Use of sucralfate in renal failure

Application of carbohydrates in approved small molecule drugs: A review

Carbohydrates are an important energy source and play numerous key roles in all living organisms. Carbohydrates chemistry involved in diagnosis and treatment of diseases has been attracting increasing attention. Carbohydrates could be one of the major focuses of new drug discovery. Currently, however, carbohydrate-containing drugs account for only a small percentage of all drugs in clinical use, which does not match the important roles of carbohydrates in the organism. In other words, carbohydrates are a relatively untapped source of new drugs and therefore may offer exciting novel therapeutic opportunities. Here, we presented an overview of the application of carbohydrates in approved small molecule drugs and emphasized and evaluated the roles of carbohydrates in those drugs. The potential development direction of carbohydrate-containing drugs was presented after summarizing the advantages and challenges of carbohydrates in the development of new drugs.

Trace minerals in patients with end-stage renal disease

The kidneys are famously responsible for maintaining external balance of prevalent minerals, such as sodium, chloride, and potassium. The kidney's role in handling trace minerals is more obscure to most nephrologists. Similarly, the impact of kidney failure on trace mineral metabolism is difficult to anticipate. The associated dietary modifications and dialysis create the potential for trace mineral deficiencies and intoxications. Indeed, there are numerous reports of dialysis-associated mishaps causing mineral intoxication, notable for the challenge of assigning causation. Equally challenging has been the recognition of mineral deficiency syndromes, amid what is often a cacophony of multiple comorbidities that vie for the attention of clinicians who care for patients with chronic kidney disease. In this paper, I review a variety of minerals, some of which are required for maintenance of normal human physiology (the U.S. Food and Drug Administration's list of essential minerals), and some that have attracted attention in the care of dialysis patients. For each mineral, I will discuss its role in normal physiology and will review reported deficiency and toxicity states. I will point out the interesting inter-relationships between several of the elements. Finally, I will address the special concerns of aluminum and magnesium as they pertain to the dialysis population.

Aluminum load in ICU patients during stress ulcer prophylaxis

BACKGROUND

Accumulating evidence has linked high aluminum (Al) levels with toxicity and disease. Our objective was to evaluate the Al exposure of ICU patients receiving stress ulcer prophylaxis with sucralfate and ranitidine.

METHODS

Within a large prospective, randomized study, a subgroup of 30 critically ill, renally intact patients on prolonged mechanical ventilation who were being treated in intensive care units (ICU) of a university hospital were allocated to two prophylaxis subgroups: enteral sucralfate, 1 g six times daily by gastric tube (n=15), or intravenous ranitidine, 200 mg daily by 24-h continuous intravenous infusion (n=15). The Al content of large and small-volume parenterals was measured and Al intake calculated for each patient and day. Aluminum levels in serum and 24-h urine were monitored every 2 days during the 16-day observation period (days 0-15).

RESULTS

Mean daily parenteral Al exposure ranged from 101.3 to 158.7 mug/day for sucralfate and ranitidine patients, respectively. In both groups, Al serum levels increased from baseline on days 1-13 and on days 3-7 in the sucralfate and ranitidine groups, respectively. From days 3-13, Al serum levels were significantly higher with sucralfate than with ranitidine (P<0.05). On days 7-13, 24-h urinary Al excretion was also significantly higher in the sucralfate than in the ranitidine group (P<0.05).

CONCLUSION

In ICU patients, only approximately 50% of parenterally administered Al is eliminated renally. Sucralfate additionally increases patients exposure to Al. In ICU patients, the mean absorption of enteral Al from sucralfate is only 0.019%.

Science review: The use of proton pump inhibitors for gastric acid suppression in critical illness

Prophylaxis is routinely provided for critically ill patients admitted to intensive care units (ICUs) who are at high risk for stress-related mucosal damage (SRMD), an erosive process of the gastroduodenum associated with abnormally high physiological demands. Traditionally, treatment options have included sucralfate, antacids and histamine H2 receptor antagonists (H₂RAs). The H₂RAs are currently the most widely used agents in prophylactic acid suppression; however, proton pump inhibitors (PPIs) have recently replaced H₂RAs in the treatment of many acid-related conditions. PPIs achieve a more rapid and sustained increase in gastric pH and are not associated with the rapid tachyphylaxis seen with H₂RAs. As a result, and after the introduction of intravenous formulations, PPIs are beginning to be used for the prophylaxis of SRMD in critically ill adults. The high prevalence of renal and hepatic impairment among the ICU population, as well as the need for multiple drug therapy in many patients, means that pharmacokinetic characteristics and the potential for drug interactions may be important considerations in the choice of prophylactic agent. This review seeks to present the pharmacological evidence that may inform decision-making about the prescription of drugs for prophylaxis of SRMD.

Pharmacotherapy of gastro-oesophageal reflux disease in children: focus on safety

Gastro-oesophageal reflux (GOR) disease is very common and, in the majority of infants, is physiological. However, untreated GOR disease in infants and children is associated with a decrease in quality of life for the child and their parents. It may also cause sometimes more severe complications, such as oesophagitis, and causing, in rare cases, failure to thrive, oesophageal stricture, apnoea and even death. Every therapeutic intervention (non-drug treatment, medical treatment and surgery) is associated with morbidity and even mortality. Moreover, efficacy data of many medications in children are non-existing, limited or disappointing. The safety profile of cisapride is comparable to that of other therapeutic interventions or to the risk of non-treatment. Therefore, the therapeutic approach of GOR disease in infants and children needs to be well-balanced, considering therapeutic efficacy and side effects. This review will focus on the side effects of the different therapeutic options.