REPLY
Treatment of Gastrointestinal Motility Disorders in Pregnancy
Belinda Ramirez and
Joel Richter
1 October 1993 | Volume 119 Issue 7 Part 1 | Page 635
IN RESPONSE:
We appreciate the comments of Dr. Nichols and stand corrected in our statement that "none of the drug is absorbed". In one study [1], the amount of aluminum recovered in the urine after administration of four 1-g doses of sucralfate was less than 0.02%, similar to the amount found after ingestion of an aluminum-containing antacid. Although systemic absorption is minimal, we agree that prolonged use could result in higher systemic levels and should be considered if sucralfate is to be used during the first trimester of pregnancy.
Drs. Picca and Fiordalisi accurately point out that not all antacids are appropriate for preventing aspiration pneumonitis during obstetric anesthesia because of the possible aspiration of insoluble particulates such as aluminum and magnesium hydroxides, carbonates, and trisilicates, resulting in a severe and permanent pulmonary lesion. In contrast, the aspiration of nonparticulate antacids, such as sodium citrate, produces a less severe and transient pulmonary lesion and should be the antacid of choice in this setting [2]. Of note, however, is that antacid prophylaxis alone does not protect all obstetric patients. Better protection is probably provided by histamine-2 blockers in combination with nonparticulate antacids or with more potent agents, such as high-dose omeprazole, given the night before surgery.
1. Haram EM, Weberg T, Berstad A. Urinary excretion of aluminum after ingestion of sucralfate and an aluminum-containing antacid in man. Scand J Gastroenterol. 1987; 22:615-8.
2. Cheek TG, Gutsche BB. Pulmonary aspiration of gastric contents. In: Shnider SM, Levinson G, eds. Anesthesia for Obstetrics. Baltimore: Williams & Wilkins; 1993:407-31.
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