Balanced Crystalloid versus 0.9% Sodium Chloride: What We Overlook in Our Research

Fisher

et al. 2022

JPRI

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It has been shown that some drugs considered to be of good quality today can cause an iatrogenic disease known as Nicolau syndrome. Nicolau syndrome is a rare cutaneous drug reaction occurring after injection many drugs. This disease has been found to be caused by the very strong local irritant activity of drug solutions. It turned out that the standard for assessing the quality of drug solutions does not include assessment of their osmotic activity and the strength of their local irritating effect on various tissues during injection. At the same time, drug solutions produced by different pharmaceutical companies may contain, in addition to the main ingredients, other ingredients (hydrochloric acid, sodium hydroxide, propylene glycol, etc.). Very often the additional ingredients increase the osmotic activity of the drug solution, which is not controlled today, so it remains unknown. This is why drug solutions produced by some pharmaceutical companies can have hypertonic activity, which can sometimes by ignorance reach values that are incompatible with the vital activity of human body tissue cells. Therefore, injections of such drug solutions can have a very strong dehydrating effect on the tissue cells at the injection sites, have a local irritating and cauterizing effect. It has been shown that even steroid solutions in some manufacturers may have excessive hypertonic and acidic activity, which gives them a local irritating effect. This is why in some cases the injection of a steroid solution does not eliminate, but rather increases local inflammation and causes necrosis. Therefore, to exclude postinjection necroses and abscesses, it is proposed to include an assessment of the osmotic activity and local irritant effect of drug solutions in the drug quality control standard and to prohibit the injection of drug solutions with excessive hypertonic activity.

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Section: Controlled and Uncontrolled Physical-chemical Properties Of ...mentioning

confidence: 99%

Post-injection Complications. Nicolau Syndrome as a Consequence of Local Irritant Effects of Drugs, Including Antiseptics, Local Anesthetics, NSAIDs, Steroids and Anticoagulants

Fisher

et al. 2022

JPRI

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“…Moreover, some of the solutions for injection, which are considered high-quality today, have very much hypotonic or hypertonic and/or hyperacidic activity [2]. In addition, it was shown that an isotonic solution of 0.9% sodium chloride for injection can have different osmotic activity in different series and from different manufacturers [3,4]. These data allow us to explain why some solutions for injection, which are considered high-quality today, can be very acidic and/or very salty (osmotically active).…”

Section: The Sources Of the Problemmentioning

confidence: 99%

“…It was found that solutions of different drugs with the same concentration of 10% have different hypertonic, local irritant and cauterizing activity. Solutions of sodium, potassium and calcium salts have the greatest hypertonic activity and local irritating and cauterizing effects [8][9][10].…”

Section: Activity Of Post-injection Abscessesmentioning

confidence: 99%

Osmotic Activity of Drugs is an Important Factor of Their Local Action at the Injection Site: What We Don't Use to Prevent Post-Injection Abscesses

2021

JPRI

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It is established that very few modern high-quality drugs in the dosage form "Solution for injection" have isoosmotic activity in the range of 280-300 mosmol/l of water. The main part of solutions for injection is hypotonic or hypertonic solutions, which can have osmotic activity in the range of 0 - 4000 mosmol/l of water. The reason for this was that the osmotic activity of drugs is not included in the list of controlled indicators of drugs quality, so it is not subject to control. It is shown that the osmotic activity of drug solutions increases with an increase in the total concentration of all dissolved ingredients present in the solution. It was found that an excessively high concentration of the drug in the solution gives it an excessively large hyperosmotic activity, which can cause a local irritant and cauterizing effect at the injection sites due to dehydration of the cells. Therefore, to exclude post-injection abscesses, it is proposed to dilute the hypertonic drug with water for injection until it is given isotonic activity.

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“…In addition, the acid activity of drug solutions may be different for drugs produced by different pharmaceutical companies and in different serial numbers for the same pharmaceutical company. 3 By the way, the value of the acid activity of drug solutions is included in the standard list of controlled indicators of the quality of medicines. 4 In addition, the pH indicator can be determined using a pH-meter in a biochemical laboratory.…”

Section: Dear Editormentioning

confidence: 99%

Letter to the Editor Regarding “Advantages of the Combination of Conscious Sedation Epidural Anesthesia Under Fluoroscopy Guidance in Lumbar Spine Surgery” [Letter]

Самородов

2021

JPR

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