Oral fluid

The calcium chelate cements are limited to the use of a cavity liner. They may be placed directly over an exposed tooth pulp to protect the pulp and stimulate the growth of secondary dentin, or used as a therapeutic insulating base under permanent restorations. The high alkalinity and high solubihty of these materials prohibits use in close proximity to soft tissues or in contact with oral fluids. 

Uses. The use of titanium alloys for cast partial dentures offers light weight, low cost, good ductihty, adequate stiffness, chemical passivity toward foods and oral fluids, and biocompatibiHty with the oral tissues. 

Various materials are used in dental prosthetic practice for the preparation of dental implants, crowns, and bridges. Some of these materials contain copper, which is added in order to improve mechanical or/and chemical properties, but some of them may contain the copper as an impurity. Considering the fact that dental implants remain in the oral cavity for a long time, and that they are exposed to the corrosive action of oral fluids and various kinds of food and beverages, it is necessary to check their possible harmful effects upon the human health. 

For patients receiving lithium, the nurse increases the oral fluid intake to about 3000 mL/d. It is important to keep fluids readily available and to offer extra fluids throughout waking hours. If there is any question regarding the oral fluid intake, the nurse monitors intake and output. 

If vomiting is severe the nurse observes the patient for signs and symptoms of electrolyte imbalance. The nurse monitors the blood pressure, pulse, and respiratory rate every 2 to 4 hours or as ordered by the primary health care provider. The nurse carefully measures the intake and output (urine, emesis) until vomiting ceases and the patient is able to take oral fluids in sufficient quantity. The nurse documents in the patient s chart each time the patient has an emesis. The nurse notifies the primary health care provider if there is blood in the emesis or if vomiting suddenly becomes more severe... 

MANAGING FLUID VOLUM E DEFICIT. The patient receiving a diuretic is observed for dehydration and electrolyte imbalances. A fluid volume deficit is most likely to occur if the patient fails to drink a sufficient amount of fluid. This is especially true in the elderly or confused patient. To prevent a fluid volume deficit, the nurse encourages patients to drink adequate oral fluids (up to 3000 mL/d, unless contraindicated). 

To prevent a fluid volume deficit, the nurse encourages oral fluids at frequent intervals during waking hours. A balanced diet may help prevent electrolyte imbalances. The nurse encourages patients to eat and drink all food and fluids served at mealtime The nurse encourages all patients, especially the elderly, to eat or drink between meals and in the evening (when allowed). The nurse monitors the fluid intake and output and notifies the primary health care provider if the patient fails to drink an adequate amount of fluid, if the urinary output is low, if the urine appears concentrated, if tiie patient appears dehydrated, or if signs and symptoms of an electrolyte imbalance are apparent. 

When appropriate, nursing measures that may be instituted to correct a fluid volume and carbohydrate deficit may be included in a plan of care. Examples of these measures include offering oral fluids at frequent intervals and encouraging the patient to take small amounts of nourishment between meals and to eat as much as possible at mealtime... 

A number of innovations made in the 1920s and 1930s may be noted. Several attempts were made to reduce the dissolution of these cements in oral fluids and their adverse effect on the pulp by inclusion of oils and greases (Simon, 1929, 1932 Eberly, 1934). None have been considered beneficial (Palfenbarger, Schoonover Souder, 1938), a not surprising result because the inclusion of hydrophobic substances is bound to interfere in the setting of an aqueous cement. 

Silicophosphate cement acts as an agent for the sustained release of fluoride, although different cements behave very differently (Wilson, Crisp Lewis, 1982). Silicophosphate cement has a disability in the mouth similar to that of dental silicate cement. It is less resistant to oral fluids than glass polyalkenoate cement, but more resistant than all other dental cements, as is shown by both in vivo studies (Norman et al., 1969 Ritcher Ueno, 1975 Clark, Phillips Norman, 1977 Mitchem Gronas, 1978 ... 

The typical procedure for analysis of cannabinoids from plasma, urine or oral fluids includes prehminary steps such as a SPE for enhancement of the analytes and for minimizing interfering effects of the matrices. Because the metaboHtes in humans are often conjugated, an anterior hydrolysis of these conjugates either with chemicals like sodium hydroxide or with enzymes [103] is recommended. 

Most of the tests that were developed for detection of cannabinoids in plants have shown that antibodies are specific for the cannabinoid structure. Because of this specifity these tests can be extensively applied for the detection of cannabinoids and metabolites in human body fluids such as plasma, urine, and oral fluids. Many different kits based on these methods were developed and they are commercially available, for example Oratect, Branan or Uplink, and OraSure. We must consider, however, that no humans have the same metabolite profile in their blood and that cross-reactivity may always occur [122,123]. Nevertheless, these tests offer a simple way of excluding most of the suspicious samples, but the results still have to be confirmed with a second method such as GC-MS [124,125]. 

In summary, the settings in which fluid replacement is used are hypovolemic patients (e.g., sepsis or pneumonia) hypervolemic patients [e.g., congestive heart failure (CHF), cirrhosis, or renal failure] euvolemic patients who are unable to take oral fluids in proportion to insensible losses (e.g., the perioperative period) and patients with electrolyte abnormalities (see below). 

Discontinue or minimize oral fluid intake after 6 p.m. 

The mainstay of treatment for vaso-occlusive crisis includes hydration and analgesia (see Table 65-7). Pain may involve the extremities, back, chest, and abdomen. Patients with mild pain crises may be treated as outpatients with rest, warm compresses to the affected (painful) area, increased fluid intake, and oral analgesia. Patients with moderate to severe crises should be hospitalized. Infection should be ruled out because it may trigger a pain crisis, and any patient presenting with fever or critical illness should be started on empirical broad-spectrum antibiotics. Patients who are anemic should be transfused to their baseline. Intravenous or oral fluids at 1.5 times maintenance is recommended. Close monitoring of the patient s fluid status is important to avoid overhydration, which can lead to ACS, volume overload, or heart failure.6,27... 

OraQuick ADVANCE 3-6 weeks Whole blood, plasma, or oral fluid Detects HIV-1 and HIV-2... 

Calciuric therapy in the form of hydration is a key component of the treatment of hypercalcemia, regardless of severity or presence of symptoms.28 Mild or asymptomatic patients may be encouraged to increase oral fluid intake (3-4 L/day). Patients with moderate to severe or symptomatic hypercalcemia should receive normal saline at 200 to 500 mL/hour according to dehydration and cardiovascular status. Patients should be encouraged to ambulate as much as possible because immobility enhances... 

Therapy includes high intake of dietary fiber, adequate oral fluid intake, use of sitz baths topical anesthetics, skin protectants and astringents may also be used. Treatment for refractory hemorrhoids includes rubber band ligation, sclerotherapy, and surgery. 

Treatment includes 10 to 14 days of antibiotic therapy for the mother (cloxacillin, dicloxacillin, oxacillin, or cephalexin), bedrest, adequate oral fluid intake, analgesia, and frequent evacuation of breast milk. 

Oral fluid and electrolyte replacement is the cornerstone of treatment. Oral Lactobacillus therapy may reduce the duration of diarrhea and or viral excretion. There is no role for antibiotics. 

Bronchiolitis is a self-limiting illness and usually requires no therapy (other than reassurance and antipyretics) unless the infant is hypoxic or dehydrated. Otherwise healthy infants can be treated for fever, provided generous amounts of oral fluids, and observed closely. 

Dams R, Murphy CM, Choo RE, Lambert WE, De Leenheer AP, et al. 2003. LC-atmospheric pressure chemical ioniza-tion-MS/MS analysis of multiple illicit drugs, methadone, and their metabolites in oral fluid foUowing protein precipitation. Anal Chem 75 798. 

Mortier KA, Maudens KE, Lambert WE, Clauwaert KM, Van Bocxlaer JF, et al. 2002. Simultaneous, quantitative determination of opiates, amphetamines, cocaine and ben-zoylcognine in oral fluid by liquid chromatography quad-rupole-time-of-fiight mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 779 321. 

Recently, Quintela et al. [58] have determined THC and the carboxy metabolite in oral fluid using HPLC coupled to a quadrupole-TOF mass spectrometer. Extreme selectivity of detection and LLOQs of 0.1 and 0.5ng/mL, respectively, were achieved through accurate mass measurement. None of the real positive samples examined was found to contain THC-COOH. 

Dams et al. [18] developed a validated quantitative LC-APCI-MS-MS method for simultaneous determination of multiple illicit drugs and their metabolites in oral fluid. This substrate is being increasingly popular for forensic applications as it provides information on recent use, similarly to blood plasma/serum, although it can be obtained with a simple, noninvasive, collection. Sample pretreatment, though limited to protein precipitation with acetonitrile, was sufficient to avoid matrix effect (see Figure 20.2). 

Polymers used as dental materials must meet several stringent requirements. Dental restorative materials must be nontoxic, have aesthetic appearance, and good adhesive and mechanical properties. In addition, these materials must exhibit long term stability in the presence of water, enzymes, and various oral fluids, and withstand thermal and load cycles. Finally, a desirable dental restorative materia] should be convenient to work with at the time of application. 

Lack of adhesion of a dental restoration to tooth structure results in microleakage at tooth-restoration interface. This occurrence can result in discoloration at the margin of the restoration, or in the formation of caries. Occlusal forces on the restoration and differences between the coeffidents of thermal expansion of the cement and tooth material can lead to leakage. In addition, oral fluids and moisture may affect the adhesion. Microleakage of composite resin restorations has been reviewed by Ben-Amar [233]. Microleakage is not as serious a problem with glass-ionomer cements as it is with resin-based restorative materials, due to reduced polymerization shrinkage [234]. 

Thermal expansion differences exist between the tooth and the polymer as well as between the polymer and the filler. The tooth has a thermal expansion coefficient of 11 x 10-6/°C while conventional filled composites are 2-4 times greater [63, 252], Stresses arise as a result of these differences, and a breakdown between the junction of the restoration and the cavity margin may result. The breakdown leads to subsequent leakage of oral fluids down the resulting marginal gap and the potential for further decay. Ideal materials would have nearly identical thermal expansion of resin, filler, and tooth structure. Presently, the coefficients of thermal expansion in dental restorative resins are controlled and reduced by the amount and size of the ceramic filler particles in the resin. The microfilled composites with the lower filler loading have greater coefficient of thermal expansions that can be 5-7 times that of tooth structure. Acrylic resin systems without ceramic filler have coefficients of thermal expansion that are 9 times that of tooth structure [202-204, 253],... 

Ben Amar M Potvin S (2007). Cannabis and psychosis what is the link Journal of Psychoactive Drugs, 39, 131-142 Bennett GA, Davies E Thomas P (2003). Is oral fluid analysis as accurate as urinalysis in detecting drug use in a treatment setting Drug and Alcohol Dependence, 72, 265-9 Bertschy G (1995). Methadone maintenance treatment an update. European Archives of Psychiatry and Clinical Neuroscience, 245, 114-24... 

Correction of solute and fluid loss and hypoglycemia with intravenous K+ and dextrose and oral fluids. 

Doses of 5 to 10 mg methamphetamine typically result in blood concentrations between 20 and 60 ng/ml. In one study,10 six healthy adults were orally administered a single dose of 0.125 mg/kg methamphetamine. Peak plasma concentrations were achieved at 3.6 h with a mean concentration of 20 ng/ml. In a second study, Lebish et al.11 observed a peak blood concentration of 30 ng/ml, 1 h after a single oral dose of 10 mg methamphetamine to one subject. In a study by Schepers et al.,12 eight subjects were administered four oral doses of 10 mg methamphetamine hydrochloride as sustained release tablets within 7 days. Three weeks later five subjects received four oral 20-mg doses. After the first dose, methamphetamine was detected in plasma between 0.25 and 2 h the cmax was 14.5 to 33.8 ng/ml (10-mg dose) and 26.2 to 44.3 ng/ml (20-mg) and occurred within 2 to 12 h. Methamphetamine was first detected in oral fluid in this study 0.08 to 2 h post dose, with a cmax of 24.7 to 312.2 and 75.3 to 321.7 ng/ml after the 10- and 20-mg doses, respectively. Peak methamphetamine concentrations in oral fluid occurred at 2 to 12 h and the median oral fluid-plasma concentration ratio was 2.0 for 24 h. In general, the detection window for drug in oral fluid exceeded that in plasma. 

Schepers, R.J.F., Oyler, J.M., Joseph, R.E., Cone, E.J., Moolchan, E.T., and Huestis, M.A., Methamphetamine and amphetamine pharmacokinetics in oral fluid and plasma after controlled oral methamphetamine administration to human volunteers, Clin. Chem., 49(1), 121-132, 2003. 

Jones, J., Tomlinson, K., and Moore, C. (2002). The simultaneous determination of codeine, morphine, hydrocodone, hydromorphone, 6-acetylmorphine, and oxycodone in hair and oral fluid. J. Anal. Toxicol. 26 171-175. 

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