A model of gastric emptying using paracetamol absorption in intensive care patients

Tarling, Maggie; Toner, Christopher C.; Withington, P. S.; Baxter, M.K.; Whelpton, Robin; Goldhill, D. R.

doi:10.1007/s001340050325

Cited by 152 publications

(101 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Gastric emptying was assessed by the acetaminophen absorption model. [26][27][28][29] Immediately before administering each study drug or the placebo, 1000 mg of enteral acetaminophen (Zenith Goldline Laboratories, Ft. Lauderdale, FL) as 31.25 mL of solution (32 mg/mL) was administered followed by 10 mL of sterile water. Arterial blood samples of 3 mL were taken from an indwelling catheter at baseline and seven additional times between 30 mins and 720 mins to determine serum acetaminophen concentrations.…”

Section: !mentioning

confidence: 99%

“…39 We evaluated gastric emptying with the acetaminophen absorption model. Studies in healthy, 26,40 diabetic, 27 hospitalized, 28 and critically ill 29 subjects have demonstrated that acetaminophen absorption is significantly correlated with gastric emptying. This model has been used in other studies to assess gastric emptying in subsets of critically ill patients 41,42 and studies evaluating prokinetic agents.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: A randomized, placebo-controlled, crossover study

MacLaren

Kuhl

Gervasio

et al. 2000

Critical Care Medicine

View full text Add to dashboard Cite

Section: !mentioning

confidence: 99%

mentioning

confidence: 99%

Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: A randomized, placebo-controlled, crossover study

MacLaren

Kuhl

Gervasio

et al. 2000

Critical Care Medicine

View full text Add to dashboard Cite

“…Tarling and co-workers found sub-therapeutic plasma levels of enterally administered paracetamol, and showed that gastric emptying time varied significantly between patients. [5] Patients in the ICU often have increased vascular permeability secondary to cytokine release, as well as hypo-albuminaemia, which alter the volume of distribution. [6] Furthermore, drug metabolism and excretion may be profoundly affected by hepatic and renal dysfunction.…”

mentioning

confidence: 99%

The pharmacokinetics of enteral antituberculosis drugs in patients requiring intensive care

et al. 2013

View full text Add to dashboard Cite

Background. There is a paucity of data on the pharmacokinetics of fixed-dose combination enteral antituberculosis treatment in critically ill patients. Objectives. To establish the pharmacokinetic profile of a fixed-dose combination of rifampicin, isoniazid, pyrazinamide and ethambutol given according to weight via a nasogastric tube to patients admitted to an intensive care unit (ICU). Methods. We conducted a prospective, observational study on 10 patients (mean age 32 years, 6 male) admitted to an ICU and treated for tuberculosis (TB). Serum concentrations of the drugs were determined at eight predetermined intervals over 24 hours by means of highperformance liquid chromatography. Results. The therapeutic maximum plasma concentration (C max ) for rifampicin at time to peak concentration was achieved in only 4 patients, whereas 2 did not achieve therapeutic C max for isoniazid. No patient reached sub-therapeutic C max for pyrazinamide (6 were within and 4 above therapeutic range). Three patients reached sub-therapeutic C max for ethambutol, and 6 patients were within and 1 above the therapeutic range. Patients with a sub-therapeutic rifampicin level had a higher mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score (p=0.03) and a lower estimated glomerular filtration rate (GFR) (p=0.03). Conclusions. A fixed-dose combination tablet, crushed and mixed with water, given according to weight via a nasogastric tube to patients with TB admitted to an ICU resulted in sub-therapeutic rifampicin plasma concentrations in the majority of patients, whereas the other drugs had a more favourable pharmacokinetic profile. Patients with a sub-therapeutic rifampicin concentration had a higher APACHE II score and a lower estimated GFR, which may contribute to suboptimal outcomes in critically ill patients. Studies in other settings have reported similar proportions of patients with 'sub-therapeutic' rifampicin concentrations.

show abstract

“…Gastric emptying GE was estimated using the Paracetamol absorption technique (Tarling et al, 1997), as Paracetamol is not absorbed in the stomach, but it rapidly enters the blood stream from the small intestine (Rawlins et al, 1997). Soluble Paracetamol (1.5 g) was dissolved in 100 ml water and given half way through the meal.…”

Section: Nutritional Contentmentioning

confidence: 99%

Glucagon-like peptide-1 (7–36) amide response to low versus high glycaemic index preloads in overweight subjects with and without type II diabetes mellitus

et al. 2007

View full text Add to dashboard Cite

Background and objective: Glucagon-like-peptide-1 (7-36) amide (GLP-1) is an insulin secretagogue and potential treatment for type II diabetes mellitus. An alternative to GLP-1 administration is endogenous dietary stimulation. We described a greater GLP-1 release following ingestion of liquids versus solids. We add to this work studying the effect of fluid preloads with differing glycaemic indices (GI) on the metabolic response to a meal. Subjects and design: GLP-1, insulin and glucose responses were measured in six overweight individuals and six subjects with type II diabetes on three occasions, after preload (milk, low GI; Ovaltine Light, high GI; or water, non-nutritive control) and meal ingestion. Results: In people with and without diabetes, the high GI preload produced the greatest glucose incremental area under the curve (IAUC) 0-20 , followed by the low GI preload, and water (Po0.001). In both groups, insulin IAUC 0-20 was higher following high and low GI preloads compared with water (NS). In people without diabetes, the GLP-1 response was higher when high and low GI preloads were consumed compared with water (P ¼ 0.041), with no significant difference between nutritive preloads. GLP-1 response did not differ between preloads in people with diabetes. Despite initial differences, total IAUCs 0-200 for biochemical variables did not differ by preload. Conclusion: We confirm that nutritive liquids stimulate GLP-1 to a greater extent than water in subjects without diabetes; however, this does not influence subsequent meal-induced response. The GI of preloads does not influence the degree of GLP-1 stimulation.

show abstract

A model of gastric emptying using paracetamol absorption in intensive care patients

Cited by 152 publications

References 22 publications

Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: A randomized, placebo-controlled, crossover study

Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: A randomized, placebo-controlled, crossover study

The pharmacokinetics of enteral antituberculosis drugs in patients requiring intensive care

Glucagon-like peptide-1 (7–36) amide response to low versus high glycaemic index preloads in overweight subjects with and without type II diabetes mellitus

Contact Info

Product

Resources

About