Assuntos
Parada Cardíaca/induzido quimicamente , Hiperpotassemia/induzido quimicamente , Hiperpotassemia/complicações , Fármacos Neuromusculares Despolarizantes/efeitos adversos , Succinilcolina/efeitos adversos , Acidentes de Trânsito , Adulto , Infecções Bacterianas/complicações , Serviços Médicos de Emergência , Feminino , Febre/complicações , Escala de Coma de Glasgow , Traumatismos Cranianos Fechados/complicações , Traumatismos Cranianos Fechados/terapia , Humanos , Micoses/complicações , Fármacos Neuromusculares Despolarizantes/metabolismo , Doenças Neuromusculares/complicações , Junção Neuromuscular/efeitos dos fármacos , Potássio/sangue , Succinilcolina/metabolismoRESUMO
OBJECTIVE: To evaluate the evidence supporting the use of intravenous proton-pump inhibitors in the treatment of gastrointestinal (GI) hemorrhage in comparison with histamine(2) (H(2))-receptor antagonists. DATA SOURCES: Clinical literature was accessed through a MEDLINE search (1966-October 2002). Data from abstracts and fully published articles were retrieved for analysis. Key search terms included pantoprazole, omeprazole, proton-pump inhibitors, gastrointestinal hemorrhage, histamine(2)-receptor antagonists, ranitidine, and cimetidine. DATA SYNTHESIS: There are limited published clinical outcome data evaluating the use of intravenous pantoprazole in patients with upper GI hemorrhage. However, there are several gastric pH studies suggesting that intravenous pantoprazole is effective in quickly obtaining and maintaining a pH >6. When considering the results from studies of high-dose intravenous omeprazole, in addition to the pantoprazole data, the relative efficacy of intravenous proton-pump inhibitors appears to be superior to that of intravenous H(2)-receptor antagonists in providing a more predictable and sustained pH control. CONCLUSIONS: Intravenous proton-pump inhibitors are suitable, possibly superior, alternatives to intravenous H(2)-receptor antagonists in treatment of upper GI bleeding.