accuracy of the test strips. Six buffer solutions (pH range, 3.0 to 6.0) were used during the testing procedure. Each of the 100 participants performed 20 pH tests in random order, providing a total of 2000 readings. The sensitivity and specificity of each test strip was computed. In addition, the degree to which the test strips under- or overestimated the pH values was analyzed using descriptive statistics. RESULTS Our criterion for correct readings was an exact match with the pH buffer solution being evaluated. Although none of the test strips evaluated in our study was 100% accurate at all of the measured pH values, those with multiple squares per pH calibration were clearly superior overall to those with a single test square. CONCLUSIONS Test strips with multiple squares per calibration were associated with greater overall accuracy than test strips with a single square per calibration. However, because variable degrees of error were observed in all of the test strips, use of a pH meter is recommended when precise readings are crucial.
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Affiliation(s)
- Norma A Metheny
- Norma A. Metheny is a professor at St Louis University School of Nursing, St Louis, Missouri. She has conducted tube feeding research over the past 25 years. .,Emily M. Gunn is an assistant professor at St Louis University School of Nursing. Her background is in medical-surgical nursing and she is currently serving in the role of clinical coordinator. .,Cynthia S. Rubbelke is an assistant professor and the e-technology coordinator at St Louis University School of Nursing. She specializes in pediatric nursing and currently teaches in the clinical simulation laboratory. .,Terrilynn Fox Quillen is a doctoral student at St Louis University School of Nursing and a community health nurse. .,Uthayashanker R. Ezekiel is an associate professor, Biomedical Laboratory Science, St Louis University. He is a molecular biologist and has expertise in functional genomics. .,Kathleen L. Meert is chief of pediatric critical care medicine at Children's Hospital of Michigan and professor of pediatrics at Wayne State University, Detroit, Michigan.
| | - Emily M Gunn
- Norma A. Metheny is a professor at St Louis University School of Nursing, St Louis, Missouri. She has conducted tube feeding research over the past 25 years.,Emily M. Gunn is an assistant professor at St Louis University School of Nursing. Her background is in medical-surgical nursing and she is currently serving in the role of clinical coordinator.,Cynthia S. Rubbelke is an assistant professor and the e-technology coordinator at St Louis University School of Nursing. She specializes in pediatric nursing and currently teaches in the clinical simulation laboratory.,Terrilynn Fox Quillen is a doctoral student at St Louis University School of Nursing and a community health nurse.,Uthayashanker R. Ezekiel is an associate professor, Biomedical Laboratory Science, St Louis University. He is a molecular biologist and has expertise in functional genomics.,Kathleen L. Meert is chief of pediatric critical care medicine at Children's Hospital of Michigan and professor of pediatrics at Wayne State University, Detroit, Michigan
| | - Cynthia S Rubbelke
- Norma A. Metheny is a professor at St Louis University School of Nursing, St Louis, Missouri. She has conducted tube feeding research over the past 25 years.,Emily M. Gunn is an assistant professor at St Louis University School of Nursing. Her background is in medical-surgical nursing and she is currently serving in the role of clinical coordinator.,Cynthia S. Rubbelke is an assistant professor and the e-technology coordinator at St Louis University School of Nursing. She specializes in pediatric nursing and currently teaches in the clinical simulation laboratory.,Terrilynn Fox Quillen is a doctoral student at St Louis University School of Nursing and a community health nurse.,Uthayashanker R. Ezekiel is an associate professor, Biomedical Laboratory Science, St Louis University. He is a molecular biologist and has expertise in functional genomics.,Kathleen L. Meert is chief of pediatric critical care medicine at Children's Hospital of Michigan and professor of pediatrics at Wayne State University, Detroit, Michigan
| | - Terrilynn Fox Quillen
- Norma A. Metheny is a professor at St Louis University School of Nursing, St Louis, Missouri. She has conducted tube feeding research over the past 25 years.,Emily M. Gunn is an assistant professor at St Louis University School of Nursing. Her background is in medical-surgical nursing and she is currently serving in the role of clinical coordinator.,Cynthia S. Rubbelke is an assistant professor and the e-technology coordinator at St Louis University School of Nursing. She specializes in pediatric nursing and currently teaches in the clinical simulation laboratory.,Terrilynn Fox Quillen is a doctoral student at St Louis University School of Nursing and a community health nurse.,Uthayashanker R. Ezekiel is an associate professor, Biomedical Laboratory Science, St Louis University. He is a molecular biologist and has expertise in functional genomics.,Kathleen L. Meert is chief of pediatric critical care medicine at Children's Hospital of Michigan and professor of pediatrics at Wayne State University, Detroit, Michigan
| | - Uthayashanker R Ezekiel
- Norma A. Metheny is a professor at St Louis University School of Nursing, St Louis, Missouri. She has conducted tube feeding research over the past 25 years.,Emily M. Gunn is an assistant professor at St Louis University School of Nursing. Her background is in medical-surgical nursing and she is currently serving in the role of clinical coordinator.,Cynthia S. Rubbelke is an assistant professor and the e-technology coordinator at St Louis University School of Nursing. She specializes in pediatric nursing and currently teaches in the clinical simulation laboratory.,Terrilynn Fox Quillen is a doctoral student at St Louis University School of Nursing and a community health nurse.,Uthayashanker R. Ezekiel is an associate professor, Biomedical Laboratory Science, St Louis University. He is a molecular biologist and has expertise in functional genomics.,Kathleen L. Meert is chief of pediatric critical care medicine at Children's Hospital of Michigan and professor of pediatrics at Wayne State University, Detroit, Michigan
| | - Kathleen L Meert
- Norma A. Metheny is a professor at St Louis University School of Nursing, St Louis, Missouri. She has conducted tube feeding research over the past 25 years.,Emily M. Gunn is an assistant professor at St Louis University School of Nursing. Her background is in medical-surgical nursing and she is currently serving in the role of clinical coordinator.,Cynthia S. Rubbelke is an assistant professor and the e-technology coordinator at St Louis University School of Nursing. She specializes in pediatric nursing and currently teaches in the clinical simulation laboratory.,Terrilynn Fox Quillen is a doctoral student at St Louis University School of Nursing and a community health nurse.,Uthayashanker R. Ezekiel is an associate professor, Biomedical Laboratory Science, St Louis University. He is a molecular biologist and has expertise in functional genomics.,Kathleen L. Meert is chief of pediatric critical care medicine at Children's Hospital of Michigan and professor of pediatrics at Wayne State University, Detroit, Michigan
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Ediriweera DS, Dilina N, Saparamadu V, Fernando I, Kurukulasuriya B, Fernando D, Kurera J. Aspirin is associated with low oral pH levels and antacid helps to increase oral pH. BMC Res Notes 2018; 11:137. [PMID: 29458438 PMCID: PMC5819276 DOI: 10.1186/s13104-018-3247-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/10/2018] [Indexed: 11/20/2022] Open
Abstract
Objective Aspirin is a commonly used medicine for primary and secondary prevention of cardiovascular diseases. It is an acidic medicine associated with gastric irritation and acid reflux, which in turn can lead to low oral pH levels. Therefore, it is important to understand the association between aspirin and oral pH levels in order to achieve an optimum oral health condition among patients who take aspirin on prescription. Results Out of 373 patients, 162 (44%) were males and 245 (66%) were on aspirin. 71% of aspirin taking patients and 29% of non-aspirin taking patients had oral pH less than 6.5 (P < 0.01). Aspirin showed a significant association with low oral pH levels (odds ratio = 1.91, 95% CI 1.23–2.99, P < 0.01). 78 patients were given antacids and followed up for 4 weeks, 63 of them (81%) showed an improvement in oral pH and the improvement was marked in the group who had oral pH between 5.5–6.0 compared to the group who had oral pH between 6.0–6.5 (P = 0.03). The results show that aspirin therapy is associated with low oral pH and administration of an antacid with aspirin helps to increase the oral pH level.
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Affiliation(s)
- Dileepa Senajith Ediriweera
- Centre for Health Informatics, Biostatistics and Epidemiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
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Raidal SL, Andrews FM, Nielsen SG, Trope G. Pharmacokinetic and pharmacodynamic effects of two omeprazole formulations on stomach pH and gastric ulcer scores. Equine Vet J 2017; 49:802-809. [DOI: 10.1111/evj.12691] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 04/11/2017] [Indexed: 11/30/2022]
Affiliation(s)
- S. L. Raidal
- School of Animal and Veterinary Sciences; Veterinary Clinical Centre; Charles Sturt University; Wagga Wagga New South Wales Australia
| | - F. M. Andrews
- Equine Health Studies Program; Department of Veterinary Clinical Sciences; School of Veterinary Medicine; Louisiana State University; Baton Rouge Louisiana USA
| | - S. G. Nielsen
- School of Animal and Veterinary Sciences; Veterinary Clinical Centre; Charles Sturt University; Wagga Wagga New South Wales Australia
| | - G. Trope
- School of Animal and Veterinary Sciences; Veterinary Clinical Centre; Charles Sturt University; Wagga Wagga New South Wales Australia
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Solana MJ, López-Herce J, Sánchez A, Sánchez C, Urbano J, López D, Carrillo A. 0.5 mg/kg versus 1 mg/kg of intravenous omeprazole for the prophylaxis of gastrointestinal bleeding in critically ill children: a randomized study. J Pediatr 2013; 162:776-782.e1. [PMID: 23149178 DOI: 10.1016/j.jpeds.2012.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 09/14/2012] [Accepted: 10/03/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare the effect of 2 doses of intravenous omeprazole on gastric pH, gastrointestinal bleeding, and adverse effects in critically ill children. STUDY DESIGN We undertook a prospective randomized clinical trial in critically ill children at risk of gastrointestinal bleeding. The effect of 2 intravenous omeprazole regimens (0.5 or 1 mg/kg every 12 hours) on the gastric pH and incidence of gastrointestinal hemorrhage was compared. The efficacy criteria were a gastric pH >4 and the absence of clinically significant gastrointestinal bleeding. RESULTS Forty patients, 20 in each treatment group, were studied. Overall, the gastric pH was greater than 4 for 57.8% of the time, with no difference between the doses (P = .66). The percentage of time with a gastric pH > 4 increased during the study (47.8% between 0 and 24 hours vs 76% between 24 and 48 hours, P = .001); the greater dose showed a greater increase in the percentage of time with a pH > 4: between hours 24 and 48 of the study, the gastric pH was greater than 4 for 84.5% of the time with the 1 mg/kg dose and for 65.5% of the time with the 0.5 mg/kg dose (P = .036). Plasma omeprazole levels were greater with 1 mg/kg dose, but no correlation was found between omeprazole plasma levels and gastric pH. No toxic adverse effects were detected, and there was no clinically significant bleeding. CONCLUSION Neither of the 2 omeprazole regimens achieved adequate alkalinization of the gastric pH during the first 24 hours. Between 24 and 48 hours, the 1 mg/kg dose maintained the gastric pH greater than 4 for a greater percentage of the time.
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Affiliation(s)
- Maria José Solana
- Department of Pediatric Intensive Care Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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