Expert opinion on drug safety
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The use of hypotonic intravenous solutions, especially 4% dextrose/0.18% saline, remains standard practice in many paediatric units in the UK. The practice of prescribing hypotonic intravenous fluids derives from the work of investigators in the 1950s, who produced arbitrarily-derived formulae for calculating the maintenance requirements for water and electrolytes in hospitalised patients. Combining these values led to the widespread acceptance of hypotonic solutions such as 4% dextrose/0.18% saline as 'standard maintenance' parenteral fluids. ⋯ The problem is compounded by the fact that 4% dextrose/0.18% saline is labelled as 'isotonic'. Whilst this solution is isosmolar compared to plasma, lack of osmotically-effective solutes means that it is hypotonic with reference to the cell membrane. There is no justification for the routine administration of hypotonic intravenous fluids.
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A large number of drugs may be responsible for the development of nail changes, including cancer chemotherapeutic agents and retinoids, however, only a few classes of drugs are consistently associated with nail symptoms. Drug-induced nail abnormalities result from toxicity to the matrix, the nail bed, the periungual tissues or the digit blood vessels. ⋯ Drug-induced nail changes usually involve several or all of the nails. In most cases, nail abnormalities are asymptomatic, but can sometimes cause pain and impair manual activities.