The diagnostics and treatment of tropical diseasesStitt, E. R. (Edward Rhodes)
Science
The diagnostics and treatment of tropical diseases
Stitt, E. R. (Edward Rhodes)
Tropical medicine
The cheapest and most generally obtainable salt is the sulphate. It
is soluble in 720 parts of water and contains 74% of alkaloid. The
opinion now prevails that this is one of the less desirable of forms
for the administration of quinine. It is frequently obtained in pill
or tablet form and it must not be forgotten that such preparations
may be almost stone-like and pass through the alimentary tract
without absorption. If used it is best to give it in acid solution
made by dissolving 5 grains of quinine sulphate in one teaspoonful (1
dram) of water with one drop of concentrated hydrochloric acid.
_Dosage of Quinine._—The ordinary full dose of quinine for an
adult is 10 grains repeated three times in a day or 30 grains
daily. Some authorities recommend 15 grains three times daily (45
grains) at the commencement of treatment and such dosage seems to
be just as efficient as the larger dose of 60 grains in a day.
In cinchonism we have ringing in the ears, fullness in the head,
deafness and dizziness. For children Bass recommends 1/20 of the
adult dose for each year of age so that a child of 5 years age
would receive ¼ of the adult dose. Beyond 15 years of age the dose
is that of an adult.
There now seems to be a tendency to use the alkaloid itself instead
of its salts, it having been found that the alkaloid and its very
insoluble tannate are absorbed from the digestive tract equally as
well as the soluble salts. Quinine is almost insoluble in water
(1-1560) and hence has less bitter taste than the soluble salts. It
is also less haemolytic so that it may be used with greater safety
where blackwater fever is feared.
Euquinine or ethylcarbonate of quinine contains 81% quinine, and
is only soluble in 1-12,000 parts of water, hence its comparative
tastelessness. It is expensive.
Quinine tannate contains only about 30% of quinine and is
practically insoluble in water. It is often given to children in
chocolate tablet form. It can often be taken by those who suffer
disagreeable effects from other salts. The dose should be 2½ times
that of quinine sulphate.
Until recently the bimuriate (72% of alkaloid and soluble in 1 part
of water) or the chlorhydrosulphate (74% of alkaloid and soluble
in 2 parts of water) have been considered the most desirable salts
for hypodermic injections or oral administration. At present,
owing to its extensive use in local anaesthesia and incident
availability, bimuriate of quinine and urea is to be recommended
for intramuscular use. It contains 60% of quinine and is soluble in
an equal amount of water.
It has been found to have a slightly greater tendency to produce
amblyopia than other quinine salts and should not be used
intravenously.
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