The message
from (Nick Maclaren) contains these words:
In article , Neil
wrote:
Plasmapheresis in the treatment of Amanita phalloides poisoning: II. A
review and recommendations. [Review] [48 refs] Therapeutic Apheresis.
4(4):308-12, 2000 Aug.

Thanks for that. It is always useful to have my (sometimes ancient)
knowledge updated - in this case, it was still more-or-less correct.
That is one fungus that you really DON'T want to eat by mistake.

It is also one fungus you don't want to eat on purpose...

--
Rusty
Open the creaking gate to make a horrid.squeak, then lower the foobar.
http://www.users.zetnet.co.uk/hi-fi/

On Tue, 9 Nov 2004 14:34:07 GMT, Jaques d'Alltrades
wrote:

Your quotes omitted one of the most effective adjuncts to the drug
therapy - sugar.

Larger than normal intake of sugars can tip the balance between survival
or thud!: if they can be kept down. Treatment should include
intravenous injection of 20 ml glucose in normal saline solution, four
or five times a day.

Mushrooms and Toadstools - Dr. John Ramsbottom, Collins NewNaturalist
Series, Ch 5, Poisonous and Edible Fungi: 1



Omitted for one reason there is no evidence to support claims for its
efficacy.

Any one on ITU would almost certainly receive glucose as a routine
infusion

By the way you don't need ( indeed there are reasons not to) mix
glucose with saline.

Normal Saline solution is 0.9%. ie 9 grammes of sodium choride in 1
litre of water. This is a standard drip mix. Glucose is also used
routinely in drips at 5% concentration. You can give 2 litres of
glucose 5% per day with 1 litre of saline 0.9% as a routine in many
situations. To mean anything the 20ml of glucose would need to be at a
defined concentration, Hospitals routinely use 5% 10% 20% and 50%
strenghts of glucose.

500mL of 50% per day gives 250g of carohydrate which is not too far
from what many take each day.

Neil

In article ,
(Neil) writes:
|
| Normal Saline solution is 0.9%. ie 9 grammes of sodium choride in 1
| litre of water. This is a standard drip mix. ...

Are you sure? Just that? No potassium or anything else?


Regards,
Nick Maclaren.

The message
from (Neil) contains these words:
On Tue, 9 Nov 2004 14:34:07 GMT, Jaques d'Alltrades
wrote:

Your quotes omitted one of the most effective adjuncts to the drug
therapy - sugar.

Larger than normal intake of sugars can tip the balance between survival
or thud!: if they can be kept down. Treatment should include
intravenous injection of 20 ml glucose in normal saline solution, four
or five times a day.

Mushrooms and Toadstools - Dr. John Ramsbottom, Collins NewNaturalist
Series, Ch 5, Poisonous and Edible Fungi: 1



Omitted for one reason there is no evidence to support claims for its
efficacy.

On the contrary, the only ancient remedies which had any sort of success
are those which featured sugar of some sort. (Like seven rabbits' brains
and three stomachs chopped small, and made into balls with honey or jam
- the theory being that as rabbits could eat a human's lethal dose there
must be something in the rabbits' stomachs and brains which neutralises
the poison(s). The honey or jam was to help it go down, but in restoring
some of the sugar which the liver under attack wasn't providing, it gave
some credence to the antidote hypothesis)

Latterly, intravenous sugars are (unless I'm *VERY* out of date) always
administered to restore the blood-sugar levels to normal...

Any one on ITU would almost certainly receive glucose as a routine
infusion

....rather than just routinely.

By the way you don't need ( indeed there are reasons not to) mix
glucose with saline.

Maybe other sugars are used now, or other preservative. I *WAS* quoting
from the (presumably first edition) 1959 impression.

Normal Saline solution is 0.9%. ie 9 grammes of sodium choride in 1
litre of water. This is a standard drip mix. Glucose is also used
routinely in drips at 5% concentration. You can give 2 litres of
glucose 5% per day with 1 litre of saline 0.9% as a routine in many
situations.
_______

To mean anything the 20ml of glucose would need to be at a
defined concentration, Hospitals routinely use 5% 10% 20% and 50%
strenghts of glucose.

Sorry - while copying that I missed out the 4% (glucose)

500mL of 50% per day gives 250g of carohydrate which is not too far
from what many take each day.

I think we got to this point because someone suggested that there was
still no treatment - no sure-fire cure, I'd agree, but treatments which
improve the chances of survival there are.

--
Rusty
Open the creaking gate to make a horrid.squeak, then lower the foobar.
http://www.users.zetnet.co.uk/hi-fi/

On 9 Nov 2004 17:17:19 GMT, (Nick Maclaren) wrote:



| Normal Saline solution is 0.9%. ie 9 grammes of sodium choride in 1
| litre of water. This is a standard drip mix. ...

Are you sure? Just that? No potassium or anything else?


Regards,
Nick Maclaren.


Fluid balance is an art form as well as a science. A typical adult in
the UK needs about 90 millimole of sodium per day and about 80 of
potassium and enough water to replace what goes out as urine plus
sweat losses (anything from 500mL to 5000 mL perday depending on the
situation).

The problem is solutions that are not "normal" ie same osmotic
strength as cells tend to cause blood problems. ( You can show this to
children using raw potato cut into chips all the same length put one
into pure water and one into a strong salt solution and the water one
swells and lenghtens the one in saline shrinks and becomes floppy. At
0,9% no change).

The upshot of this is set strength tend to be used. Glucose is
metabolised off so it provides water the glucose provides the right
concentration without leaving a residue so to speak. You are quite
right potassium is needed but in the short term ( 24 hrs) you can do
without. After that it is added typically 20 -40 millimole per litre
of fluid.

There are much fancier mixes ( listen on ER for "lactated Ringer's
solution" ) However in the UK glucose and saline are the main ones
with sodium bicarbonate as a backup.

For intravenous feeding you get a huge mix tha tis highly complex and
looks like milk.

Regards

Neil

On Tue, 9 Nov 2004 19:09:15 GMT, Jaques d'Alltrades
wrote:

The honey or jam was to help it go down, but in restoring
some of the sugar which the liver under attack wasn't providing, it gave
some credence to the antidote hypothesis)

Latterly, intravenous sugars are (unless I'm *VERY* out of date) always
administered to restore the blood-sugar levels to normal...

People with liver failure are very vulnerable to hypoglycaemia and
this is watched for very very closely. Treatment is usually by a
steady infusion of 10% glucose with higher concentrations as
needed.Intermittent boluses are used but only when needed not as a
regular item.


Any one on ITU would almost certainly receive glucose as a routine
infusion

...rather than just routinely.

By the way you don't need ( indeed there are reasons not to) mix
glucose with saline.

Maybe other sugars are used now, or other preservative. I *WAS* quoting
from the (presumably first edition) 1959 impression.

The difference between fluid management and ITU care from 1959 and the
present day is as big as the diferences between the PC you sre sitting
in front of now and the one you would have used in 1960. Glucose ( AKA
dextrose ) is virtually the only one used. Mannitol very rarely for
special reasons but nowt else



Sorry - while copying that I missed out the 4% (glucose)

4% glucose 0.18% saline is mainly used in paediatrics for volume
reasons it means in kids you can match salt given to the childs size.


I think we got to this point because someone suggested that there was
still no treatment - no sure-fire cure, I'd agree, but treatments which
improve the chances of survival there are.

Improve survival yes but my point is these treatments are non specific
and as such very chancy. If you are poisoned with nerve gas ( or
insecticide) you get pralidoxime which is a direct antidote. Morphine
you get naloxone, paracetamol N-acetylcysteamine and so on ( but for
very few more).

With Amanita poisoning you get those things which help your liver and
kidneys cope until they heal themselves. Your survival hinges much
more on time taken to recognise the poison than on a "cure". To call
this a treatment is to elevate routine supportive measures which I
agree are vital and successful to the level of an antidote they are
not.

Neil

In article , Neil wrote:

Fluid balance is an art form as well as a science. A typical adult in
the UK needs about 90 millimole of sodium per day and about 80 of
potassium and enough water to replace what goes out as urine plus
sweat losses (anything from 500mL to 5000 mL perday depending on the
situation).

The problem is solutions that are not "normal" ie same osmotic
strength as cells tend to cause blood problems. ( You can show this to
children using raw potato cut into chips all the same length put one
into pure water and one into a strong salt solution and the water one
swells and lenghtens the one in saline shrinks and becomes floppy. At
0,9% no change).

The upshot of this is set strength tend to be used. Glucose is
metabolised off so it provides water the glucose provides the right
concentration without leaving a residue so to speak. You are quite
right potassium is needed but in the short term ( 24 hrs) you can do
without. After that it is added typically 20 -40 millimole per litre
of fluid.

My understanding is that normal saline as used in hospitals contains
potassium as well as sodium, and perhaps magnesium and calcium as
well, because it is more general and safer.

For example, if someone is admitted suffering from dehydration and
is actually short of potassium, it is NOT good to rehydrate them with
a potassium-free saline! You need a blood analysis to be certain,
and there often isn't time.


Regards,
Nick Maclaren.

The message
from (Neil) contains these words:
On Tue, 9 Nov 2004 19:09:15 GMT, Jaques d'Alltrades
wrote:

The honey or jam was to help it go down, but in restoring
some of the sugar which the liver under attack wasn't providing, it gave
some credence to the antidote hypothesis)

Latterly, intravenous sugars are (unless I'm *VERY* out of date) always
administered to restore the blood-sugar levels to normal...

People with liver failure are very vulnerable to hypoglycaemia and
this is watched for very very closely. Treatment is usually by a
steady infusion of 10% glucose with higher concentrations as
needed.Intermittent boluses are used but only when needed not as a
regular item.

Perhaps I didn't make it clear that this was a *VERY* elderly 'cure'.

/snip/

Improve survival yes but my point is these treatments are non specific
and as such very chancy. If you are poisoned with nerve gas ( or
insecticide) you get pralidoxime which is a direct antidote. Morphine
you get naloxone, paracetamol N-acetylcysteamine and so on ( but for
very few more).

But we aren't discussing general panaceas - the discussion was very
specific. I quote from your earlier post:
----------------------
As this was originally about lawn mushrooms and what follows is
undiluted science I offer an apolgy for being a little off topic and
indigestible but I think the ungarnished science is a salutary
reminder. There is no magic serum or curative treatment just some that
tip the odds more in your favour. The following is the current
published medical data and basically the treatment for Amanita
poisoning is that which any big hopsital with a renal unit ,
transfusion unit and ITU would offer. The last resort is a liver
transplant. with lifelong immunosupression to follow.
------------------------

And that's where the sugar bit took off.


With Amanita poisoning you get those things which help your liver and
kidneys cope until they heal themselves. Your survival hinges much
more on time taken to recognise the poison than on a "cure". To call
this a treatment is to elevate routine supportive measures which I
agree are vital and successful to the level of an antidote they are
not.

I don't think we differ there.

--
Rusty
Open the creaking gate to make a horrid.squeak, then lower the foobar.
http://www.users.zetnet.co.uk/hi-fi/

The message
from (Neil) contains these words:

Fluid balance is an art form as well as a science. A typical adult in
the UK needs about 90 millimole of sodium per day and about 80 of
potassium and enough water to replace what goes out as urine plus
sweat losses (anything from 500mL to 5000 mL perday depending on the
situation).

The problem is solutions that are not "normal" ie same osmotic
strength as cells tend to cause blood problems. ( You can show this to
children using raw potato cut into chips all the same length put one
into pure water and one into a strong salt solution and the water one
swells and lenghtens the one in saline shrinks and becomes floppy. At
0,9% no change).

In the chemical sense, a normal solution is one of one gramme-equivalent
of dissolved substance to a litre of water.

--
Rusty
Open the creaking gate to make a horrid.squeak, then lower the foobar.
http://www.users.zetnet.co.uk/hi-fi/

On 9 Nov 2004 21:04:01 GMT, (Nick Maclaren) wrote:



My understanding is that normal saline as used in hospitals contains
potassium as well as sodium, and perhaps magnesium and calcium as
well, because it is more general and safer.

Absolutely not. Calcium and magnesium are rarely given. If you looked
on a normal UK hospital ward you would find glucose 5% and 0.9 %
sodium choride. Some bags would have added potassium. You would
perhaps find 50% and 10% glucose and maybe 1.4% sodium bicarbonate.
anything else is a rarity. Magnesium and calcium would be present in
TPN ( Total Parenteral Nutrition) which you can in theory live on for
months or years.



For example, if someone is admitted suffering from dehydration and
is actually short of potassium, it is NOT good to rehydrate them with
a potassium-free saline! You need a blood analysis to be certain,
and there often isn't time.

If needed any AED should be able to get a reading of sodium, potassium
and a full blood gas analysis ( pH and oxygen/CO2 levels) as fast as
the sample can be run to the lab and very likely done in the same room
as the patient if they are in the resuscitation bay. Glucose readings
take 1 minute at the bedside or 5 minutes in the lab if you want high
precision.

On Tue, 9 Nov 2004 21:21:41 GMT, Jaques d'Alltrades
wrote:



In the chemical sense, a normal solution is one of one gramme-equivalent
of dissolved substance to a litre of water.


Agreed but in the hospital or physiological sense "normal" means 0.9%
saline or 5% glucose which are iso osmotic with cells.

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