Lasix

Deepali Kumar, M.D., M.SC., F.R.C.P. (C)

• Assistant Professor of Medicine
• Transplant Infectious Diseases
• University of Alberta
• Staff Physician
• Transplant Infectious Diseases
• University of Alberta Hospital
• Edmonton, Alberta, Canada

Monitoring Measure blood pressure and blood glucose frequently during acute illness arteria iliaca lasix 40 mg discount. Special Considerations/Preparation 412 Micormedex NeoFax Essentials 2014 Hydrocortisone sodium succinate is available as powder for injection in 2-mL vials containing 100 mg pulse pressure 25 purchase 100mg lasix mastercard. Also available in 2- arteriographic embolization order cheap lasix on-line, 4- arrhythmia medscape order generic lasix from india, and 8-mL vials with a concentration of 125 mg/mL after reconstitution heart attack marlie grace order cheap lasix line. The cooled solution was triturated with the sodium carboxymethylcellulose and left overnight blood pressure kits for nurses buy lasix visa. Ground hydrocortisone tablets were triturated with polysorbate 80 and the vehicle was added; water was added to 100 mL [7]. Acyclovir, amikacin, aminophylline, amphotericin B, ampicillin, atropine, aztreonam, calcium chloride, calcium gluconate, cefepime, chloramphenicol, clindamycin, dexamethasone, digoxin, dopamine, enalaprilat, epinephrine, erythromycin lactobionate, esmolol, famotidine, fentanyl, furosemide, heparin, hydralazine, insulin, isoproterenol, lidocaine, linezolid, lorazepam, magnesium, metoclopramide, metronidazole, morphine, neostigmine, netilmicin, nicardipine, oxacillin, pancuronium, penicillin G, piperacillin, piperacillin/tazobactam, potassium chloride, procainamide, propofol, propranolol, remifentanil, sodium bicarbonate, vecuronium and vitamin K1. The daily dose is a function of infant weight as indicated in the following table [1]. Adverse Effects 415 Micormedex NeoFax Essentials 2014 Infuvite Pediatric is administered in intravenous solutions, which may contain aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired [1]. Research indicates that patients with impaired kidney function, including premature neonates who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg per day accumulate aluminum at levels associated with central nervous system and bone toxicity. Anaphylactic reactions following parenteral multivitamin administration have been reported rarely [1]. Monitoring Assess blood vitamin concentrations periodically in patients on long-term therapy to monitor for vitamin deficiencies or excesses [1]. Special Considerations/Preparation After Infuvite Pediatric is diluted in an intravenous infusion, the resulting solution is ready for immediate use. Inspect visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Vial 1 (4 mL) Inactive ingredients: 50 mg polysorbate 80, sodium hydroxide and/or hydrochloric acid for pH adjustment and water for injection. Vial 2 (1 mL) Inactive ingredients: 75 mg mannitol, citric acid and/or sodium citrate for pH adjustment and water for injection. Adverse Effects Infuvite Pediatric is administered in intravenous solutions, which may contain aluminum that may be toxic. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solution, which contain aluminum. Store between 2 and 8 degrees C (36 and 46 418 Micormedex NeoFax Essentials 2014 degrees F). Administration Dilute prior to administration in an appropriate volume of dextrose or saline and give over 15 minutes [2]. This study was terminated early due to a recall of the intravenous ibuprofen lysine product; 105 of the needed 168 infants were enrolled by study 419 Micormedex NeoFax Essentials 2014 termination [4]. Pharmacology Ibuprofen lysine is a lysine salt solution of racemic ibuprofen, an inhibitor of prostaglandin synthesis. Adverse Effects Decreased urine output is less severe and occurs less frequently than with indomethacin [3] [5]. The cohorts were from 2 separate decades which could introduce historical bias [7]. Special Considerations/Preparation 420 Micormedex NeoFax Essentials 2014 Supplied as a 10-mg/mL sterile solution for injection in 2-mL single use vials. Bellini C: Pulmonary hypertension following L-lysine ibuprofen therapy in a preterm infant with patent ductus arteriosus. This study was terminated early due to a recall of the intravenous ibuprofen lysine product; 105 of the needed 168 infants were enrolled by study termination [4]. The mean half-life in premature neonates is approximately 43 hours, with large interpatient variability. Adverse Effects 422 Micormedex NeoFax Essentials 2014 Decreased urine output is less severe and occurs less frequently than with indomethacin [3] [5]. Although the available (and few) data suggest that the displacement of bilirubin from albumin is minimal with an ibuprofen dosing regimen of 10-, 5-, 5-mg/kg (every 24 hr), a more significant increase in unbound bilirubin can be expected in those infants with a high unconjugated bilirubin/albumin ratio and those in whom high ibuprofen concentrations are achieved [6]. Special Considerations/Preparation Supplied as a 10-mg/mL sterile solution for injection in 2-mL single use vials. Should be diluted prior to administration in an appropriate volume of dextrose or saline. Terminal Injection Site Compatibility Ceftazidime, dopamine, epinephrine, furosemide, heparin, insulin, morphine, phenobarbital, potassium chloride, sodium bicarbonate. Ohlsson A: Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants. Pharmacology Imipenem is a broad-spectrum carbapenem antibiotic combined in a 1:1 ratio with cilastatin, a renal dipeptidase inhibitor with no intrinsic antibacterial activity. Clearance is directly 424 Micormedex NeoFax Essentials 2014 related to renal function. Special Considerations/Preparation Available as powder for injection in 250-mg, and 500-mg vials. When reconstituted with compatible diluent, solution is stable for 4 hours at room temperature, 24 hours refrigerated. Terminal Injection Site Incompatibility Amikacin, amiodarone, azithromycin, fluconazole, gentamicin, lorazepam, milrinone, sodium bicarbonate, and tobramycin. Local reactions at the injection site and increased platelet counts are the most frequent adverse effects. Other reactions, including eosinophilia, elevated hepatic transaminases, and diarrhea, also occur in more than 5% of patients. Terminal Injection Site Compatibility Acyclovir, aztreonam, cefepime, famotidine, insulin, linezolid, midazolam, propofol, remifentanil, and zidovudine. Contraindications/Precautions Contraindicated in active bleeding, significant thrombocytopenia or coagulation defects, necrotizing enterocolitis, untreated proven or suspected infection, and/or significantly impaired renal function [1]. Metabolized in the liver to inactive compounds and excreted in the urine and feces. In most studies, the response of the ductus and adverse effects of indomethacin are only weakly correlated with plasma concentration. Adverse Effects Hypoglycemia is common, usually preventable by increasing the glucose infusion rate by 2 mg/kg per minute. Reconstituted indomethacin is stable in polypropylene syringes and glass vials for 12 days when stored at room temperature or refrigerated. Title Indomethacin Dose Closure of Ductus Arteriosus: Usually three doses per course, maximum two courses. If oliguria occurs, observe for hyponatremia and hypokalemia, and consider prolonging the dosing interval of renally excreted drugs (eg, gentamicin). Concomitant therapy with furosemide may lead to increased hyponatremia and a significant rise in serum creatinine [2] [3]. Serum half-life is approximately 30 hours, with a range of 15 to 50 hours, partially dependent on postnatal age. Rapid (less than 5-minute) infusions are associated with reductions in organ blood flow. Gastrointestinal perforations occur frequently if used concurrently with corticosteroids. Special Considerations/Preparation Supplied as a lyophilized powder in 1-mg single-dose vials [1]. Solution Compatibility 431 Micormedex NeoFax Essentials 2014 Sterile water for injection. Terminal Injection Site Compatibility Furosemide, insulin, nitroprusside, potassium chloride, and sodium bicarbonate. Terminal Injection Site Incompatibility Calcium gluconate, cimetidine, dobutamine, dopamine, gentamicin, and tobramycin. Insulin and dextrose dosages are adjusted based on serum glucose and potassium concentrations. The use of higher insulin concentrations and longer wait times will shorten the time to steady-state. Other studies have examined preconditioning and/or priming volumes; running a certain volume of insulin infusion through the tubing prior to initiation. A recent study found that 20 mL of priming volume was sufficient to minimize adsorption losses for a 1 unit/mL insulin infusion. Enhances cellular uptake of glucose, conversion of glucose to glycogen, amino acid uptake by muscle tissue, synthesis of fat, and cellular uptake of potassium. Monitoring Follow blood glucose concentration frequently (every 15 to 30 minutes) after starting insulin infusion and after changes in infusion rate. Amiodarone, ampicillin, aztreonam, caspofungin, cefazolin, cefoxitin, cimetidine, digoxin, dobutamine, esmolol, famotidine, gentamicin, heparin, hydrocortisone succinate, ibuprofen lysine, imipenem, indomethacin, lidocaine, meropenem, midazolam, milrinone, morphine, nitroglycerin, pentobarbital, potassium chloride, propofol, ranitidine, sodium bicarbonate, sodium nitroprusside, ticarcillin/clavulanate, tobramycin, and vancomycin. Administration Intravenous: Only regular insulin for injection may be administered intravenously. For continuous infusion, dilute regular insulin in compatible solution to a concentration of 0. Euglycemic hyperinsulinemia due to exogenous insulin administration may cause metabolic acidosis. Terminal Injection Site Incompatibility Aminophylline, dopamine, micafungin, nafcillin, phenobarbital, and phenytoin. Uses Adjuvant treatment of fulminant neonatal sepsis, hemolytic jaundice, and neonatal alloimmune thrombocytopenia. Contraindications/Precautions Contraindicated in patients with selective IgA deficiency [1]. Significant lot-to-lot variation of specific antibodies may occur with all products. Adverse Effects Rare cases of hypoglycemia, transient tachycardia, and hypotension that resolved after stopping the infusion have been reported. The risk of necrotizing enterocolitis may be increased in term and late preterm infants treated for isoimmune hemolytic jaundice. The manufacturing process of these products now includes a 440 Micormedex NeoFax Essentials 2014 solvent/detergent treatment to inactivate hepatitis C and other membrane-enveloped viruses. Special Considerations/Preparation *Reconstitute lyophilized products with supplied diluent. Use immediately (no more than 2 hours after reconstitution if prepared Gammagard S/D 2. Use immediately once vial has been entered and discard any (Grifols) use solution stabilized) unused portion. Gamunex 10% 10% ready-forNone (glycine Vials pooled under aseptic conditions must be used within 8 hours. Use immediately once vial has been entered; discard unused Octagam 5% 5% ready-for-use 100 mg/mL portion. Use immediately once vial has been entered and discard any unused Privigen 10% 10% ready-forproline portion. Intravenous immunoglobulin and necrotizing enterocolitis in newborns with hemolytic disease. Title Intravenous Immune Globulin (Human) Dose Usual Dosage: 500 to 750 mg/kg per dose over 2 to 6 hours. For neonatal alloimmune thrombocytopenia, doses have ranged from 400 mg/kg to 1 g/kg. Most studies have used a single dose, although additional doses have been given at 24 hour intervals. Uses 444 Micormedex NeoFax Essentials 2014 Adjuvant treatment of fulminant neonatal sepsis, hemolytic jaundice, and neonatal alloimmune thrombocytopenia. Serious immediate anaphylactic and hypersensitivity reactions have been reported rarely. The manufacturing process of these products now includes a solvent/detergent treatment to inactivate hepatitis C and other membrane-enveloped viruses [1]. Use caution in patients predisposed to acute renal failure and administer at the minimum concentration available and the minimum rate of infusion practicable in such patients. No significant differences in clinical outcomes using the different products have been seen. All preparations are reported to contain more than 92% IgG monomers and a normal distribution of IgG subclasses. Total IgG titers in treated, septic neonates remain elevated for approximately 10 days. Animal studies have demonstrated reticuloendothelial system blockade when higher doses (greater than 1 g/kg) have been used. The manufacturing process of these products now includes a solvent/detergent treatment to inactivate hepatitis C and other membrane-enveloped viruses. Shelf life varies, but is at least 445 Micormedex NeoFax Essentials 2014 2 years, when stored properly. Use immediately once vial has 10% read-for-use None (glycine 10% been entered and discard any unused portion. Solution is stable for 24 hours with aseptic technique and continuous refrigeration. Gammaked 10% 10% ready-forNone (glycine Store at room temperature or refrigerated. Gadient P: Juvenile myasthenia gravis: three case reports and a literature review. Optimal dose in neonates has yet to be determined due to differences in aerosol drug delivery techniques, although the therapeutic margin appears to be wide.

Elderly or debilitated patients seem to tolerate peptic ulceration or bleeding less well when these events do occur blood pressure 35 year old female purchase cheapest lasix. Naproxen is known to be substantially excreted by the kidney hypertension recipes buy on line lasix, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function blood pressure levels low too low buy 40 mg lasix. Because elderly patients are more likely to have decreased renal function iglesias heart attack buy lasix mastercard, care should be taken in dose selection blood pressure medication names starting with m purchase cheap lasix on-line, and it may be useful to monitor renal function [see Clinical Pharmacology (12 hypertension lisinopril purchase lasix online now. Geriatric patients may be at a greater risk for the development of a form of renal toxicity precipitated by reduced prostaglandin formation during administration of nonsteroidal anti-inflammatory drugs [see Warnings and Precautions (5. Hypertension, acute renal failure, respiratory depression, and coma have occurred, but were rare [see Warnings and Precautions (5. Because naproxen sodium may be rapidly absorbed, high and early blood levels should be anticipated. A few patients have experienced convulsions, but it is not clear whether or not these were drug-related. Consider emesis and/or activated charcoal (60 to 100 grams in adults, 1 to 2 grams per kg of body weight in pediatric patients) and/or osmotic cathartic in symptomatic patients seen within four hours of ingestion or in patients with a large overdosage (5 to 10 times the recommended dosage). Forced diuresis, alkalinization of urine, hemodialysis, or hemoperfusion may not be useful due to high protein binding. For additional information about overdosage treatment contact a poison control center (1-800-222-1222). Naproxen is a propionic acid derivative related to the arylacetic acid group of nonsteroidal anti-inflammatory drugs. Naproxen and naproxen sodium have the following structures, respectively: Naproxen is an odorless, white to off-white crystalline substance. It is lipid-soluble, practically insoluble in water at low pH and freely soluble in water at high pH. Naproxen sodium is a white to creamy white, crystalline solid, freely soluble in water at neutral pH. The enteric coating dispersion contains methacrylic acid copolymer, talc, triethyl citrate, sodium hydroxide and purified water. The dissolution of this enteric-coated naproxen tablet is pH dependent with rapid dissolution above pH 6. Prostaglandins sensitize afferent nerves and potentiate the action of bradykinin in inducing pain in animal models. Because naproxen is an inhibitor of prostaglandin synthesis, its mode of action may be due to a decrease of prostaglandins in peripheral tissues. These differences between naproxen products are related to both the chemical form of naproxen used and its formulation. Steady-state levels of naproxen are reached in 4 to 5 days, and the degree of naproxen accumulation is consistent with this half-life. This suggests that the differences in pattern of release play only a negligible role in the attainment of steadystate plasma levels. Residence time in the small intestine until disintegration was independent of food intake. The presence of food prolonged the time the tablets remained in the stomach, time to first detectable serum naproxen levels, and time to maximal naproxen levels (Tmax), but did not affect peak naproxen levels (Cmax). At doses of naproxen greater than 500 mg/day there is less than proportional increase in plasma levels due to an increase in clearance caused by saturation of plasma protein binding at higher doses (average trough Css 36. The naproxen anion has been found in the milk of lactating women at a concentration equivalent to approximately 1% of maximum naproxen concentration in plasma [see Use in Specific Populations(8. Elimination Metabolism Naproxen is extensively metabolized in the liver to 6-0-desmethyl naproxen, and both parent and metabolites do not induce metabolizing enzymes. Both naproxen and 6-0-desmethyl naproxen are further metabolized to their respective acylglucuronide conjugated metabolites. Approximately 95% of the naproxen from any dose is excreted in the urine, primarily as naproxen (<1%), 6-0-desmethyl naproxen (<1%) or their conjugates (66% to 92%). In patients with renal failure metabolites may accumulate [see Warnings and Precautions (5. Specific Populations Pediatric: In pediatric patients aged 5 to 16 years with arthritis, plasma naproxen levels following a 5 mg/kg single dose of naproxen suspension [see Dosage and Administration (2)] were found to be similar to those found in normal adults following a 500 mg dose. Pharmacokinetic studies of naproxen were not performed in pediatric patients younger than 5 years of age. Pharmacokinetic parameters appear to be similar following administration of naproxen suspension or tablets in pediatric patients. Geriatric: Studies indicate that although total plasma concentration of naproxen is unchanged, the unbound plasma fraction of naproxen is increased in the elderly, although the unbound fraction is <1% of the total naproxen concentration. Unbound trough naproxen concentrations in elderly subjects have been reported to range from 0. Hepatic Impairment: Naproxen pharmacokinetics has not been determined in subjects with hepatic insufficiency. Chronic alcoholic liver disease and probably other diseases with decreased or abnormal plasma proteins (albumin) reduce the total plasma concentration of naproxen, but the plasma concentration of unbound naproxen is increased. Renal Impairment: Naproxen pharmacokinetics has not been determined in subjects with renal insufficiency. Given that naproxen, its metabolites and conjugates are primarily excreted by the kidney, the potential exists for naproxen metabolites to accumulate in the presence of renal insufficiency. Mutagenesis Naproxen tested positive in the in vivo sister chromatid exchange assay for but was not mutagenic in the in vitro bacterial reverse mutation assay (Ames test). Impairment of Fertility Male rats were treated with 2, 5, 10, and 20 mg/kg naproxen by oral gavage for 60 days prior to mating and female rats were treated with the same doses for 14 days prior to mating and for the first 7 days of pregnancy. Generally, response to naproxen has not been found to be dependent on age, sex, severity or duration of rheumatoid arthritis. In patients with osteoarthritis, the therapeutic action of naproxen has been shown by a reduction in joint pain or tenderness, an increase in range of motion in knee joints, increased mobility as demonstrated by a reduction in walking time, and improvement in capacity to perform activities of daily living impaired by the disease. In a clinical trial comparing standard formulations of naproxen 375 mg twice a day (750 mg a day) vs 750 mg twice a day (1500 mg/day), 9 patients in the 750 mg group terminated prematurely because of adverse events. Nineteen patients in the 1500 mg group terminated prematurely because of adverse events. In clinical studies in patients with rheumatoid arthritis, osteoarthritis, and polyarticular juvenile idiopathic arthritis, naproxen has been shown to be comparable to aspirin and indomethacin in controlling the aforementioned measures of disease activity, but the frequency and severity of the milder gastrointestinal adverse effects (nausea, dyspepsia, heartburn) and nervous system adverse effects (tinnitus, dizziness, lightheadedness) were less in naproxen-treated patients than in those treated with aspirin or indomethacin. In patients with ankylosing spondylitis, naproxen has been shown to decrease night pain, morning stiffness and pain at rest. In double-blind studies the drug was shown to be as effective as aspirin, but with fewer side effects. In patients with acute gout, a favorable response to naproxen was shown by significant clearing of inflammatory changes. Naproxen has been studied in patients with mild to moderate pain secondary to postoperative, orthopedic, postpartum episiotomy and uterine contraction pain and dysmenorrhea. Onset of pain relief can begin within 1 hour in patients taking naproxen and within 30 minutes in patients taking naproxen sodium. Analgesic effect was shown by such measures as reduction of pain intensity scores, increase in pain relief scores, decrease in numbers of patients requiring additional analgesic medication, and delay in time to remedication. Naproxen may be used safely in combination with gold salts and/or corticosteroids; however, in controlled clinical trials, when added to the regimen of patients receiving corticosteroids, it did not appear to cause greater improvement over that seen with corticosteroids alone. When added to the regimen of patients receiving gold salts, naproxen did result in greater improvement. Its use in combination with salicylates is not recommended because there is evidence that aspirin increases the rate of excretion of naproxen and data are inadequate to demonstrate that naproxen and aspirin produce greater improvement over that achieved with aspirin alone. Cardiovascular Thrombotic Events Advise patients to be alert for the symptoms of cardiovascular thrombotic events, including chest pain, shortness of breath, weakness, or slurring of speech, and to report any of these symptoms to their health care provider immediately [see Warnings and Precautions (5. Gastrointestinal Bleeding, Ulceration, and Perforation Advise patients to report symptoms of ulcerations and bleeding, including epigastric pain, dyspepsia, melena, and hematemesis to their health care provider. Hepatotoxicity Inform patients of the warning signs and symptoms of hepatotoxicity. Heart Failure and Edema Advise patients to be alert for the symptoms of congestive heart failure including shortness of breath, unexplained weight gain, or edema and to contact their healthcare provider if such symptoms occur [see Warnings and Precautions (5. Anaphylactic Reactions Inform patients of the signs of an anaphylactic reaction. Instruct patients to seek immediate emergency help if these occur [see Contraindications (4) and Warnings and Precautions (5. Tell your healthcare provider about all of the medicines you take, including prescription or over-the-counter medicines, vitamins or herbal supplements. Do not start taking any new medicine without talking to your healthcare provider first. No part of this publication may be reproduced, copied, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the copyright holder. Applications to reproduce, store, copy or translate should be made to the Secretary General. Reference to the document, its title and summary may be copied or abstracted in data retrieval systems without subsequent reference. It includes substantial new information concerning the human health consequences of exposure to this class of chemicals. Glycol mono-ethers are liquids that combine the solubility characteristics of ethers and alcohols since both functional groups are present. As a result, they are widely used in solvent applications, including formulations such as paints, inks and cleaning fluids. Non-solvent applications include uses as anti-icing agents in jet fuel, hydraulic system fluids and as chemical intermediates. The hazard assessment of several glycol ethers can be based on short-term exposure studies because long-term exposure have not lead to more severe or different systemic effects. Glycol ethers have the potential to penetrate the skin (as a liquid or vapour) and this, therefore, represents a potentially significant route of exposure. The majority of glycol ethers are of low acute toxicity; the main effect seen in laboratory animals at high doses is narcosis, typical of many solvents. Overall, numerous studies with glycol ethers show that they do not exhibit genotoxic activity. The results of carcinogenicity studies with glycol ethers are consistent with this lack of genotoxic activity. The systemic toxicity of the ethylene-based glycol ethers is mediated by their metabolism to the corresponding alkoxyacetic acids. Methyland ethyl-substituted ethylene glycol ethers can cause bone marrow depression, testicular atrophy, developmental toxicity, and immunotoxicity in animals. It should be noted that methyland ethyl-ethers of ethylene glycol are not used in consumer products in Europe. In contrast, the longer chain ethylene glycol ethers (ethylene glycol butyl ether, -propyl ether, -isopropyl ether and -phenyl ether) do not cause any of these effects. Toxicity commonly associated with the longer chain homologues involves red blood cell haemolysis (anaemia), to which humans are resistant. The alkoxyacetic acid metabolites of glycol ethers are responsible for the haemolysis. None of the ethylene-bond effects have been observed for the propylene glycol ethers (isomers in commercial products); they are secondary alcohols and cannot be metabolised to their corresponding alkoxypropionic acids. The only change observed with propylene glycol ethers is an adaptive liver response and male rat kidney toxicity, which is not considered relevant to humans. Many such reports relate to methyland ethyl-substituted glycol ethers and are confounded by simultaneous exposures to other chemicals as well as limited information on exposure levels, which do not allow firm conclusions to be made concerning the contribution of glycol ethers to the observed effects. The toxicological findings reported to date indicate that, except for haemolytic anaemia and the liver and kidney effects in long-term studies, the effects seen in animals are also relevant to humans. They are therefore widely used in solvent applications, including formulations such as paints, inks and cleaning fluids. Clinical signs of acute intoxication in animals are consistent with non-specific depression of the central nervous system, which is typical of many solvents. Lethargy and haemoglobinuria have been observed in glycol ethers that produced haemolysis in rodents. Although some glycol ethers are irritant to the eye, most are not, and none are appreciably irritant to the skin on acute exposure. As with other solvents, prolonged or repeated skin exposure may lead to a severe skin irritation. It is recognised that the glycol ether class lacks specific determinants for either genotoxicity or carcinogenicity. Negative results obtained in conventional genotoxicity assays, both in vivo and in vitro, confirm the lack of genotoxic activity for this class of solvents. Some glycol ethers have been tested in life-time studies in rats and mice, including ethylene glycol ethyl ether, ethylene glycol n-butyl ether, diethylene glycol ethyl ether, 2-propylene glycol 1-methyl ether and propylene glycol tert-butyl ether. However, the tumour responses seen in these cases were probably caused by mechanisms that are species-specific or reflect a mode of action to which humans are resistant. Overall, glycol ethers do not pose a significant genotoxic or carcinogenic risk to humans. For the ethylene-based glycol ethers, the major route of metabolism is via alcohol and aldehyde dehydrogenases to the corresponding alkoxyacetic acids. A secondary route involves O-dealkylation to ethylene glycol and its oxidation metabolites. The minor impurity isomers are, like the ethylene glycol ethers, substrates for alcohol and aldehyde dehydrogenases, producing the corresponding propoxyacetic acids.

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However blood pressure 75 over 55 buy genuine lasix line, no information was available on the concentrations of thyroxine wykladzina arteria 95 discount 100mg lasix with mastercard, triiodothyronine or thyroid-stimulating hormone in long-term bioassays in rodents prehypertension heart attack lasix 40mg overnight delivery. Therefore hypertension pathophysiology discount lasix generic, while hepatic metabolism of thyroxine resulting in increased thyroidstimulating hormone is possibly involved in the induction of thyroid tumours in rats phase 4 arrhythmia buy lasix 100 mg with mastercard, the other mechanisms cannot be excluded because the information is incomplete prehypertension 131 discount lasix 100mg free shipping. In mice, increased hepatocellular proliferation has been found at doses that produce hepatocellular cancer in mice. In rats, liver toxicity has been shown to be accompanied by enhanced lipid peroxidation and generation of reactive oxygen species. They have been used since the 1950s for termite control, on agricultural crops, on lawns, on livestock and for other purposes. In these countries, human exposure is still possible owing to their persistence in the environment and their consequent occurrence in meat, fish and other fat-containing foodstuffs, but the mean daily intake has probably decreased. Although no excess was seen in the rate of mortality from all cancers, some, but not all, of the studies showed a slight excess of lung cancer. These studies differed widely in size and methods and in exposure assessment, which was either reported by the subjects themselves (or proxy respondents) or estimated from measures of the concentrations of chlordane metabolites in samples of fat tissue or blood. The populations studied also varied widely, some studies including higher proportions of farmers, who are occupationally exposed to pesticides, while the subjects in others (including most studies of women) had no occupational exposure to chlordane. In most studies, exposure to many other organochlorine or other types of pesticides was also assessed. In the studies in mice, increased incidences of hepatocellular neoplasms (including carcinomas) were seen in both males and females. In a third study in rats, technical-grade chlordane marginally increased the incidence of liver adenomas in male rats. Heptachlor, which is also a component of technical-grade chlordane, is biotransformed to its epoxide. Subsequent dechlorination reactions lead to hydroxylated compounds, which are excreted primarily as glucuronides. Accidental or intentional exposure to chlordane has resulted in signs of neurotoxicity and, in some cases, death. In experimental animals, the toxic effects of chlordane on the liver include lipid peroxidation and cell proliferation secondary to cytotoxicity. In the thyroid, chlordane has been shown to decrease thyroxine concentrations in rats. Both chlordane and heptachlor induce hepatic and gonadal microsomal oxidative enzymes and also steroid hormone metabolism. Chlordane and heptachlor are toxic to reproduction and development in mice, rats and mink. Preand postnatal exposures to chlordane affected the development of the immune system in rodents. No data were available on the genetic and related effects of chlordane or heptachlor in humans. Both compounds inhibited gap-junctional intercellular communication and induced gene mutations in rodent cells. There is sufficient evidence in experimental animals for the carcinogenicity of chlordane and of heptachlor. Overall evaluation Chlordane and heptachlor are possibly carcinogenic to humans (Group 2B). References Agency for Toxic Substances and Disease Registry (1989a) Toxicological Profile for Heptachlor/Heptachlor Epoxide (Report No. The determination of organo-halide pesticides in municipal and industrial wastewater. In: Compendium of Methods for the Determination of Toxic Compounds in Ambient Air, 2nd Ed. Scientific Reviews of Soviet Literature on Toxicity and Hazards of Chemicals: Heptachlor (Issue 3), Moscow, Centre of International Projects, United Nations Environment Programme Izushi, F. The mutagenicity of selected herbicides and insecticides in the Salmonella microsome test (Ames test) in relation to the pathogenetic potency of contaminated groundand drinking-water. Estimation of the dietary intake of organochlorine pesticides, heavy metals, arsenic, aflatoxin M1, iron and zinc through the total diet study, 1990/91. Hexachlorobenzene was produced or imported in the European Community at 8000 t/year in 1978, and a company in Spain reportedly produced an estimated 150 t/year. Approximately 1500 t/year of hexachlorobenzene were manufactured in Germany for the production of rubber chemicals, but this production was discontinued in 1993. Intentional production of hexachlorobenzene has declined as a result of restrictions on its use since the 1970s, but it may still be produced as an incidental by-product in some processes (see section 1. The major agricultural application was as a seed dressing for crops such as wheat, barley, oats and rye to prevent growth of fungi. The use of hexachlorobenzene in such applications was discontinued in many countries in the 1970s owing to concerns about adverse effects on the environment and human health. In industry, hexachlorobenzene has been used directly in the manufacture of pyrotechnics, tracer bullets and as a fluxing agent in the manufacture of aluminium. It has also been used as a starting material in the production of pentachlorophenol, a porositycontrol agent in the manufacture of graphite anodes, and as a peptizing agent in the production of nitroso and styrene rubber for tyres. In 1977, about 300 t of hexachlorobenzene were generated in Japan as a waste by-product in the production of tetrachloroethylene, almost all of which was incinerated. It was estimated that > 5000 t/year hexachlorobenzene were produced as a by-product during tetrachloroethylene production in the former Federal Republic of Germany in 1980. According to the Finnish Register of Employees Exposed to Carcinogens, 15 laboratory workers were exposed in Finland in 1997 (Savela et al. Hexachlorobenzene has been detected in workplace air during the production of pentachlorophenol in the Russian Federation (Melnikova et al. In 1994, the average concentration of hexachlorobenzene in the serum of 57 workers in a Spanish organochlorine compound factory was 120 fig/L. Maintenance workers had a higher average concentration (247 fig/L, n = 12) than production (105 fig/L, n = 36), laboratory (49 fig/L, n = 6) or administrative (16 fig/L, n = 3) workers (Sala et al. The average plasma concentration in nine Swedish aluminium foundry workers who used hexachloroethane for degassing was 313 ng/g of lipid (controls, 67 ng/g of lipid) in 1992 (Selden et al. Hence, hexachlorobenzene persists in the environment and may be expected to accumulate in sediment long after application has ceased. During the period when it was being used as a pesticide, a number of studies were carried out to determine its concentration in food. The concentrations of hexachlorobenzene in air are generally low, although they were higher in the past. Measurements between July 1988 and September 1989 in Egbert, Ontario (Canada), showed a wide range of concentrations in air, from 0. Measurements near chlorinated solvent and pesticide manufacturing facilities in 1974 revealed much higher concentrations in air, ranging from 24 to 23 296 ng/m3 (Agency for Toxic Substances and Disease Registry, 1998). The Niagara River, which drains a more heavily industrialized area, showed more variable and generally higher concentrations, ranging from 0. Under polluted conditions, much higher concentrations can occur (Agency for Toxic Substances and Disease Registry, 1998). Previous studies suggest that the contamination was greater when hexachlorobenzene use was common. Uncontrolled hazardous waste sites established in the early 1970s are some of the most heavily contaminated areas. Hexachlorobenzene in sediments can enter the food chain by uptake by small organisms in direct contact with sediment. The measured concentrations in composited fish samples from the Great Lakes ranged from < 2. More recent results show a decrease in concentrations in the Great Lakes, the concentrations in trout ranging from 0. Hexachlorobenzene is preferentially sequestered in fat, and the typical concentration in duck muscle was only 0. Newsome and Ryan (1999) reported a study of breast milk from various populations in northern and southern Canada in 1986, 1992 and 1996. The mean concentration in breast milk from Canadian women in a national study in 1992 was 14. Hexachlorobenzene is found in human tissues, including blood, with mean values of 3 fig/L in Spain (To-Figueras et al. Because of concerns about risks to human health and the environment, the use of hexachlorobenzene has been discontinued in many countries. Hexachlorobenzene is one of 12 persistent organic pollutants being considered for international action to reduce or eliminate their releases under a global convention. As of December 2000, the participating governments had agreed to phase out hexachlorobenzene and five other chlorinated pesticides (aldrin, chlordane, endrin, heptachlor and toxaphene) Hogue, 2000). During the examinations, 56 samples of milk were obtained from lactating women (Peters et al. Among the women in the population, no significant associations for equivalent sites were seen. The average concentration of hexachlorobenzene in 40 air samples taken from the area was 35 ng/m3, which was approximately 100 times higher than the average concentration measured in five samples taken in a control city (Barcelona). Similarly, the average concentration of hexachlorobenzene in sera from 13 local volunteers (26 fig/L; range 7. In addition, 608 of the 1800 study participants donated blood samples, which were analysed by gas chromotography for content of organochlorine compounds. In men, the concentrations were highest among those employed at the factory (geometric mean, 54. A benign or malignant neoplasm was reported by 13% of the female participants and 4. The confirmed cancer prevalence was non-significantly higher among inhabitants employed at the electrochemical factory than among the other study participants (odds ratio, 1. Body uptake was measured either by cumulated concentrations of hexachlorobenzene in breast adipose tissue samples, or in serum samples, or both. The results of these studies and of studies of cancers at other sites are summarized in Table 3. As hexachlorobenzene accumulates in fat tissue in increasing amounts with age, those studies in which the confounding effect of age was not strictly controlled for are difficult to interpret. The tissue samples were analysed for the content of neutral organochlorine compounds and polycyclic aromatic hydrocarbons by gas chromatography, and the concentrations were compared with those seen in breast tissue samples obtained during routine post-mortem examinations of 33 accidental fatalities. A total of 41 samples from cases (93%) and all 33 samples from controls showed detectable concentrations of hexachlorobenzene, yielding a mean concentration in positive samples of 140 ng/g (standard deviation, 80) and 110 (50) ng/g of fat, respectively, with an associated p value of 0. The mean ages were similar for the two groups (63 and 59 years for cases and controls, respectively), but more controls had a history of current or past smoking (15 of 20) than did cases (six of 20). The mean concentrations of hexachlorobenzene were 23 ng/g of fat (wet weight) in tissues of women with breast cancer and 20 ng/g in women with benign breast disease, with an associated p value in a test unadjusted for other variables of 0. The study subjects were chosen from among 41 women who were referred to the medical centre for a biopsy because of a breast mass and who volunteered to participate in the study; four were excluded as they had lesions of borderline malignancy. The estrogen receptor status of the adenocarcinomas was determined, and fat organochlorine concentrations, including hexachlorobenzene, were measured by high-resolution gas chromatography. The mean adipose tissue concentrations of hexachlorobenzene were 33 ng/g (standard deviation, 13) in the 17 control subjects, 42 ng/g (16) in nine estrogen receptor-positive subjects and 31 ng/g (11.

The common diseases which affect goats and sheep in sub-Saharan countries are helminthosis blood pressure medication with a b purchase lasix 100mg without a prescription, peste des petits ruminants prehypertension during third trimester order generic lasix line, contagious ecthyma hypertension 2 nigerian movie generic lasix 100mg on-line, goat/sheep pox blood pressure chart and pulse effective lasix 40mg, pneumonia blood pressure medication pregnancy discount 100mg lasix mastercard, anthrax blood pressure palpation buy lasix 40mg lowest price, blackquarter, footrot, caseous lymphadenitis and brucellosis. Other diseases include heartwater, coccidiosis, trypanosomosis, Nairobi sheep disease, Rift Valley fever, blue tongue, mastitis and tuberculosis. Mange mites, fleas, ticks, lice and Oestrus ovis are the major ectoparasites infesting small ruminants in the region. Most often, scientific literature published in journals is collected in libraries in universities and research institutions to which workers in the extension service have little access. Therefore, this handbook is an attempt to extend the accumulated knowledge on diseases of goats and sheep in subSaharan Africa to field workers. It is also suitable for students undertaking veterinary or small ruminant health-related studies in the region. Emphasis is on the most commonly reported diseases of goats and sheep but some of the less common conditions and those with a great potential to occur have also been mentioned. Authors are of the opinion that consultation of literature given under the list of references for further details will greatly complement the handbook. Two sub-systems, nomadism and transhumance are found under the extensive system of management. In the transhumant system, livestock production is associated with rain-fed agriculture. Under the extensive system, animals graze on communal land and, animal herds owned by different families or individuals compete for grazing and water. At night, animals are protected from theft and/or predation by confinement in night enclosures which are constructed using thorn bushes or wooden poles depending on the availability of these materials. The only human input into this system is the unpaid family labour used to look for the animals and the main management objective is to avoid risks of diseases, drought and to maintain herd numbers. Because of shortage of water and forage, malnutrition is the major limiting factor for profitable production of small ruminants particularly during the dry season. Intermingling of animals in communal grazing land facilitates spread of infectious diseases such as peste des petits ruminants, contagious caprine pleuropneumonia, contagious ecthyma, goat and sheep-pox, footrot, trypanosomosis, helminthosis and ectoparasitic infestations. In Cameroon, higher incidence of accidents has been observed among the extensive compared with intensively managed small ruminants. The high mobility of people and their animals in search of scarce resources, particularly under the nomadic system makes it difficult to devise or institute small ruminant improvement programmes. Livestock are sedentary, although movement of animals for a short-distance is not uncommon. Under the semi-intensive system, since most of the land is utilised for crop production, land available for animals is limited. Studies conducted in Tanzania, Kenya, Swaziland and Ethiopia have indicated that herd sizes under this system range between 1-20 goats or sheep although some households may have more animals. The restriction of feeding and sub-standard husbandry practices associated with this system results in lowered productivity of the animals just as in the extensive system. Supplementary 3 feeding of animals under this system has a great potential for improving productivity and because animals are sedentary, it is possible to institute small ruminant improvement programmes. Houses are similar to those under the agropastoral system, but in some areas, animals are kept in the family house for fear of theft. Animals are individually owned and only family labour is involved in animal management under this system. Because feeding is restricted, animals have no choice of feed and this results in poor body condition and low weight gains. Tethering has been found to be associated with low weight gains and predisposition of animals to heavy helminth burdens in Tanzania, Kenya, Cameroon, Nigeria and in the Gambia. Studies in Kenya have indicated that mineral deficiencies are common in tethered compared to free range goats. Stall-feeding Stall-feeding (zero-grazing) is commonly practised in the densely populated and intensively cultivated areas of Kenya, Tanzania, Nigeria and Ethiopia. Fodder crops are sometimes grown for the goats and concentrates are also provided. Houses are constructed of concrete or wooden walls, usually with slatted or concrete floors and thatched with grass or sheet iron roofs. Because of the high nutrient demand of dairy goats and, proper veterinary care which cannot be met under the extensive, semi-intensive and tethering system, 4 production can be very poor if the dairy goats are kept under such systems. In recent studies in Tanzania, it has been shown that, attempts by small-holders to raise dairy goats under the tethering system without supplementation have been disappointing. In Nigeria, some workers have reported that pneumonia is more prevalent in confined animals than in extensively kept small ruminants. Nevertheless, there is a great potential for increasing milk production under this sub-system especially in peri-urban and urban areas. This an efficient mixed farming system where animals graze below tree crops and are protected from heat stress by the tree canopy shade. In return, they fertilise the land with their excreta, graze waste herbage and control weeds. This system is not widespread in the sub-Saharan region although small ruminant commercial or stud flocks are important components of ranching systems in South Africa, Kenya, Zimbabwe and Swaziland. In other countries, the systems are mostly identified with government and research institutions. Animals are either stall-fed or grazed on improved pastures during the day and are housed at night. Most commonly small ruminants are integrated with dairy, beef and sometimes large scale crop farming. However, considerable economic losses may be encountered under this system if husbandry practices are poor. It follows from the above section that, the prevalence of various disease problems in small ruminants are influenced by management systems. Therefore, any disease control programmes in an area should be formulated with due consideration of the management systems. Adeniji 5 (Editor) Proceedings of the Workshop on the Improvement of Small Ruminants in West and Central Africa, 21-25 November 1988, Ibadan, Nigeria, pp 19-29. Proceedings of the Workshop on the Improvement of Small Ruminants in Eastern and Southern Africa, 18-22 August, Nairobi, Kenya, pp 333-342. Maasai Herding: An analysis of the livestock production system of Maasai pastoralists in eastern Kajiado District, Kenya. Kategile (Editors) Proceedings of the Workshop on the Improvement of Small Ruminants in Eastern and Southern Africa, 1822 August, Nairobi, Kenya, pp 91-109. Kategile (Editors) Proceedings of the Workshop on the Improvement of Small Ruminants in Eastern and Southern Africa, 18-22 August, Nairobi, Kenya, pp 357-364. A Kategile (Editors) Proceedings of the Workshop on the Improvement of Small Ruminants in Eastern and Southern Africa, Nairobi, pp 67-79. Proceedings of the Workshop on the Improvement of Small Ruminants in Eastern and Southern Africa, Nairobi, pp 343-351. Mubi (Editors) Proceedings of the Workshop on the Future of Livestock industries in East and Southern Africa, held at Kadona Ranch Hotel, Zimbabwe, 20-23 July 1992. Melaku (Editors) Proceedings of a Conference on African Small Ruminant Research and Development, 18-25 January 1989, Bamenda, Cameroon. Kategile (Editors) Proceedings of the Workshop on the Improvement of Small Ruminants in Eastern and Southern Africa, 18-22 August, Nairobi, Kenya, Wilson, R. Helminths cause direct losses due to deaths and indirect losses due to reduced productivity through reduced feed intake and liveweight gains and, decreased quality of skins, wool or mohair. Trichostrongylus axei, Bunostomum trigonocephalum, Cooperia curticei, Trichuris ovis, Trichuris globulosus, Strongyloides papillosus, Gaigeria pachyscelis and Chabertia ovina also contribute to the syndrome. Lungworms such as Dictyocaulus filaria, Muellerius capillaris and Protostrongylus rufescens cause parasitic bronchitis particularly in young animals. Fasciola gigantica is the commonest species associated with fasciolosis in most sub-Saharan countries. Fasciola hepatica has also been shown to be a significant cause of fasciolosis in highland areas of Kenya, north-eastern and southwestern Tanzania, Ethiopia, Lesotho and the Republic of South Africa. Clinical paramphistomosis in small ruminants is caused by Paramphistomum microbothrium. The significance of Stilesia globipunctata and Avitellina centripunctata infections in small ruminants in sub-Saharan Africa has not been well documented. The presence of other cestodes such as Echinococcus granulosus, Taenia ovis (metacestode, Cysticercus ovis), Taenia multiceps (metacestode, Coenurus cerebralis) and Taenia hydatigena (metacestode, Cysticercus tenuicollis) in tissues or organs leads to condemnation of the affected tissues/organs. Moisture facilitates horizontal and vertical migration of nematode larvae on the environment. The humid tropical climate is favourable for the survival, development and transmission of gastrointestinal nematodes throughout the year. High stocking density increases the contamination of the environment with nematode eggs or larvae and thus makes the infective stages to be more accessible to susceptible animals. On the other hand, low stocking rates and extensive management systems in the traditional husbandry systems preclude a built-up of high worm burdens. The concentration of animals at watering points particularly during the dry season may also result in massive contamination of pastures with eggs or larvae leading to outbreaks of parasitic gastro-enteritis. Tethering of goats and sheep during the wet season which is common in many agro-pastoral societies has been reported to result in increased environmental contamination with infective larvae and incidence of clinical disease. However, if tethered animals are moved each day to fresh ground and the number of animals in the area is small, the risk of helminthosis is reduced. Similarly, if animals are totally confined and fed on helminth free diets the risk of helminthosis is reduced. Anthelmintic treatment reduces the prevalence and severity of gastrointestinal nematode infections and may significantly influence their epidemiology. Indiscriminate use of anthelmintics may result in the development of resistant nematode strains and this 9 problem is increasing in importance across the sub-Saharan region. Host factors: the incidence rate and severity of infection with gastrointestinal nematodes can also be influenced by host factors such as age, breed, nutrition, physiological state and presence or absence of intercurrent infections. Hormonal changes during late pregnancy and lactation lower the resistance of the host to nematodes and consequently result in the establishment of higher worm burdens. Prolactin and glucocorticoids are considered to be modulators of periparturient egg rise in goats and sheep. Poor nutrition lowers the resistance of the animal thus enhancing the establishment of worm burdens and increasing the pathogenicity of the parasites. Trichostrongylus spp has a lower biotic potential and hence its establishment is slower. Some animals may harbour adult worms in the lungs and act as carriers which continue to contaminate the pastures and maintain the 10 infection in the environment. Therefore, factors which influence the epidemiology of the intermediate hosts will determine the epidemiology of the parasite as well. However, unlike gastrointestinal nematodes, trematodes have indirect life cycles and intermediate hosts play an important role in their epidemiology. The humid environment of most sub-Saharan countries is favourable for the embryonation and hatching of Fasciola spp eggs throughout the year. It has been found that the concentration of animals at watering points during the dry season is a favourable factor for the transmission of F. The eggs embryonate and hatch into first (L1), second (L2) and third (L3) larvae, the latter being the infective stage. Animals are infected with Haemonchus spp, Trichostrongylus spp and Oesophagostomum spp by ingestion of L3 with pastures. The larva of Trichuris ovis is contained within the egg and the infective L1 is released when the egg is ingested by the host. Lungworms Adult Dictyocaulus spp are found in the trachea or bronchi where eggs are produced. Under suitable conditions of temperature and moisture, the L1 hatches into L2 and L3. The L4 passes through the lymphatic and venous circulation to the heart and then through the pulmonary circulation to the lungs where they enter the alveoli. Maturation occurs in the bronchi or trachea and the mature worms start to produce eggs. Trematodes Adult Fasciola spp lay eggs in the bile ducts and the eggs are transported to the gall bladder through the bile. The cercariae leave the snail hosts, encyst onto herbage just below the water level and become metacercariae, which are the infective stage. They excyst in the duodenum, penetrate the intestinal wall and pass through abdominal cavity (or sometimes through the blood stream) to the liver where they penetrate the liver capsule. The immature flukes migrate in the liver parenchyma and then enter the bile ducts where they mature and start to produce eggs. The life cycle of Schistosoma spp is similar to that of Fasciola spp but when the eggs are passed out in the faeces of the host they already contain a miracidium which hatches shortly if environmental conditions are optimum. Gastrointestinal cestodes the adults worms are found in the small intestine of goats or sheep. However, most commonly in field infections the clinical and pathological features of parasitic gastro-enteritis are due to the additive pathogenic effects of several nematodes. Haemonchosis Haemonchosis is considered to be the most economically important disease of goats and sheep in Africa. Three syndromes; hyperacute, acute and chronic haemonchosis occur in goats and sheep. The syndrome is of short duration and is characterised by sudden death although in some animals dark coloured faeces may be seen before death. Hyperacute haemonchosis has limited gross pathological features due to sudden death, although a large number of immature or young adults may be found on the 13 abomasal mucosa at post mortem examination. At necropsy, chronic haemonchosis is characterised by pallor carcass, hyperplastic thickening of the abomasal wall, chronic expansion of the bone marrow and resorption of the cancellous and cortical bones. There may be sudden death without evidence of anaemia or emaciation but weakness of the legs is a frequent feature.