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Forum: Caveat Emptor-Possible Pharmacueticals for SIP Part 3

13 September 2006

Bronco Bill – at 13:46

Continued from here


Bronco Bill – at 10:46

This thread is a morph of the “Tom DVM Pet Med Questions” thread.

A word or two of caution: unless you know EXACTLY what you are doing, and EXACTLY what certain medications can and will do, DO NOT TRY TO SELF-MEDICATE with prescription medicines, whether human or animal.

Just my 2 cents…please carry on.


JV – at 11:58

Carrey in VA -
I do not know pediatrics in general. I can’t give you an answer myself, but I did find an article that has a good overview from the “Medical Journal of Australia”: http://tinyurl.com/hryyp . I understand this article really doesn’t answer your question.

What I would suggest is that you discuss with your ped what to do for your child either 1. in a pandemic situation, or 2. since you plan a vacation/trip “somewhere where you will be out of touch with medical care (on a boat?).”

Maybe someone with pediatric knowledge can help here. Also, a pharmacist would be good to ask about the pulicort.

For everyone with medical questions, if your questions are not answered by your doctors, there is some very good info online now. It is too bad we may have to go to that. Just put the appropiate words into google. For this situation, I put in “croup emergency treatment.” Then you can sort out how in depth an article you want. Also, calling up your pharmacist and asking questions is great too.

Sorry I can’t be of more help.


Carrey in VA – at 12:25

I think I have found the drug they give him in the nebulizer that I can not give him at home. I went looking and when reading the info on Vaponefrin it hit me that the “rebound” is what the docs were worried about (not seizures) and that is why I couldn’t give it too him myself. They also gave him steriod shots.

It seems that my son has had a severe case of croup these past 2 years, which makes it even more scary. Every site I’ve read says that in severe cases hospitalzation is NECESSARY.

Cold air does help ALOT, so I could bundle him up and take him outside. He has always gotten really bad in the middle of the night, and after driving the 30 minutes to the hospital, he always sounds better, almost so much better that I debate on weither to go back home or not.

RPh – at 15:58

“Croup” as such is actually an infection of sorts that results in airway swelling and a barky sounding cough. Most cases of croup are fairly mild, and don’t require hospitalization.

If your child’s case is severe, I might suggest that there is another underlying cause that needs to be considered (e.g. Asthma?)

Corticosteroid treatment (including Pulmicort) is useful for both asthma and croup. Asthma sufferers will use them more or less regularly, where as patients with croup will only require short courses of therapy.

Are you confident with the differential diagnosis of croup?

Carrey in VA – at 16:03

He was hospitalized the past 2 years for croup, both for 3–4 days. I have the pulmicort left over from my other son who is asthmatic.

He has only gotten the croup twice, once each year between Thanksgiving and Christmas, and both times was admitted after multiple treatments and steroid shots.

12 October 2006

Pseudorandom – at 21:12

I am bumping this to ask your thoughts on using subcutaneous rehydration (similar to IV rehydration, just via subcutaneous instead of IV routes) in the event of illness where it is apparent that the individual is simply not getting enough fluid back into his/her body despite oral rehydration efforts. I have looked into this on PubMed and it seems to be a cheerfully accepted rehydration method in nursing homes, with fewer side effects than IV access.

Specifically, what equipment would be needed to do this? I have given subcutaneous fluids to cats with kidney failure, so I know what everything looks like and what the general procedure is, but I am not clear what the technical names are for the different tubing types. Obviously, the bag of fluid would be needed (dextrose vs. lactated ringers … any thoughts?), and high-gauge needles with the butterfly for the other end … but what is the name of the tubing that comes in between? I have seen “extension tubes” online, but they have different types of couplers and the medical supply websites don’t explain it very well (if at all).

Thanks in advance for your thoughts and any help that you can give on identifying the proper tubing.

seacoast – at 21:39

I believe that you can also hydrate with warm water enemas, at least that was on a thread way back in October. Grace RN?

beehiver – at 23:47

bump

Hoping Tom DVM or other docs might be able to comment on the possibilities of subcutaneous rehydration…thanks

beehiver – at 23:49

So sorry, meant to reference the post at 21:12 by Pseudorandom in my previous bump.

Tom DVM – at 23:56

beehiver. Just popped in and haven’t read the whole thread but you wanted to know about subcutaneous rehydration.

Well, first of all, oral rehydration will work just as efficiently as intravenous or subcutaneous even if the dudodenal villi have been pretty much destroyed by the virus or subsequent diarrhea. The trick is to get the volume high enough to balance output (diarrhea) with input oral electrolyte fluids…it is possible and I’m sure you would be able to do it in a pandemic if you were prepared with the electrolyte powder stockpiled and it was palatable to children. It should be remembered that in relative terms the dehydration from influenza will be far less significant then the dehydration from say…E. coli infections.

If that fails you are right to consider subcutaneous rehydration or intravenous if you had intravenous fluids and knew how to insert a catheter which pretty well rules out everybody.

The problem with subcutaneous rehydration is quite significant pain…I don’t think you would be able to do it unless the child was comatose.

If I could add one other thing…one of the main benefits of prednisolone is to plug holes in blood vessels preventing loss through the gut and therefore decreasing the need for electrolytes.

Thanks. It was a really interesting question and I would never have considered subcut. fluids if you hadn’t asked.

Tom DVM – at 23:59

Given the choice, an enema would probably work much better although I don’t know how you would do an enema when you were dealing with diarrhea…I will try to chase Grace RN down to answer this part of the question.

13 October 2006

beehiver – at 00:14

Tom, thanks so much. You have been so good to everyone on the fluwiki…you replied to a different post of mine a couple days ago, and I have not even had time to go back and reply or say thank you. So please know my thanks goes beyond here.

So…would subcutaneous rehydration would work for adults. You mentioned “signifcant pain”…is it bad enough that it could not be alleviated by something like acetominophen? Oops, maybe you’ve never had sub-q drip going, lol.

We are weighing the options for rehydration…the discussion up until now on the wiki, has been a bit confusing as to what is the best formula to use.

On another subject…we have managed to get a scrip for methylprednisolone. Is this what you would use if you found you or someone in your family, between a rock and a hard place? That may sound like an after-the-fact question, but the doc agreed to write it and we did not ask further questions…

I looked in the PDR (Physician’s Desk Reference) and there were a few drug interactions with methylprednisolone that caught my attention…wouldn’t be a problem with my family, but a lot of other people do a lot of medical drugs. Maybe we can talk more about that later. In the meantime I was happy to hear you are feeling better and don’t feel like this discussion can’t wait for another day, okay.

Tom DVM – at 00:38

beehiver. Thanks. I have a lot of experience with subcutaneous fluids and I do believe it is far too painful to use on a concious human. I think given the circumstances, we would be unable to follow through with it…acetominophen wouldn’t be enough…and you can’t give anything with sugar in it subcutaneously.

…the best option is to start drinking fluids early and make sure they are nice and palatable so the kids will want them…add carbonation if necessary.

I would definitely give prednisolone to my family members…as you know aspirin has serious side-effects as well…I believe that for short term treatment courses and the moderate dosages that we are talking about…there would be no problem…

…we have fifty years of working with these drugs and I honestly belive that these drugs are one of the safest drugs every developed if you aren’t taking it for months on end.

beehiver – at 00:54

Okay Tom…and tonite, a prompt thanks again!

Tom DVM – at 00:56

beehiver. Thanks for your input and your excellent reference sourcing. /:0)

Pseudorandom – at 07:48

Tom DVM, thank you for your input. I’m a bit confused now, since it seems to be at odds with what (limited material) I have read on this subject.

The primary reference that I was using regarding the safety and tolerability of subcutaneous fluid administration (hypodermoclysis) is: Yap LKP, Tan SH and Koo WH. Hypodermoclysis or subcutaneous infusion revisited. Singapore Medical Journal 2001 42(11):526–529.

They studied 51 hospice patients receiving hypodermoclysis, in the form of either dextrose saline or dextrose 5% solutions. Their conclusions are as follows: Hypodermoclysis has been practised with considerable success in our hospice. Numerous other studies have also shown that it is safe, reliable and can easily be administered with minimal patient discomfort. It is most suitable for hydration of the elderly and terminally ill where patient comfort is prime. Its use can even be extended to the home setting. The only limitations are a slight delay in transfer of fluids into the vascular compartment and that only 1.5 L/day of fluid should be administered at each site. Nonetheless, two infusion sites can run concurrently, making it possible to deliver # L/day when necessary. Hypodermoclysis is not meant to replace the intravenous route in resuscitation of shock or severe dehydration … (and then the wrap-up).

Are we talking about different procedures? They consistently refer to it as a method to be considered when comfort is an issue.

Thanks again for your help.

Tom DVM – at 09:30

Hi Pseudorandom. Thank you very much for the reference.

I was in fact extrapolating from my experience of treating several animal species with subcutaneaous fluids. Subcutaneous fluids are absorbed as efficiently as intravenous fluids and in very sick animals, you don’t have the additional risk of cardiac arrest or direct electrolyte imbalance that can occur with IV fluids…

…based on my experience with animals I concluded it would be too painful for humans…which apopears to be contrary to your reference. One reference does not make a trend but human doctors may have figured out a way around the problem.

Dextrose in solution is not a problem for IV injections but is a problem with subcut. injections for two reasons…1) dextrose is irritating and reduces the number of times you can use an injection site and 2) dextrose provides a growth medium for subcutaneous infections subsequent to subcutaneous fluids…

…personally, based on my experience, I believe it would be inhumane to give an older, bedridden person subcutaneous fluids and I would not do so…an less invasive alternative could be to deliver oral electrolytes through a temporary feeding tube but even with that you have to deal with the potential of aspiration…

…but aspiration risk can be managed, once things start to head south as a subcutaneous injection site, the problems really start to magnify each other in a hurry.

Maybe I shouldn’t be extrapolating to humans at all as a veterinarian who treats the other 9,999 animals in the world /:0)…and I would be happy to turn the responsibility over to the medical profession, as a whole, when they step up to the plate…

…and the American and Canadian Medical Assoc. can start by providing prescriptions so people can stockpile needed oral medications if they wish.

I would be interested in the personal experience of those who have managed subcut. fluids to comment on the pain involved and I agree it would be an important aid in a pandemic if it is not too painful…I just can’t see putting a sick child through it…Thanks again.

Pseudorandom – at 09:59

Thanks, Tom DVM. If I could figure out what tubing to buy I’d test it out on myself and report back after recovering from my trusty vasovagal freakout to the needle. ;)

I will definitely keep your advice regarding the dextrose in mind! I was leaning toward the lactated ringer solution for a little electrolyte replacement, but wasn’t sure if the dextrose would be better from the viewpoint of keeping someone’s blood sugar up if liquids won’t stay down. Not if it is an irritant and growth medium! But really, this is only for the worst-case scenario of persistent vomiting and diarrhea, if it is apparent that we just can’t keep enough liquids in the person.

Yes, I also wish that the medical profession would “step up to the plate.” The docs that I work with by and large believe that the hospital’s infectious disease unit will take care of everybody if there is a pandemic. And that there will be no need to shelter in place. And that the hospital will always have room for another terribly sick person, no matter how many are already there. I’d bust a gut laughing at the idea if it weren’t so pitifully uninformed.

Keep up the good fight, sir. It’s greatly appreciated.

mojo – at 10:15

As a former rn I wouldn’t do it. I have seen IV’s infiltrate into the surrounding tissue and have treated many reddened, hot, and infected areas due to this. It is painful. I myself have experienced it(infiltrated iv with fluid going into the tissues) when I was admitted to the hospital. It hurts.

Obviously according to your article it is being done but I have never seen it in practice. On the other hand I am an wildlife rehabber and do use this as a last resort in animals. It is painful. They don’t like it one bit. I always first go the oral route even if I have to tube them. I use lactated Ringers.

Tom DVM – at 10:23

Pseudorandom. Thanks.

Excellent questions that repeatedly come up on flu wiki…elevate the discussion and debate for all concerned…and I have to say that the level of discussion on flu wiki has now evolved to a level that I would expect if I was discussing things only with professionals…

… I would never even have considered subcutaneous fluids, based on my experience, if you had not raised the issue.

mojo What works in a laboratory or in theory often, in my experience, doesn’t work in the field.

Thanks for your commenting about your experiences with human animals and animal animals. /:0)

Pseudorandom – at 10:33

Thanks, guys. I’d rather take your voices of experience than rely on a journal article. My list of potential preps is now one item shorter. :)

mojo, thanks for helping take care of the wild critters. I have some friends that operate a wildlife rehab center and all I can say is that they are God’s own swearing and smoking angels sent down to earth.

Closed - Bronco Bill29 December 2006, 11:43

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