Blood promin levels in man

BLOOD JOHN

PROMIN

LEVELS

IN MAN

A. Tool~iEY, ~/[.D., AND MIRIA~f E. DICE CLEVELAND~ OHIO

results following the administration of promin ~ in patients ill T HE with streptococcic infections are described in a previous communication. 1 This paper is a report on the blood promin levels of eighty-five patients. There were great variations in the blood levels before it was decided to give the patients a standard dose of 5 Gin. of promin intravenously three times a day for three days. When this amount was given, the blood levels tended to become more uniform, although the results were not always identical. COMMENT It was difficult to determine what should be the standard blood promin level. Nine of the eighty-five patients received less than 15 Gin. of the drug. The levels in these cases were below 4 rag. per 100 e.c. Ignoring these, fifty-eight of seventy-seven, or 72 per cent, had levels of 4 rag. per 100 c.c. or above at some time during" the course of treatment. Absorption was better in some patients than in others. Occasionally, even large amounts of the drug produced only low blood levels. One patient, No. 16, had a level of 100 rag. per 100 e.e. after 15 Gin. had been injected. Practically the same figures were obtained on rechecking. After 45 Gin. had been given, the level decreased to 68.8 mg. per 100 e.e. Patient 42, in whom the level was 20 rag. per 100 e.e., had influenzal meningitis and had been treated with sulfapyridine and sulfanilamide previous to administration of promin. The level of 30 rag. per 100 e.e. in patient 60 is not to be considered seriously, since the blood was taken too soon after the injection of promin. Twenty patients had a difference of at least 0.8 rag. per 100 e.c. between levels, the first level taken after the smaller dosage being higher than the second taken after a greater amount had been given. This might indicate early accumulation and temporary retention followed, in a few days, by rapid excretion. Since, clinically, patients showed improvement after being given the standard dose mentioned above, perhaps a blood promin level between 4 and 10 rag. per 100 c.e. would be satisfactory from a clinical standpoint. REFERENCE 1. Toome3% J o h n A., a n d Roach, F r e d e r i c k E.:

J. PEmAr. 18: 1, 194A.

F r o m the Division of Contagious Diseases, City H o s p i t a l ; the D e p a r t m e n t of Pediatrics. "Western Reserve U n i v e r s i t y ; the D e p a r t m e n t of P a t hol ogy, City H o s p i t a l ; a n d the School of Medicine, W e s t e r n R e s e r v e U ni ve rs i t y. *Supplied by P a r k e , D a v i s & Co. 6

T 0 0 M E Y AND DICE:

PEOMIN

TABLE I AMOUNT

NO.

AGE

COL~ ~g SEX

OF

TOTAL / P B O M I N ~ H I C ~ PEOMIN KAD BE B E E N GIVEN GIVEN AT TII~ TIME BLOOD

(G~.)

LEVEL T A K E N GM.)

11

6 11 8 8 16 13 18 12 18 (1st course) 27 (2nd course) 12 17 6 9 27 24: 13 14 10 45 15 45

53

W

57 29

W W

M

1(

37 32 41 40

W W W W

M M F M

11 4{

8 9 10 ]1

11 23 26 21

W W W W

F F M F

12 13 14 15

14 too, 22 0 5

W W W W

M M M IK

3~ 1[

16

29

W

F

4{

17

23

W

M

4(

18 19

10 74

W W

F F

4~ 4[

20

44

W

F

4[

21 22

6 15

W W

M iv

4[ 4~.

23

35

W

F

4[

24

59

W

F

4[

25

42

W

F

4[

20

24

W

F

4~

27

49

W

F

3(

1( 2~

4~

28

12

W

F

4~

29

21

W

F

4~

30

55

W

F

7}

Fasting 10 40 45 15 45 15 45 45 20 45 15 45 15 45 15 45 10 45 18 (1st course) 18 (2nd course) 15 45 10 45 9 (1st course) 18 45 ( 2 n d course)

BLOOD LEVEL BLOOD PEOMIN TAKEN LEVELS DAYS AFTEE (MG./IO0 PROMIN C.C.) STARTED 3.9 3.7 2.7 1.4 2.9 0.7 1.4 1.1 2.1 3

1.6

4 4 3 2 4 5 4 3 1 3 1 3 5 6 2 4 4 2 4 2 4 4 2 4 2 4 2 4 2 4 2 4 4

1.8 4.4 0.4 1.5 1.4 3.3 0.9 1.8 2.9 8.8 100.0 68.8 0.1 trace 4.4 3.4 1.7 3.7 8.4 3.0 5.0 2.7 3.2 1.6 3.3 7.8 7.3 7.0 4.4 4.1 5.0 4.1 1.6 0.8

2 4 2 11 2

4.2 6.6 2.7 0.7 3.5 4.1 8.9

THE

JOURNAL

OF

PEDIATRICS

TABLE I - - C O N T ~ D

TOTAL

NO.

COLOR

AGE

(G~.)

AMOUNT OF PROMIN WI~ICH HAD BEEN GIVEN AT TI1V[E BLOOD LEVEL TAKEN

(G~.) 31

W

32

W M

33

44

W

34 35

~ 2

W W

36

40

37

22

38

50

F

39

31

P

40

3

M

41

M

89

42

43 44

F ] 7

M M

45

F

46

F

47

60

M

48

28

F

49

20

F

50

19

F

51

23

F

52

21

M

53

12

M

54

28

F

55

53

M

56

26

Ig

57

4O

F

58

16

B

F

59

63

W

M

20 45 20 45 15 45 22 20 45 20 45 20 45 20 45 20 45 20 45 25 45 20 45 24 20 45 20 45 25 45 15 45 15 45 20 45 20 45 20 45 20 45 20 45 20 45 20 35 20 45 20 45 20 45 20 45

BLOOD LEVEL TAKEN DAYS AFTER PROhIIN STARTED

BLOOD PROMIN LEVELS

(~G./100 C.C.)

8.7 5.4 5.8 2.0 4.4 1.7 1.6 5.8 4.6 3.2 4.0 3.3 4.5 7.2 5.6 2.0 5.0 5.8 4.3 8.0 9.2 14.5 20.0 (Died) 0.9 6.4 5.8 9.7 10.4 10.2 4.8 6.5 4.9 5.2 4.4 4.6 6.0 5.7 4.4 2.3 2.2 1.7 4.4 4.4 5.2 9.0 4.8 9.4 6.5 3.8 1.7 2.6 2.2 3.9 3.6 2.1 4.1

T 0 0 M E u AND DICE:

PROMIN

TABLE I - - G O N T ~ D

TOTAL NO.

COLOR L

sEx l

AMOUNT OF P•0MIN W]~ICH HAD BEEN GIVEN AT TI1V[E BLOOD LEVEL TAKEN

(O~I.) 60

61 62 63 64 65 66 67 68

45

69

75

70

45

71

45

72

45

73

45

74 75 76 77 78

B

79

W

8O

W

81

W

82

W

83

W

84

W

85

W

15 (1st course) 45 20 (2nd course) 45 20 45 20 45 20 45 20 45 20 45 20 45 20 45 20 45 2O 45 65 75 20 45 20 45 20 45 15 45 20 20 45 20 45 20 45 20 45 20 45 20 45 20 45 20 45 20 45 75 20 45 60 8

36

BLOOD LEVEL TAKEN DAYS APTER PROMIN STARTED

BLOOD PROMIN LEVELS (MG./100 C.C,) 5,6 4.1 30.0 5.4 3.7 5.2 3.2 7.1 4.2 2.3 3.0 6.3 3.0 6.8 5.2 6.2 17.2 15.0 5.2 3.4 2.2 2.5 3.8 4.5 1.8 2.2 3.7 6.5 7.7 5.4 6.6 4.4 2.4 2.4 4.0 4.2 4.4 7.9 5.7 7.1 14.4 8.6 9.0 7.4 4.6 7.0 9.2 5.5 3.5 5.2 6.2 6.4 3.5 8.0 1.7 (Died) 0.9 0.2