The relationship between experimental fluid therapy and wound edema in scald wounds.

It is evident clinically that fluid loads administered acutely after thermal injury increase wound edema, but this relationship has not been well defined. Scalded rats were given intravenous water loads of up to 40% body weight. Concomitantly, sodium and albumin loads were also varied around clinically recommended norms for resuscitation (0-48 mEq sodium/kg, albumin in concentration of 1-10%). Attendant edema and sodium content were measured in the wound and in uninjured skeletal muscle. Wound edema was found to be linearly related to the net volume of the fluid administered, irrespective, within wide limits, of its sodium or albumin content. The positivity of the slope of the regression of wound edema on administered volume varied depending on extent of the injury. The changes in uninjured muscle were comparatively small. Wound sodium content always closely paralleled water content. Since all of the treatments studied had an equivalent propensity to enter the wound, other criteria must be used to judge their efficacy in the resuscitation of acutely burned patients.

Cimetidine inhibits burn edema formation.

Large doses of cimetidine significantly inhibit edema formation in thermally injured rat skeletal muscle. Tissue sodium influx and potassium efflux is also sharply restricted. These effects were obtained even if the administration of cimetidine was delayed for up to 4 hours after injury, but no beneficial effect occurred if drug administration was delayed for 14 hours, when most of the edema had already accumulated. The minimal effective dose is between 0.1 to 0.2 mg/gm.

Cerium nitrate: a new topical antiseptic for extensive burns.

The wounds of 60 burned patients were treated topically with cerium nitrate, which was applied either as a cream or in aqueous solution. Cerium nitrate has a potent antiseptic effect in human burn wounds, especially against gram negative bacteria and fungi. Pseudomonas aeruginosa was recovered from the wounds infrequently and never predominated. Fungi were practically never found. No patient treated with cerium developed a necrotizing wound infection. Analysis of the detailed bacteriological data indicated that, in contrast to previous results with use of the nitrate or sulfadiazine salts of silver, when gram negative species predominated, the flora tended to be predominantly gram positive when cerium was used. Therefore, some patients were treated simultaneously with cerium nitrate and silver sulfadiazine; this resulted in an even more efficient suppression of the wound flora than was observed previously with either cerium alone or silver salts alone; results with the simultaneous topical therapy in patients with injuries that previously were uniformly lethal were excellent. No toxicity attributable to the use of cerium was observed, although one instance of methemoglobinemia due to nitrate was documented. The adsorption of topically applied cerium essentially is nil. The use of cerium nitrate was associated with a nearly 50 percent reduction in the anticipated death rate. Cerium nitrate is a promising new topical antiseptic agent for the treatment of burns, particularly when it is used in combination with silver sulfadiazine.

Renal function after thermal trauma: the effects of treatment on renal blood flow and sodium and water excretion.

Effective renal plasma flow, urine sodium excretion, and glomerular filtration rates were reduced markedly to 44%, 46%, and 60% of normal, respectively, in rats subjected to thermal trauma. A sodium load of about 2 mEq. per 100 Gm. of body weight restores these functions toward normal. Doubling the concomitant water load had no discernible beneficial effect, but rats resuscitated with the larger water load were in greater positive water balance. These experimental data suggest that the water loads commonly administered clinically for the treatment of burn shock may be unnecessarily large.

Concentration of mercury in animal products and soils of North Dakota.

Total mercury (Hg) was determined in milk, eggs, beef, pork, human head hair, soil and water obtained from four geographical areas of North Dakota. The sampling areas were selected on the basis of differences in prevalent agricultural practices, climate and topography. Statewide average Hg concentrations in ppb were milk, 0.8; eggs, 12; beef muscle, 5; beef liver, 10; pork muscle, 11; pork liver, 15; head hair, 1708; soil, 30; rainwater and well water, less than one. There were no significant differences observed among areas in Hg content of any substance sampled except beef muscle. Beef muscle obtained from areas 2 and 4 contained significantly (P less than or equal to 0.05) higher levels of Hg than beef muscle from the other two areas. However, the magnitudes of differences were small (4 to 6 ppb). Considerable variation among individual beef and swine were noted but only six beef of 453 sampled and three swine of 156 sampled had tissue Hg exceeding 50 ppb. Appreciable variation was observed in Hg in eggs with respect to farms within an area, eggs from the same farm, and sampling times within a year. Few eggs sampled contained more than 50 ppb. Significantly (P less than or equal to 0.01) higher levels of Hg were found in head hair of women as compared with men and relatively large differences among individuals were observed. Average Hg in hair was generally low irrespective of sex of donor or area of the state as compared with data given in the literature. Soil Hg levels were consistently low in all areas of the state, and no relationship between cropping practices and soil Hg was detected.