scholarly journals Aluminium leaching in fluid warming devices – A Review

Author(s):  
Danielle K. Bayoro ◽  
Daniel Hoolihan ◽  
Michael J Pedro ◽  
Edward A. Rose ◽  
Andreas D. Waldmann

Abstract Current guidelines recommend the use of an intravenous fluid warmer to prevent perioperative hypothermia. Among the various methods of warming intravenous fluids, contact warmers are among the most effective and accurate, particularly in clinical conditions requiring rapid infusions of refrigerated blood or fluids. Contact warmers put the infusate in direct contact with a heating block. Some fluid warmers use heating blocks manufactured from aluminium. Several recent publications, however, have shown that uncoated aluminium blocks can leach potentially toxic amounts of aluminium into the body. In this review we performed a systematic literature review on aluminium leaching with contact fluid warmers and describe what manufacturer and competent authorities did in the past years to ensure patient safety. The search resulted in five articles describing the aluminium leaching. Four different devices (Level 1 Fluid Warmer from Smiths Medical, ThermaCor from Smisson-Cartledge Biomedical, Recirculator 8.0 from Eight Medical International BV, enFlow from Vyaire) were shown to leach high levels of aluminium when heating certain intravenous fluids. One manufacturer (Vyaire) voluntarily removed their product from the market, while three manufacturers (Eight Medical International BV, Smisson-Cartledge Biomedical, and Smiths Medical) revised the instructions for use for the affected devices. The enFlow fluid warmer was subsequently redesigned with a parylene coating over the heating block. The scientific literature shows that by using a thin parylene layer on the heating block, the leaching of aluminium can be nearly eliminated without affecting the heating performance of the device.

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. SCI-33-SCI-33
Author(s):  
John W. Semple

The spleen is the largest secondary lymphoid organ in the body and contains up to 25 percent of the body's lymphocyte populations. It is not only responsible for initiating immune responses against a multitude of infectious antigens within its white pulp, it also has the exquisite ability to filter the blood and remove, for example, senescent erythrocytes and platelets. This natural process is carried out within the red pulp of the spleen which is composed monocyte-rich connective tissue cords of Billroth intertwined with sinus cavities lined by parallel-oriented endothelial cells that have interendothelial slits which allow for the mechanical sorting of "old" cells. This occurs because of the inability of the senescent cells to properly migrate through the endothelial fenestrae into the venous circulation allowing them to be identified by cells of the reticuloendothelial system (RES) and quickly destroyed by phagocytosis. This process also allows for the efficient recycling of iron from destroyed erythrocyte hemoglobin molecules. There are a wide variety of clinical conditions that can significantly alter the ability of the RES to destroy blood cells including hereditary blood cell defects, inflammation, cancer and abnormal immune responses. This lecture will focus on the central role that the spleen plays in not only generating immune responses against platelets but also in primarily causing the destruction of both senescent and antibody-opsonized platelets leading to thrombocytopenia. It will discuss the soluble and cellular mechanisms of splenic sequestration, destruction and the ability of the spleen to modulate anti-platelet immunity. Mechanisms involving complement activation, Fc Receptor-mediated phagocytosis, antibody dependent cellular cytotoxicity and platelet self-destruction will be addressed. It will compare the spleen's platelet destructive capabilities with other organs, particularly the liver and will detail how immune responses generated in the white pulp can modulate platelet destructive processes in the red pulp. Disclosures Semple: Amgen: Consultancy, Honoraria, Speakers Bureau; Rigel: Consultancy, Honoraria; UCB: Consultancy, Honoraria.


2020 ◽  
pp. 30-30
Author(s):  
Valeti Rajeswari ◽  
Kolluru V D Karthik ◽  
Srinivasula Sriranga Pravallika

Honey bee sting induced Cerebral infarction is a rare entity . We report a case of 55year old male presented with anaphylactic shock following honey bee sting along with weakness of left side of the body and the face . He was managed with anti histaminics, adrenaline injections, Intravenous fluids , vasopressors , anti platelets and anticoagulants .


Anaesthesia ◽  
1991 ◽  
Vol 46 (4) ◽  
pp. 318-319
Author(s):  
J.P. Nolan ◽  
A.A.C. Dow
Keyword(s):  

2013 ◽  
pp. 16-22
Author(s):  
Alessandro Castiglione ◽  
Claudia Aimoni ◽  
Giovanni Scanelli

Background: Balance is primarily related to the proper functioning of three sensory input: vestibular, visual and proprioceptive. The integration of these different afferences contributes to the proper attitude of the body in static and dynamic conditions. Equilibrium disorders are common among elderly patients and are responsible for falls and fractures, leading sometimes to catastrophic outcomes, representing a serious health and social problem. Approximately one third of elderly patients at home and about 50% of institutionalized, over 75 year-old, suffer from this particular condition, with at least one fall a year and almost 50% of these with recurrent episodes. Females are more affected than males. Attempts to ascertain the underlying cause of unbalance should be done, leading then to specific treatment. Nevertheless, many elderly patients do not have a single disease but rather a multitude of medical conditions which may cause dizziness, imbalance and vertigo: effects of ageing, drugs, cardiovascular and neurological disorders, ocular and orthopaedic diseases. Aim of the study: A literature review was carried out with the intention to offer practical and useful notions for the management and treatment of equilibrium disorders. Discussion: In clinical practice, the main challenge is to distinguish between peripheral and central imbalance disorders. The data collected from history and clinical exams should be integrated with the intent to include the patient in one of the following clinical conditions: vertiginous syndrome, pre-syncope and/or syncope, neurological diseases, other conditions.Conclusions: Following the differential diagnosis, treatment mainly consists in drug administration (antiemetic and vestibular suppressor drugs) and vestibular rehabilitation (physiotherapy and vestibular exercises).


1942 ◽  
Vol 76 (1) ◽  
pp. 15-30 ◽  
Author(s):  
W. M. Balfour ◽  
P. F. Hahn ◽  
W. F. Bale ◽  
W. T. Pommerenke ◽  
G. H. Whipple

Radio iron is a tool which makes iron absorption studies quite accurate in dogs and reasonably satisfactory in human beings. This method is vastly superior to others previously used. Normal human pregnancy without significant anemia may show active radio iron absorption—16 to 27 per cent of iron intake. The pregnant woman as a rule shows 2 to 10 times the normal absorption of radio iron. Diseased states in which iron stores are known to be very abundant—pernicious anemia, hemochromatosis, familial icterus, and Mediterranean anemia —show very little absorption, probably less than normal. This is in spite of a severe anemia in all conditions except hemochromatosis. Chronic infections in spite of anemia show no utilization of radio iron, whether it may be absorbed or not. Leukemia shows little utilization of radio iron in red cells in spite of absorption (autopsy), probably because of white cells choking the red marrow. Polycythemia shows very low values for iron absorption as do normal persons. Two pregnant women showed only normal iron absorption. We believe that reserve stores of iron in the body, rather than anemia, control iron absorption. This control is exerted upon the gastro-intestinal mucosa which can refuse or accept iron under various conditions.


2018 ◽  
Vol 6 ◽  
pp. 2050313X1775089 ◽  
Author(s):  
Girish Gulab Meshram ◽  
Neeraj Kaur ◽  
Kanwaljeet Singh Hura

Staphylococcal scalded skin syndrome is a condition which predominantly affects children and causes a spectrum of skin lesions. We present a case of a 2-month-old infant with complaints of fever and fragile blisters over the body. The mucosal areas were spared. The diagnosis of staphylococcal scalded skin syndrome was reached on clinical grounds and culture report. The patient responded well to the treatment, which included an antibiotic (cloxacillin), an analgesic (paracetamol), and hydration with intravenous fluids. He was discharged after 8 days, with almost complete resolution of his skin lesions. Having a high clinical suspicion for staphylococcal scalded skin syndrome, early diagnosis/treatment, and following robust hygiene measures are imperative for the effective management of staphylococcal scalded skin syndrome. More efforts are needed to develop novel therapies for staphylococcal scalded skin syndrome.


2005 ◽  
Vol 40 (2) ◽  
pp. 184-188 ◽  
Author(s):  
Scott W. Savage ◽  
Tad A. Gomez ◽  
Richard Burrell

Abstract-USP <797> is the culmination of the pharmacy professions’ low adoption of “recommended” Compounded Sterile Products’ (CSPs) guidelines and medication compounding incidents that were a result of these preparation practices. Currently, the Joint Commission on Accreditation of Health care Organizations (JCAHO) expects accredited health care agencies to comply with the provisions within USP <797>. This article depicts the Gap Analysis and subsequent Action Plan of a Level 1 trauma, academic medical center's structural and operational processes for the preparation of CSPs. The objective of this article series is to increase awareness, resources, and the body of information available for facilities’ assessing and strategically planning compliance and implementation of USP <797>.


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