Oral aspiration

When a topical gel, such as lidocaine viscous, is used for oral anestiiesia for die control of pain, the nurse instructs die patient not to eat food for 1 hour after use because local anestiiesia of die mouth or throat may impair swallowing and increase die possibility of aspiration. 

Aspiration Oral contents Anaerobes, viridans streptococci Gastrointestinal contents with pH increase Enteric gram-negative bacilli... 

Pneumonia owing to aspiration of oral contents is caused by a variety of anaerobes (Bacteroides spp., Fusobacterium spp., Prevotella spp., and anaerobic gram-positive cocci), as well as Streptococcus spp. M. catarrhalis and Eikenella corrodens may be involved, but much less frequently.14,15 When gastric contents are aspirated, then enteric gram-negative bacilli and Staphylococcus aureus are more commonly the pathogens.15... 

If a patient aspirates his or her oral contents and pneumonia develops, then anaerobes and Streptococcus spp. are the primary pathogens. Antibiotics active against these organisms include penicillin G, ampicillin/sulbactam, clindamycin, and metronidazole. 

Patients with severe intestinal disease or liver abscess should receive metronidazole 750 mg three times daily for 10 days, followed by the luminal agents indicated above. The pediatric dose of metronidazole is 50 mg/kg per day in divided doses, which should be followed by a luminal agent. An alternative regimen of metronidazole is 2.4 g/day for 2 days in combination with the luminal agent. Tinidazole (Tindamax, recently introduced on the United States market) administered in a dose of 2 g daily for 3 days (pediatric dose 60 mg/kg for 5 days) is an alternative to metronidazole. If there is no prompt response to metronidazole or aspiration of the abscess, an antibiotic regimen should be added. Patients who cannot tolerate oral doses of metronidazole should receive an equivalent dose intravenously. 

In healthy individuals URT flora multiplies in gastric aspirate during treatment with antisecretory compounds and in particular proton pump inhibitors [34, 40, 44], This concerns viridans streptococci, coagulase-negative staphylococci, Haemophilus sp., diphtheroids, Moraxella sp., lactobacilli, and other streptococci, most of which are Gram-positive bacteria. With dedicated measures anaerobic species of oral origin are also recovered [66]. 

Solubility/miscibility Insoluble in water and ethanol. Soluble in ether and oils Biological considerations Aspiration may cause lipoid pneumonia Chemical compatibility/Stability considerations Flammable Uses (routes) Oral, vaginal, rectal, dermal. Suspending agent... 

Figure 17 Volume dependent in vivo dissolution of micronized felodipine FCDNa indicates the dissolved fraction of felodipine aspirated at mid-jejunum of Labradors. The orally administered dose of 10 mg was suspended in 200 mL saline 0.9% (Experiments E and F) or glucose 20% (Experiments B, D, and S). VR represents the recovered fluid volume. Source From Ref. 10, Figure 16.12.

For oral exposures, different fuel oils have differing lethality profiles in rats. Acute lethal doses in rats were reported to be 12,000 mg/kg for kerosene (Muralidhara et al. 1982) and 47,300 mg/kg for JP-5 (Parker et al. 1981). However, an oral dose of 12,200 mg/kg of Deobase was not lethal in rats (Muralidhara et al. 1982). Although differences in the oral toxicity of fuel oils and differences in species thresholds of toxicity may exist, the oral toxicity of fuel oils is relatively low. The intestinal absorption of fuel oils is also relatively low, and aspiration, with its resultant pulmonary effects, is the primary risk from the ingestion of fuel oils. 

Phase I data were presented at the 95th AACR meeting, March 2004. Normal healthy male volunteers were subjected to bone marrow aspirations prior to and 4 h following a single 25 mg oral dose of the compound or placebo. L21649 achieved plasma concentrations of 103.4 nM at 4 h post-dose. In July 2004, similar clinical data were presented at the 29th National Medicinal Chemistry symposium. The PK/PD correlated well, and at that time, it was believed that the plasma levels should be closer to the EC90 levels for maximal efficacy. 

Rectal Administer to adults during impending coma or coma stage of portal-systemic encephalopathy when the danger of aspiration exists or when endoscopic or intubation procedures interfere with oral administration. The goal of treatment is reversal of the coma stage so the patient can take oral medication. Reversal of coma may occur within 2 hours of the first enema. Start recommended oral doses before enema is stopped entirely. 

Lipid pneumonitis Lipid pneumonitis may result from oral ingestion and aspiration of mineral oil, especially when the patient reclines. The young, elderly, debilitated, and dysphagic are at greatest risk. 

Meperidine (Demerol) [C-ll] [Narcotic Analgesic] Uses Moderate/ severe pain Action Narcotic analgesic Dose Adults. 25-50 mg IV, 50-100 mg IM Peds. 1 mg/kg IV/IM (onset w/in 5 min IV and 10 min IM duration about 2 h) Caution [C, ] Contra Convulsive disorders and acute abdomen Disp Prefilled 1 mL syringes 25, 50, 75, 100 mg/mL various amps and vials oral syrup and tabs SE N/V (may be severe), dizziness, weakness, sedation, miosis, resp d ession, xerostomia (dry mouth) Interactions t CNS depression W/ opiates, sedatives/ hypnotics TCNS stimulation W/amphetamines t risk of tox W7 phenytoin EMS Pt should be receiving O2 prior to administration have resuscitation equipment and naloxone available naloxone can be used as an antidote to reverse resp depression aspirate prior to IM administration inadv tent IV admin of IM doses may cause tach and syncope mix w/ NS to make a 10 mg/mL soln and inj very slowly N/V may be sev e may premedicate w/ an antiemetic... 

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