Subcutaneous Fluid Administration in Elderly Subjects: Validation of an Under‐Used Technique

Lipschitz, Stanley; Campbell, Alastair V.; Roberts, M. S.; Wanwimolruk, Sompon; McQueen, E. G.; McQueen, Malcolm; Firth, L. A.

doi:10.1111/j.1532-5415.1991.tb05898.x

Cited by 79 publications

(42 citation statements)

References 9 publications

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“…Sehen and SingerEdelstein [1] reviewed 1,850 s.c. infusions given to 270 patients in acute and long-stay geriatric beds and concluded that the s.c. route was the method of choice for adminis tering fluid to elderly patients in nonurgent situations. Other writers have reported simi lar findings [2][3][4], Lipschitz et al [7] demon strated using radioisotope tracers that normal saline (with hyaluronidase) given subcuta neously was rapidly and fully absorbed into the bloodstream.…”

Section: Discussionmentioning

confidence: 92%

“…For the purpose of this study, we used a continuous infusion over 24 h. Overnight infusions leave the pa tient free from restrictions by day and are par ticularly useful in patients requiring rehabili tation [4], Hyaluronidase, which breaks down s.c. tissue, increases the speed of absorption of s.c. fluids [2,7], but is not necessary in most patients.…”

Section: Discussionmentioning

confidence: 99%

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Subcutaneous Fluids in Elderly Hospital Patients with Cognitive Impairment

O'Keeffe

Lavan

1996

Gerontology

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Sixty patients (mean age 80 years) with cognitive impairment who required parenteral fluids for at least 48 h were randomized to receive either intravenous (i.v.) or subcutaneous (s.c.) fluids. There was no significant difference in the mean volume of fluid prescribed over 48 h in the two groups (s.c. 3.3 litres vs. i.v. 3.6 litres) or in the proportion of prescribed fluids actually administered (s.c. 0.82 vs. i.v. 0.76). After adjusting for baseline differences, there was no difference between serum urea or creatinine levels in the two groups at 48 h. Agitation related to the infusion was reported in 11 (37%) patients receiving s.c. fluids and 24 (80%) patients receiving i.v. fluids (p < 0.005). The cost of the cannulae used during the study was E6.80 for the s.c. group and E28.70 for the i.v. group. Local oedema was noted in 2 patients in the s.c. group and led to re-siting of the infusion in 1 patient. No other complication was noted. These results suggest that s.c. fluid therapy is the treatment of choice in nonurgent situations for confused patients who require parenteral fluids.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Subcutaneous Fluids in Elderly Hospital Patients with Cognitive Impairment

O'Keeffe

Lavan

1996

Gerontology

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“…10,23,[39][40][41][42] Clinical history demonstrates the increased dispersion and faster absorption of a broad range of drugs and fluids administered with hyaluronidase products. 10,23,[38][39][40][41][42][43][44] With rHuPH20, for example, Thomas and colleagues 45,46 have demonstrated an accelerated PK profile of SC morphine coadministered with rHuPH20 compared with SC morphine alone, with earlier and greater peak exposure and comparable total bioavailability. Similarly, administration of rHuPH20 significantly enhanced gravity-driven SC infusion flow rates of fluid and electrolytes compared with placebo, leading the authors to suggest the possibility of using hyaluronidaseenabled SC infusions as replacements for pump-driven intravenous fluid therapy.…”

Section: History Of Hyaluronidase Administrationmentioning

confidence: 99%

Review of the Mechanism of Action and Clinical Efficacy of Recombinant Human Hyaluronidase Coadministration with Current Prandial Insulin Formulations

Muchmore

Vaughn

2010

Journal of Diabetes Science and Technology

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Abbreviations: (A1C) derived average glucose, (C max ) peak plasma concentration, (PK) pharmacokinetics, (PPG) postprandial plasma glucose, (rHuPH20) recombinant human hyaluronidase, (SC) subcutaneous, (t max ) time to peak plasma concentration Keywords: diabetes, glycemic control, hyaluronidase, rHuPH20, ultrafast insulin AbstractFor patients with type 1 or type 2 diabetes, achieving good glycemic control is critical for successful treatment outcomes. As many patients remain unable to reach glycemic goals with currently available rapid-acting analog insulins, ultrafast insulin products are being developed that provide an even faster pharmacokinetic profile compared with current rapid prandial insulin products. The overall strategy of these ultrafast insulin products is to better mimic the normal physiologic response to insulin that occurs in healthy individuals to further improve glycemic control. Recombinant human hyaluronidase (rHuPH20) is a genetically engineered soluble hyaluronidase approved by the U.S. Food and Drug Administration as an adjuvant to increase the absorption and dispersion of other injected drugs; mammalian hyaluronidases as a class have over 6 decades of clinical use supporting the safety and/or efficacy of hyaluronidase coadministration. Clinical findings have demonstrated that coadministration of rHuPH20 with insulin or an insulin analog achieved faster systemic absorption, reduced inter-and intrapatient variability of insulin absorption, and achieved faster metabolic effects compared with injection of either insulin formulation alone. The magnitude of this acceleration is similar to the incrementally faster absorption of prandial insulin analogs as compared with regular insulin. In addition, coadministration of rHuPH20 with regular insulin or insulin analog also improved the achievement of prandial glycemic targets. Thus, rHuPH20 coadministration shows promise as a method of establishing a more rapid insulin profile to prandial insulin in patients with diabetes and has the potential to yield substantial improvements in postprandial glycemic excursion.

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“…Hyaluronidase is known to improve diffusion of a solution of NaCl in the subcutaneous tissue and to decrease the delay of appearance of Na in plasma (11). In the presence of hyaluronidase, the appearance in plasma of tritiated water infused subcutaneously is as rapid as appearance following IV infusion (12). The same effect has not been demonstrated for glucose infusion.…”

Section: Discussionmentioning

confidence: 99%