Respiratory fluids

Those associated with the acute and chronic treatment of ne d>orns for respiratory, fluid and electrolyte problems. 

Their pronounced ability to dissolve molecular oxygen in combination with their non-toxicity and complete physiological inertness makes perfluorocarbon fluids attractive for applications as respiratory fluids and as components of artificial blood substitutes [102] (Scheme 4.44). Many perfluorocarbons and perfluorinated amines can dissolve up to 40-50% v/v oxygen at 1 atm and 37 °C. It has been speculated that this unusual oxygen-dissolving capacity is related to the molecular shape and the occurrence of "cavities in perfluorocarbon fluids [103]. 

Scheme4.44 Compounds used as respiratory fluids (e.g. perfluorodecalin) or as components of artificial blood substitute mixtures [102a].

Wood Creosote. Beechwood creosote has been and continues to be used therapeutically on a limited basis in Asia as an expectorant/cough suppressant based on its presumed ability to increase the flow of respiratory fluids. The efficacy of creosote (type not specified, but presumably beechwood creosote) as an expectorant was studied by measuring the output of respiratory tract fluids in cats given a single oral dose of 0.1 or 5 mL/kg (concentration not specified) (Stevens et al. 1943). Creosote produced a slight increase in the output of respiratory tract fluid under these conditions. This is not considered a toxic effect. Given the limitations of this study (e.g., no dose information, no other respiratory effects evaluated), it provides no useful information on the potential respiratory effects of beechwood creosote after oral exposure. 

Grotberg, J. B., Respiratory fluid mechanics and transport processes, Annu. Rev. Biomed. Engr., 3 421-457,... 

The likelihood that materials will produce local effects in the respiratory tract depends on their physical and chemical properties, solubiHty, reactivity with fluid-lining layers of the respiratory tract, reactivity with local tissue components, and (in the case of particulates) the site of deposition. Depending on the nature of the material, and the conditions of the exposure, the types of local response produced include acute inflammation and damage, chronic... 

Expectorants enhance the production of respiratory tract fluid and thus faciUtate the mobilisation and discharge of bronchial secretions. Historically, expectorants have been divided iato two classes based on specific mechanisms of action. Stimulant expectorants iacrease respiratory tract secretion by a direct effect on the bronchial secretory cells. Sedative expectorants act by gastric reflex stimulation. Many compounds classed as expectorants have been iaadequately studied and the mechanisms of action are not known with certainty. 

The synthesis of dextromethorphan is an outgrowth of early efforts to synthesize the morphine skeleton. /V-Methy1morphinan(40) was synthesized in 1946 (58,59). The 3-hydroxyl and the 3-methoxy analogues were prepared by the same method. Whereas the natural alkaloids of opium are optically active, ie, only one optical isomer can be isolated, synthetic routes to the morphine skeleton provide racemic mixtures, ie, both optical isomers, which can be separated, tested, and compared pharmacologically. In the case of 3-methoxy-/V-methylmorphinan, the levorotatory isomer levorphanol [77-07-6] (levorphan) was found to possess both analgesic and antitussive activity whereas the dextrorotatory isomer, dextromethorphan (39), possessed only antitussive activity. Dextromethorphan, unlike most narcotics, does not depress ciUary activity, secretion of respiratory tract fluid, or respiration. 

The respiratory system has several mechanisms for removing deposited particles (8). The walls of the nasal and tracheobronchial regions are coated with a mucous fluid. Nose blowing, sneezing, coughing, and swallowing... 

Health effects attributed to sulfur oxides are likely due to exposure to sulfur dioxide, sulfate aerosols, and sulfur dioxide adsorbed onto particulate matter. Alone, sulfur dioxide will dissolve in the watery fluids of the upper respiratory system and be absorbed into the bloodstream. Sulfur dioxide reacts with other substances in the atmosphere to form sulfate aerosols. Since most sulfate aerosols are part of PMj 5, they may have an important role in the health impacts associated with fine particulates. However, sulfate aerosols can be transported long distances through the atmosphere before deposition actually occurs. Average sulfate aerosol concentrations are about 40% of average fine particulate levels in regions where fuels with high sulfur content are commonly used. Sulfur dioxide adsorbed on particles can be carried deep into the pulmonary system. Therefore, reducing concentrations of particulate matter may also reduce the health impacts of sulfur dioxide. Acid aerosols affect respiratory and sensory functions. 

Bacterial catabolism of oral food residue is probably responsible for a higher [NHj] in the oral cavity than in the rest of the respiratory tract.Ammonia, the by-product of oral bacterial protein catabolism and subsequent ureolysis, desorbs from the fluid lining the oral cavity to the airstream.. Saliva, gingival crevicular fluids, and dental plaque supply urea to oral bacteria and may themselves be sites of bacterial NH3 production, based on the presence of urease in each of these materials.Consequently, oral cavity fNTi3)4 is controlled by factors that influence bacterial protein catabolism and ureolysis. Such factors may include the pH of the surface lining fluid, bacterial nutrient sources (food residue on teeth or on buccal surfaces), saliva production, saliva pH, and the effects of oral surface temperature on bacterial metabolism and wall blood flow. The role of teeth, as structures that facilitate bacterial colonization and food entrapment, in augmenting [NH3J4 is unknown. 

Treatment of barbiturate toxicity is mainly supportive (ie, maintaining a patent airway, oxygen administration, monitoring vital signs and fluid balance). The patient may require treatment for shock, respiratory assistance, administration of activated charcoal, and in severe cases of toxicity, hemodialysis. 

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... 

During tiie ongoing assessment, tiie nurse assesses the respiratory status every 4 hours and whenever tiie drug is administered. The nurse notes the respiratory rate, lung sounds, and use of accessory muscles in breathing, hi addition, tiie nurse keeps a careful record of the intake and output and reports any imbalance, which may indicate a fluid overload or excessive diuresis. It is important to monitor any patient with a history of cardiovascular problems for chest pain and changes in the electrocardiogram. The primary health care provider may order periodic pulmonary function tests, particularly for patients with emphysema or bronchitis, to help monitor respiratory status. 

TH E PATIEN T WITH ED EM A. Fhtients with edema caused by heart failure or other causes are weighed daily or as ordered by the primary health care provider. A daily weight is taken to monitor fluid loss. Weight loss of about 2 lb/d is desirable to prevent dehydration and electrolyte imbalances. The nurse carefully measures and records the fluid intake and output every 8 hours. The critically ill patient or the patient with renal disease may require more frequent measurements of urinary output. The nurse obtains the blood pressure, pulse, and respiratory rate every 4 hours or as ordered by the primary health care provider. An acutely ill patient may require more frequent monitoring of the vital signs. 

Solutions used to manage body fluids are often administered IV. Before administering an IV solution, the nurse assesses the patient s general status, reviews recent laboratory test results (when appropriate), weighs the patient (when appropriate), and takes the vital signs. Blood pressure, pulse, and respiratory rate provide a baseline, which is especially important when the patient is receiving blood plasma, plasma expanders, or plasma protein fractions for shock or other serious disorders. 

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