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Effect of ranitidine on gastric acid hypersecretion in an infant with short bowel syndrome
Insights
Ranitidine effectively reduced gastric acid hypersecretion in an infant with short bowel syndrome. Doses significantly inhibited acid output, improving nutrient absorption potential during enteral feeding trials.
Area of Science:
- Pediatric Gastroenterology
- Pharmacology
- Gastrointestinal Physiology
Background:
- Short bowel syndrome (SBS) in infants can lead to gastric acid hypersecretion, impairing nutrient absorption.
- Managing hypersecretion is crucial for optimizing nutritional outcomes in infants with SBS undergoing enteral feeding.
- Understanding the pharmacodynamics of antisecretory agents like ranitidine is essential for pediatric care.
Observation:
- Intravenous ranitidine was administered in graded doses to a 3-month-old male infant with SBS.
- Gastric volume and hydrogen ion (H+) secretion were serially measured for 12 hours post-administration.
- Plasma ranitidine concentrations were correlated with the inhibition of gastric acid secretion.
Findings:
- Ranitidine demonstrated dose-dependent inhibition of gastric acid secretion, with higher doses achieving over 90% inhibition within 4 hours.
- The drug significantly reduced gastric secretion volume by approximately 50% across all tested doses.
- The IC50 and IC90 values for H+ secretion inhibition were determined, providing pharmacokinetic insights.
- A potential decrease in ranitidine's antisecretory effect was observed towards the end of a 5-week treatment period, possibly linked to increased oxyntic mucosal function.
Implications:
- Ranitidine is a viable option for managing gastric acid hypersecretion in infants with SBS, potentially aiding enteral feeding success.
- Pharmacokinetic data (IC50, IC90) can guide optimal dosing strategies in this vulnerable population.
- Monitoring for potential tachyphylaxis or changes in mucosal function may be warranted with prolonged ranitidine use.
- The absence of observed adverse effects supports its safety profile in this infant study.
Abstract:
We studied the effect of ranitidine given in graded bolus intravenous doses on gastric acid hypersecretion in an unfed 3-month-old male with short bowel syndrome. We measured gastric volume and H+ serially for 12 h following each bolus and correlated inhibition of H+ secretion with plasma ranitidine concentration. In the first 4 h post drug, doses of 0.3, 1.0, 2.0, and 4.0 mg/kg resulted in 78, 93, 97, and 98% inhibition, respectively. The cumulative 12-h effect of the drug was to inhibit H+ secretion 67, 63, 72, and 87%. The IC50 for H+ secretion was between 50 and 100 ng/ml, and the IC90 between 130 and 150 ng/ml. Volume of gastric secretions was reduced by approximately 50% by all ranitidine doses. Because gastric acid hypersecretion interferes with nutrient absorption, the infant was treated with ranitidine during a 5-week trial of enteral feeding. A decrease in the antisecretory effect of ranitidine apparent at the end of the treatment period temporally related to an increase in oxyntic mucosal function. No adverse drug effects were observed during treatment.