Supplemental General Recommendations

These general recommendations, if followed, should result in longer satisfactory service from the equipment. These recommendations should in every case be considered as supplemental to, and not as a substitute for, the manufacturer s instructions. 

Folic acid supplementation with 1 mg daily generally is recommended in adult SCD patients, women considering pregnancy, and any SCD patient with chronic hemolysis.6 Because of accelerated erythropoiesis, these patients have an increased need for folic acid. There are conflicting studies in the SCD population, especially among infants and children, but if the child has chronic hemolysis, supplementation is recommended.21... 

Polymeric formulas typically have low osmolality of 300 to 500 mOsm/kg. These formulas also usually supply essential vitamins and minerals in amounts similar to the Adequate Intakes or Recommended Dietary Allowances for these nutrients when the formula is delivered in amounts adequate to meet the macronutrient requirements of most patients. Many polymeric formulas are inexpensive relative to oligomeric formulas. Most polymeric formulas are lactose-free and gluten-free, as are most modern tube feeding products. Products designed to be used as oral supplements generally are polymeric and often have sucrose or other simple sugars added to improve taste. 

Recommend products that contain the following on their label scientific name of the botanical, quantity of the herb, name and address of the actual manufacturer, a batch or lot number, date of manufacture, and expiration date. When available, products that are standardized to the active ingredient(s) should be recommended. A common rule of a one-year expiration date on dietary supplements generally applies [5]. 

The major sterol in both human and bovine milk is cholesterol. Trace amounts of other sterols are present also (e.g., lanosterol in bovine milk and desmosterol and some phytosterols in human milk). The amount of cholesterol present in human milk is 10—15 pg/100ml, and although supplemented in some commercial formulae, it is present in amounts 5-10 times less than in human milk. Since the role of dietary cholesterol is still not fully defined, an intake similar to that obtained through breast-feeding is generally recommended (Uauy, 1990 Suskind and Lewinter-Suskind, 1993 Tsang et al., 1993). 

Retrobulbar injection probably offers little therapeutic advantage over the combined subconjunctival and parenteral routes. This route is recommended only for regional anesthesia of the orbit, particularly to supplement general anesthesia (Miller 1992). 

Milder forms of volume depletion may be managed in outpatient settings. For example, supplemental fluids can be added to the usual estimated daily requirements of 30 to 35 mL/kg in patients older than 12 years of age with dehydration. Commercially available carbohy-drate/electrolyte drinks generally are more palatable than water and may promote earlier recovery. When the dehydration involves substantial losses of salt as well aswater, additional sodium may need to be added to these drinks because they usually contain 50 mEq/L or less of sodium. This is less than the amounts of sodium (e.g., 90 to 120 mEq/L) generally recommended for rehydration." The additional sodium will increase osmolarity, but this does not appear to delay gastric emptying." Also, guidelines for oral rehydration of children with acute diarrhea are available, which, if used appropriately, may prevent future hospitalization." Intravenous rehydration of... 

Both inorganic selenium and selenomethionine are also found in selenium supplements. The amounts in these supplements generally range from 10 to 25 pg/tablet (Goodman et al. 1990). A guide to vitamin and minerals recommends that not more than 200 pg selenium/day should be taken in any form (Hender 1990). 

To help prevent vitamin D deficiency, most milk is now enriched with it. Other good sources of the vitamin are meat, poultry, fish, peanut butter, eggs, margarine, and liver, especially cod-liver oil. These sources exist in addition to the vitamin D produced naturally from exposure to sunshine. Unlike water-soluble vitamins, such as vitamin C, fat-soluble vitamins are stored in the liver and fat tissue and can become highly toxic if taken in excess. For these reasons, most nutrition experts do not generally recommend additional dietary supplements for vitamin D. Some individuals taking special medication for cholesterol, or who have dark sldn (which reduces the ability of sunshine to produce vitamin D), may require a diet rich in vitamin D or a supplement, see also Calcium Cholesterol. 

This section presents a summary of recommended practices for each substance. These recommendations supplement general work practices (e.g., no eating, drinking, or smoking where chemicals are used) and should be followed if additional controls are needed after using all feasible process, equipment, and task controls. Table 2 (page xviii) explains the codes used. Each category is described as follows ... 

Although information is limited, a reduction in saquinavir plasma levels of the magnitude seen in the first study could diminish its antiviral efficacy. All garlic supplements should probably be avoided in those taking saquinavir as the sole protease inhibitor (no longer generally recommended). While the pharmacokinetic effect on single-dose ritonavir was not clinically important, this requires confirmation in a multiple-dose study. 

Tests at the boiling point should be conducted with minimum possible heat input, ana boiling chips should be used to avoid excessive turbulence and bubble impingement. In tests conducted below the boiling point, thermal convection generally is the only source of liquid velocity. In test solutions of high viscosities, supplemental controlled stirring with a maraetic stirrer is recommended. 

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