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By the mouth.
DIRECTIONS FOR THE USE OF SODIUM HYDNOCARPATE.
The drug is supplied in grain Tablets for oral administration,
One tablet may be given three times a day after food, and the number increased by one daily until a total of ten or twelve tablets 20 to 24 grains) are taken each day, as long as the digestion is not disturbed while some patients can take as many as twenty tablets (40 grains) daily for long periods with advantage.
Preparation of Solutions for Hypodermic and Jotravenous use.
A 3% solution is made by dissolving 3 grams of the drug together with half a grain of Sodium Citrate (which is added to lessen the tendency of the drag to produce clotting in the injected veins thus interfering with further use of the same vessels) The solution is then sterilized in the autoclave, and % Carbolic Acid added to preserve it. If an auto- clave is not available the Carbolic Acid should be first added and the carbolized solution heated on a waterbath to too C for 20 minutes. When a number of patients are being injected at a time from 50 to 100 c. c. can conveniently be made in a small flask and after sterilizing the mouth may be covered with a sterile rubber cap, the upper surface of which may be washed with Absolute Alcohol or other antiseptic and punctured with the needle of a sterile syringe to take up the required dose, as used by Sir Almroth Wright for vaccines. If any precipitate or gelatination of the solution occurs on standing after Steri- lization it should be filtered and re-sterilized. If slight precipitation recurs but dissolves on warming, the solution may be injected after so re-dissolving the precipitate. A very fine precipitate passing though a filter paper may be safely injected even intravenously. If sterile it never causes suppuration on bypodermic injection, while the slight local swelling at the site of the injection should be absorbed in 3 or 4 days at the most. The solution is put up in ampoules for hypodermic and intravenous use.
Dosage.
For hypodermic use one grain in 2 c. c. (a 3% solution) may be commenced with and if only slight local irritation is produced it may rapidly be increased to 2 grains in c. c or 1% in 5 c. c, and given 2 or 3 times a week, in addition to full doses by the mouth daily.
The injections may be made in the upper arm, suprascapular fossa, or between the shoulder blades; a second injection should not be made in exactly the same spot as an earlier one if any hardening of the tissue remains.
Jojections Into tubercles.
In the case of large tubercles not yielding to the general treatment a few minims of a weak solution, such as 1 in 500 or 1 in togo, may be injected directly into the nodules with advantage.
Intravenously.
This is much the least painful and far the most effective way of giving the drug. As .fever and swelling of the diseased parts may be produced by intravenous injections It was
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at first recommended to begin with one-tenth of a grain of Sodium Hydrocarpate in o'z c. cr miniras) of the 3% solution and increase by one-tenth of a grain at each dose. Prolonged erience has shown that such reactions do no harm and are always followed by more improvement than is otherwise obtained. The first dose of Sodium Hydnocarpate ey therefore be grain in 1 c. c. ; one grain in 2 c. c. may be given for the second dose, subsequently increased by c.c. at a time up to 2 grains in 4 cc. unless a severe action
is obtained, in which case the same dose should be repeated until no reaction occurs. Some ents can stand 5 c. c. doses without getting giddy. The intravenous injections may be en once or twice a week, and the tablets given by the mouth on the other days of the ----k, but not on the days the intravenous doses are given, Tielty.
Rabbits will stand the equivalent of about 50 grains for a man of so kilos weight. When a dose of about 2 grains intravenously is reached io patients transient giddiness is times produced, and if it is severe this is an indication for not increasing the dose "ser. The intravenous injections should always be given slowly and especially the last ac. dose, so that if any giddiness occurs the injections may be immediately stopped. No effects beyond transient giddiness and headache have been seen to follow the injections. en a patient returns for another injection it is sometimes found that the last injected - shows'a hard condition due to clotting for half an inch or so at the site of injection. Except for the inconvenience of losing the use of the vein for injections no harm has ollowed this occurrence, which has been much less frequent since % Sodium Citrate was ided to the solution.
Method of injection.
The drug is unirritating, so the same vein may be used repeatedly for the injections, Erh give rise to no pain apart from the mere prick of the needle. The veins of the forearm y be conveniently distended by tying a bandage, or stretching a stout piece of rubber bing around the upper arm and passing one end in a loop under the other end of clamping the ends of the tubing together, so that the pressure can be quickly released by pulling out e loop or realising the clamp before the injection of the fluid, which prevents any escape the fluid or blood into the tissues around the vein which might lead to thrombosis... lion may then he applied in Cotton Wool over the puncture. It is essential to use a
rp fairly fine needle as a vein is readily pushed in front of a blunt one without being ured. The veins at the bend of the elbow are generally the most convenient for the urpose but those in the foream or on the back of the wrist or hand and the internal aphenous to the ankle are often useful. If the veins are very small the air pressure band blood pressure instrument may be used to distend them the required degree, the pressure Cong released after the vein has been punctured before the fluid is injected. Panctions.
These consist in fever for a day or two, and rarely for a longer period accompanied by ing of tubercular deposits, and sometimes actual breaking down with discharge of en down bacilli, and followed by reduction in the induration of the reacting parts and cal absorption of the nodules. Steady improvement may, however, result in the absence such reactions, although usually it is slower.
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