Some electrolyte disturbances in mechanically ventilated patients

Serum sodium and potassium were measured using the flame photometry and serum phosphorus by the calorimetric method before, during, and after withdrawal of mechanical ventilation in 20 GOAD patients. Ten patients who were not in need of mechanical ventilation were taken as a control, serum sodium and potassium and phosphorus were also measured on admission and before discharge. It was found that serum sodium was statistically significantly higher during mechanical ventilation comparable with its level before mechanical ventilation [P < 0.01] and with its level after withdrawal of mechanical ventilation [P < 0.05]. Serum sodium level was also higher in the 10 control patients before discharge from the respisatory intensive care unit, when compared with its level on admission [P < 0.05]. Serum potassium and phosphorus levels were found to be lower during mechanical ventilation when compared with their level before mechanical ventilation P < 0.001. There was no statistically significant change in serum potassium nor phosphorus in the control group. We conclude that mechanical ventilation may be associated with hypernatremia, hypokalaemia, and hypophosphatemia, and so it is necessary to estimate serum electrolytes frequently to correct any changes early and to avoid complications

Aminophylline therapy in chronic obstructive airway disease and concomitant ischaemic heart disease [COAD and concomitant IHD]

Forty patients with COAD had been selected 50% were non ischemic while the other 50% were ischemic. Each group was subdivided into those with maintenance aminophyllinemone therapy and another group on other bronchodilator, so on giving aminophylline would result in combined bronchodilator therapy. All our patients had a resting 12 leads E.C.G. Aminopylline was given 24 hours prior to 24 hours ambulatory E.C.G. in a dose of 500 mg every eight hours either by direct I.V. or by infusion. It was found that: Ventricular arrhythmogenicity detected only with the ischaemic group and was absent in the non ischaemic group, while it was minor in the form of grade Ia for those on aminophylline only, it was major in the form of runs of 2 and 3 for those; combined therapy. Supraventricular arrhythmogenicity in the ischaemic group was as that in the non ischaemic group i.e. normal to minor supraventricular arrhythmia. In those on monotherapy of aminophylline and major supraventicular arrhythmia in the form of runs of SVT in those on combined bronchodilator therapy. From these results we can conclude that in COAD and concomitant I.H.D. bronchodilating monotherapy with aminophylline in the normal than therapeutic doses is not contraindicated. On the other hand, when more than one bronchodilator is required it is better to couple aminophylline with inhale beta 2 agonists

Long-term prophylactic treatment of occupational asthma

A long-term one year therapeutic trial was conducted to evaluate ketotifen's protective effect and safety in 45 patients with occupational asthma and to determine whether concomitant bronchodilator and/or steroid therapy can be reduced during the treatment period. The patients were given ketotifen capsules of 1 mg twice daily for 12 consecutive months; before the start of treatment, then at monthly intervals, the patients were examined clinically for vital signs, degree of dyspnoea, presence of cough and expectoration, type of sputum and prolonged expiration and the number of asthma attacks since last examination. Ventilatory function tests were also done at the same intervals. The laboratory tests performed at the beginning of the trial and at monthly intervals entailed whole blood picture, urea, alkaline phosphatase, SGOT and SGPT. The drug was highly effective [hardly any symptoms, no asthmatic complaints remain, no anti- asthmatic treatment necessary] in 16 cases out of 45 [35.6%], it was effective in 25 cases [55.5%], its effect was moderate in 3 cases [6.7%] and it showed poor effect in one [2.2%]. excellent tolerance was recorded in 43 cases [95.6%] and good tolerance in two cases [4.4%]. The reported side effects were sedation and dryness of the mouth, which were of mild intensity, and did not necessitate discontinuation of treatment