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Related Concept Videos

Drug Toxicity: Overview01:00

Drug Toxicity: Overview

Drug toxicity quantifies the harm a compound causes to an organism, varying by dose and potentially impacting whole systems or specific organs like the liver. Toxic reactions may arise from venomous insect or spider bites, with effects ranging from mild symptoms to severe outcomes such as brain damage or death. Common forms of acute poisoning include ethanol intoxication and overdose of pain or fever medications, with substances like GHB and heroin being particularly lethal at doses close to...
Drug Toxicity: Dose-Dependent Reactions01:24

Drug Toxicity: Dose-Dependent Reactions

Drug toxicities can be stratified into pharmacological, pathological, or genotoxic based on their mechanisms. The incidence and severity of these toxicities generally increase with the drug's concentration in the body and exposure time.Pharmacological toxicity is evident when the therapeutic effects of drugs overshoot into adverse reactions in a predictable, dose-dependent manner. Central nervous system (CNS) depression from barbiturates is a classic example, with effects escalating from...
Drug toxicity: Drug–Drug Interaction01:30

Drug toxicity: Drug–Drug Interaction

Drug–drug interactions can precipitate toxicity through multiple mechanisms. Absorption interactions alter how drugs enter the body, exemplified when ranitidine increases the absorption of basic drugs, while cholestyramine decreases the levels of propranolol. Protein binding interactions occur when drugs share the same binding sites on plasma proteins. Drugs like aspirin and warfarin, when bound in excess, can lead to increased free drug concentrations, enhancing the potential for...
Drug Distribution: Volume of Distribution01:25

Drug Distribution: Volume of Distribution

The volume of distribution refers to the theoretical volume necessary to contain the entire amount of an administered drug at the same concentration observed in the blood plasma. The body's intracellular fluid compartment, which makes up two-thirds of the total body water, is contrasted with the extracellular fluid compartment—comprising plasma and interstitial fluid—that accounts for one-third. The volume of distribution can vary depending on the characteristics of the drug.
Toxicokinetics: Overview01:21

Toxicokinetics: Overview

Studies that assess how a drug is absorbed, distributed, metabolized, and excreted (ADME) at toxic doses are termed toxicokinetics. Understanding toxicokinetics helps predict adverse drug reactions (ADRs) and manage toxicity in humans.Toxicokinetics differs from pharmacokinetics mainly in the dose levels studied, with toxicokinetics focusing on higher toxic doses. The kinetics at these levels can be non-linear due to altered physiological processes. Toxicodynamics examines the relationship...
Drug Toxicity: Risk factors01:24

Drug Toxicity: Risk factors

Adverse Drug Reactions (ADRs) are potential complications that arise during pharmacotherapy, influenced by multiple risk factors. Age plays a significant role; both neonates and the elderly are at heightened risk due to their respective immature and diminished metabolic and elimination processes. Gender also impacts ADRs, with females experiencing a 1.5 to 1.7-fold greater risk than males, which may be linked to pharmacokinetic, pharmacodynamic, and hormonal differences. Notably, neonates, the...

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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
06:59

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

Published on: November 9, 2016

Fluids are drugs: type, dose and toxicity.

Karthik Raghunathan1, Andrew D Shaw, Sean M Bagshaw

  • 1Department of Anesthesiology, Duke University Medical Center/Durham VAMC, Durham, North Carolina, USA.

Current Opinion in Critical Care
|July 3, 2013
PubMed
Summary

Intravenous fluid therapy for critically ill patients requires careful consideration of fluid type and accurate dosing. Physiologically balanced crystalloids are often preferred, with dosing guided by volume responsiveness to minimize toxicity.

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Area of Science:

  • Critical care medicine
  • Pharmacology
  • Nephrology

Background:

  • Intravenous (i.v.) fluid therapy is a cornerstone in managing critically ill patients.
  • The choice of fluid, accurate dosing, and potential toxicities are critical considerations.

Purpose of the Study:

  • To discuss the formulation of intravenous fluid therapy prescriptions ('volume prescriptions') for critically ill patients.
  • To review the pros and cons of different fluid types, accurate dosing strategies, and qualitative/quantitative toxicities.
  • To interpret recent clinical trial results and updated physiologic concepts in i.v. fluid therapy.

Main Methods:

  • Review of current literature and clinical trial data on intravenous fluid therapy.
  • Interpretation of updated physiologic concepts relevant to fluid resuscitation.
  • Analysis of efficacy and safety profiles of different fluid types (crystalloids vs. colloids).

Main Results:

  • Fluid choice and dosing are critical; any fluid can be harmful if administered incorrectly.
  • While efficacy differences between crystalloids and colloids are modest, safety differences are significant.
  • Quantitative toxicity can be reduced by using dynamic parameters to predict volume responsiveness. Qualitative toxicity remains a concern for colloids and isotonic saline.

Conclusions:

  • Context is crucial for intravenous fluid therapy, akin to drug prescription.
  • Physiologically balanced crystalloids may serve as the default fluid for critically ill patients.
  • The role of colloids in fluid therapy is uncertain, and optimal dosing requires assessing volume responsiveness.