Ranitidine and intragastric pH profiles in seriously ill patients

Hg, Dammann; Flasshoff, D; Müller, Peter; Kather, H; Simon, Bernd

doi:10.1007/bf01311717

Cited by 5 publications

(2 citation statements)

References 5 publications

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“…There are conflicting reports that ranitidine can produce sustained pH elevation in high-risk patients [88,89]. Other reports suggested that ranitidine is either comparable or superior to cimetidine in controlling gastric pH [90][91][92].…”

Section: Prophylaxismentioning

confidence: 99%

Stress Ulcer Syndrome

Zuckerman

Cort

Shuman

1988

J Intensive Care Med

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MO 63110.Stress ulcer syndrome refers to gastroduodenal erosions or ulcers that develop acutely in relation to major physiological stress, usually manifested clinically as upper gastrointestinal (UGI) bleeding. These lesions occur most often in the gastric fundus. Endoscopy has shown gastroduodenal mucosal lesions in 75 to 100% of intensive care unit (ICU) patients within 72 hours of admission. Patients at high risk for stress ulcer include those with large body surface area burns, intracranial lesions associated with coma, fulminant hepatic failure, sepsis, and trauma and abdominal, cardiovascular, and thoracic surgery patients. Also considered high risk are ICU patients with superimposed complications such as shock, mechanical ventilation for more than 3 days, coagulopathy, jaundice, and sepsis. Approximately 15% of ICU patients will experience UGI bleeding from stress ulcer. Patients bleeding from stress ulcer have an overall mortality rate approaching 65% compared with 9 to 22% mortality in patients without stress ulcer. When stratified according to occult blood loss versus clinically significant bleeding, mortality can be as high as 90% in patients overtly bleeding; 30% of deaths are directly related to bleeding. Both antacids and H 2 receptor antagonists are effective in prophylaxis for stress ulcer bleeding.Gastrointestinal bleeding is a major problem in intensive care medicine, and upper gastrointestinal (UGI) hemorrhage may occur in 10% or more of intensive care unit (ICU) patients [1]. Bleeding representing the usual spectrum of UGI mucosal lesions can be responsible for admission to the ICU, but bleeding can also be a secondary complication that occurs during the ICU stay. The latter has been referred to as the clinical syndrome of &dquo;stress ulcer.&dquo; Stress ulcers are acutely formed defects in the gastroduodenal mucosa that develop in a critically ill patient with a severe physiological derangement.

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Section: Prophylaxismentioning

confidence: 99%

Stress Ulcer Syndrome

Zuckerman

Cort

Shuman

1988

J Intensive Care Med

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“…However, neither repeated bolus injec tions of I I2-receptor antagonists nor omeprazole consis tently maintain intragastric pH above 4 in all patients [9][10][11][12][13][14][15]. Furthermore, continuous infusion is superior to re peated bolus injection of these drugs in reducing intra gastric acidity [9,10,15],…”

mentioning

confidence: 99%

Effect of Intravenous Infusion of Omeprazole and Ranitidine on Twenty-Four-Hour Intragastric pH in Patients with a History of Duodenal Ulcer

Kiilerich

Rannem²,

Elsborg³

1995

Digestion

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The effect on intragastric pH of two different dose regimens of continuous intravenous infusion of omeprazole (4 or 8 mg/h after a bolus of 80 mg), and ranitidine (0.25 mg/kg/h after a bolus of 50 mg) was studied in 10 patients with duodenal ulcer disease in symptomatic remission. The pH was monitored over 24-hour periods during fasting in a cross-over, randomised design including a baseline period. With the high omeprazole dose it was possible to maintain a pH ≥ 4 in all patients but 1 and 6 of the patients also maintained a pH ≥6. The lower dose of omeprazole seemed to be somewhat less effective. Continuous infusion of ranitidine was as efficient as the higher omeprazole infusion although with a tendency to decreased pH levels towards the end of the 24-hour period. Thus, in order to obtain consistently high pH levels of 4-6 over a prolonged period a continuous infusion of omeprazole, an 80-mg bolus plus a continuous infusion of 8 mg/h seem to be needed.

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