Abstract
We evaluated the effect of a cimetidine continuous infusion (2 g in 24 h) on the intragastric pH of 16 critically ill patients (11 men, 5 women, mean age 45 years). During the 24 h pre-trial period and the subsequent 24 h cimetidine infusion, an intragastric combined electrode was placed in the fundus and the pH recorded with a portable pH module and data collection unit. In each patient, the cimetidine infusion induced a prolonged rise of intragastric pH. For all patients the mean percentage of readings above pH 4.0 was 11% pre-trial and 75% during the cimetidine 24 h infusion (p<0.001). The percentages of readings above 5.0, 6.0, 7.0 were also significantly higher during infusion than pre-trial in the 16 patients. After starting the cimetidine infusion, there was a concomitant rise of median plasma cimetidine and median intragastric pH in the 7 patients studied. After 6 h, median plasma cimetidine remained above 1 mcg/ml. These results and recent data from the literature suggest that in critically ill patients a continuous infusion of cimetidine might prevent stress ulcerations better than bolus injections by maintaining intragastric pH above 4.0 during longer time intervals.
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Fiddian-Green RG, McCough E, Pittenger G, Rothman E (1983) Predictive value of intramural pH and other risk factors for massive bleeding from stress ulceration. Gastroenterology 85:613
Fimmel CJ, Etienne A, Gilluffo T, Ritter CV, Gasser T, Rey JP, Caradonna-Moscatelli P, Sabbatini F, Pace F, Bühler HW, Bauerfeind P, Blum AL (1985) Long-term amnulatory gastric pH monitoring: validation of a new method and effect of H2-antagonists. Gastroenterology 88:1842
Hastings PR, Skillman JJ, Bushnell LS, Silen W (1978) Antacid titration in the prevention of acute gastrointestinal bleeding. N Engl J Med 298:1041
Kivilaakso E, Fromm D, Silen W (1978) Effect of the acid secretory state on intramural pH of rabbit gastric mucosa. Gastroenterology 75:641
Marrone GC, Silen W (1984) Pathogenesis, diagnosis and treatment of acute gastric mucosal lesions. Clin Gastroenterol 13:635
Milaly GW, Cockbains S, Johns DB, Hanson RG, Smallwood RA (1982) High pressure liquid chromatographic determination of cimetidine in plasma and urine. J Pharm Sci 71:590
Ostro MJ, Russell JA, Soldin SJ, Mahon WA, Jeejeebhoy KN (1985) Control of gastric pH with cimetidine boluses versus primed infusions. Gastroenterology 89:532
Pancorbo S, Bubrick MP, Chin TWF, Miller KW, Onstad G (1984) Cimetidine dynamics after repeated intravenous injection. Clin Pharmacol Ther 35:50
Peterson WL, Barnett C, Feldman M, Richardson CT (1979) Reduction of twenty-four-hour gastric acidity with combination drug therapy in patients with duodenal ulcer. Gastroenterology 77:1015
Piper DW (1973) Antacid and anticholinergic therapy. Clin Gastroenterol 2:361
Priebe HJ, Skillman JJ, Bushnell LS (1980) Antacid versus cimetidine in preventing acute gastrointestinal bleeding: a randomized trial in 75 critically ill patients. N Engl J Med 302:426
Smith P, O'Brien P, Fromm D, Silen W (1977) Secretory state of gastric mucosa and resistance to injury by exogenous acid. Am J Surg 133:81
Zinner MJ, Zuidema GD, Smith PL, Mignosa M (1981) The prevention of upper gastrointestinal tract bleeding in patients in an intensive care unit. Surg Gynecol Obst 153:214
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Tomé, G., Fiasse, R., Reynaert, M. et al. Effect of a 2 g cimetidine infusion on twenty-four-hour intragastric pH in critically ill patients. Intensive Care Med 14, 379–383 (1988). https://doi.org/10.1007/BF00262892
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DOI: https://doi.org/10.1007/BF00262892