Detoxification and Cleansing Programs
Successful treatment of MOH, whether as an outpatient or in a multidisciplinary outpatient or inpatient program, requires the integration of three components detoxification, bridge therapy, and establishment of daily prophylaxis (see Table 12.13). Table 12.14 Components of treatment of Medication overuse headache Detoxification (wean)
To treat their symptoms and reduce the risk of seizures and DTs during outpatient detoxification. Benzodiazepines are the treatment of choice for alcohol withdrawal, according to U.S. and Scottish guidelines (SIGN, 2003). In healthy people with mild to moderate alcohol withdrawal, carbamazepine has many advantages, making it a first-line treatment for properly selected patients (Asplund et al., 2004).
Genetic polymorphisms often affect the qualitative and quantitative functions of enzymes needed for the inactivation or detoxification of toxic chemicals. One of the better known examples is the absence of the enzyme to metabolize alcohol in some population groups. This enzyme alcohol dehydrogenase is absent in nearly 20 of the Japanese population and such individuals develop adverse effects after even minimal doses of alcohol. Similarly the genetic polymorphisms associated with metabolizing enzymes (e.g. acetyltransferase and cholinesterase) produce variations in the ability to inactivate many xenobiotics often drugs. Such polymorphisms, in certain instances, have resulted in grouping individuals as fast metabolizers and slow metabolizers (Rang etal. 1995).
Results in the production of hydrogen peroxide, another, but less reactive oxidant, SOD should act together with catalase or GPx 137 . Catalase and GPx detoxify intra- and extracellular hydrogen peroxide to produce water and oxygen 138 . Data by the Zini group suggest that the seminal catalase and SOD activities do not derive from the testis or epididymis, but rather from seminal vesicle or prostate 139 .
Detoxification Detoxification (detox), the first step in treating chemical addiction, is the removal of all harmful substances from the addicted client's system. When physical dependence is present, medical interventions are used to counter the uncomfortable and, in some cases, high-risk symptoms of withdrawal. These tools include medications to treat symptoms, to rebuild the patient's damaged system, and to combat cravings (D. E. Smith & Seymour, 2001). Some addictions can be treated using a substitution and tapering process, such as phenobarbital for sedative-hypnotic detoxification or methadone for opioid detox. Methadone is also sometimes used for maintenance purposes until a patient is better prepared for detoxification (see Harm Reduction Programs later in Part V). Detoxification can only be done under the supervision of a physician. Not until the drug is fully eliminated can the brain return to its preaddiction potential. When there is physical dependence, medical interventions...
For further information on detoxification services see Morse, G. R. (1999). Detoxification A guide for medically assisted withdrawal from chemical addiction. London Mark Allen Publishing. For a detailed description of the Detoxification Services Definitions that explains the levels of care for Substance Abuse and Mental Health Services visit In addition to minimizing withdrawal symptoms during detoxification, medications are used to treat co-occurring psychiatric disorders some 25 to 75 of all clients have a current or past comorbid psychiatric disorder (Ziedonis & Krejci, 2001). 1. Symptomatic treatment Using a drug whose pharmacological action is unrelated to the abused drug but whose effects ameliorate emotional or physical symptoms related to the use of the abused drug (e.g., to ease discomfort when detoxifying).
As a complementary therapy, hydrotherapy provides relaxation and symptom relief from many ailments. As noted in Part Six Alternative (Unproven or Disproved) Treatments Taken Internally, however, hydrotherapy is sometimes promoted as a potentially curative therapy. Colonic irrigation is an example. Such unproven methods may involve exposing the body to extremes of temperature through water or through internal cleansing, potentially dangerous procedures promoted to detoxify the body and restore health.
Treatment of MOH is as varied as the proposed revisions to its definition, due in large part to lack of understanding of the natural biology and history of this headache disorder. Certain principles, covered in Chap. 11, can be used as a bedrock for therapy, and should be observed in any attempt to treat MOH. These include 1) absolute detoxification, 2) addition of preventive medication, and 3) behavioral steps for maintaining health. 1. Detoxification from the offending agents
Relapse rates of these approaches are not easy to find, and any available head-to-head comparisons have been open label studies. One Italian study found no difference between outcomes at 6 months when comparing day-hospital care and inpatient therapy about 40 had a 50 drop in headache frequency, and 53 reduced abortive drug intake by more than 50 when the two populations were combined. Other studies have demonstrated that most relapses occur within the first year after successful detoxification and that the type of drug use responsible for MOH may determine the risk of relapse. The rates for relapse vary in prospective studies, from 38 to 71 (see Table 12.12).
Detoxification Many states now have a registry for every patient that allows practitioners to see every scheduled medication by type, date, and number that a patient is provided by which prescriber (examples, in Ohio, OARRS in Kentucky, KASPAR in Michigan, MAPS, etc.). Sign up for this service and check on the amount of medication being consumed before initiating the wean .You can be rudely surprised. We had to admit a patient using 12-16 butalbital-containing tablets a day for observation and carefully governed detoxification (see Table 12.15).
Yet some patients receive significant relief from depression, if not complete remission, when they take these medications prior to a period of abstinence. If relieving emotional pain is a primary reason clients have become addicted to psychoactive substances, providing and monitoring appropriate prescribed drugs may ameliorate their addiction. This decision should be made in consultation with a medical doctor.
Michael Smith, M.D., began and still administers the acupuncture detox program at that hospital. The program combines treatment of five-needle ear acupuncture and herbal detox tea, along with case managers to coordinate conventional health and substance abuse counseling, social services, urinalysis, and a recommended 12-step program in Narcotics and or Alcoholics Anonymous. The ear acupuncture alters the blood and brain chemistry of dopamine receptors and other neurotransmitters. After treatment, the patients can opt for tiny, stainless steel balls taped in their ears. In between treatments, they can press on these balls to simulate the relaxation they experienced during acupuncture, which will help them through the detox. The acupuncture detox protocol is for the patients to have acupuncture treatment six days a week, whether they're trying to quit using tobacco, alcohol, heroin, or crack. During the course of the next four to six weeks, the treatments can taper off as the patients...
The first Ru-based anticancer drugs were designed to target DNA, similarly to cisplatin. However, NAMI-A and KP1019 belong to a newer generation of Ru-based drugs that do not target primary tumors and DNA, but instead target metastases cells and proteins. A recent approach is design of Ru-drugs with multiple modes of activity by combining Ru with an active targeted ligand. Some examples are the Ru-SERMs complexes (selective estrogen receptor modulators) that target both hormone-dependent and -independent breast tumors and RAPTA complexes designed to inhibit Glutathione-S-Transferases (GST), a cytosolic detoxification enzyme associated with drug resistance.
Physicians interface with the medical or behavioral effects of alcoholism when patients deteriorate to the point of trauma, end-organ damage, or behavioral impairment. As with other chronic disorders, alcoholism is slow but progressive. As the disease progresses, the ability to control drinking diminishes, which distinguishes an alcoholic from a nonalcoholic. Many physicians view detoxification as the treatment of this disorder, which is similar to giving diabetics one injection of insulin to control their diabetes. It treats the immediate problem but does little to address the chronic disorder in 1 week or 1 month. Although the goal for an alcoholic is complete abstinence from alcohol, the norm is alcohol consumption in increasing amounts. The family physician can view intermittent periods of abstinence or reductions in alcohol consumption as progress in treatment of the disease and encourage further efforts. Relapse must be evaluated carefully, and keys to change can open the door...
The liver is unique in that it receives both nutrient-rich deoxy-genated blood (portal vein) and oxygenated blood (hepatic arteries). The portal vein branches as it enters the liver, where its blood percolates around hepatocytes in tiny vascular channels known as sinusoids. Hepatocytes detoxify the blood, metabolize fats, carbohydrates, and drugs, and produce bile. The sinusoids receive deoxygenated blood from the portal veins (provide blood for metabolism and detoxification) and oxygenated blood from the hepatic arteries (provide oxygen for hepatocytes). Blood exits the sinusoids into a central vein, which empties into the hepatic veins and ultimately into the inferior vena cava, which passes through the diaphragm before entering the right atrium of the heart.
The authors believe that absolute detoxification or wean from overused medications is the crucial step in treating patients in MOH. Any compromise in this regard will increase the likelihood of failure. Occasionally, a patient will hit the wall during the taper of rebound medications, or go into a particularly nasty withdrawal headache. In those circumstances, a run of oral steroids can sometimes put the patient over the final hump of detoxification. The trick is recognizing when to initiate the referral for one of these programs. If the therapeutic alliance is strong enough to withstand a failure of conventional outpatient wean, an outpatient trial of weaning is reasonable. If the clinician feels there is only one shot at getting a patient detoxified and turned around, an interdisciplinary program is more likely to be successful.
Some junior colleges, such as the Nova Scotia Community College (Annapolis Valley Campus), offer training programs in addiction counseling services. Graduates of the Human Services program who, during their second year complete a concentration in addictions counseling, graduate with an Addictions Counseling Diploma and find employment in crisis centers, hospitals, addiction centers, detox centers, community services, group homes, halfway houses, or outpatient services.
In body tissues, primarily the liver, producing hypoxic damage. High levels of ethanol saturate the ADH enzyme system when the ADH system is overwhelmed, the microsomal ethanol oxidizing system must take over the detoxification process. The microsomal ethanol oxidizing system is an inducible cytochrome P-450 (CYP 450) enzyme system it participates in phase 1 metabolism and also produces acetaldehyde as its end product. 4,25 Acetaldehyde exerts direct toxic effects on the liver by damaging hepatocytes, inducing fibrosis, and by directly coupling to proteins, interfering with their intended actions. Metabolism of large amounts of ethanol shifts hepatic metabolic processes away from oxidation and toward reduction. These changes in metabolism account for the fatty liver, hypertriglyceridemia, and acidemia observed in alcoholic liver disease.
Therapeutics Approaches include prevention, detoxification, reestablishment of one's unique constitutional balance. Foods, emotions, and behaviors are used to adjust dosha levels. Panchakarma is used to remove aggravated doshas and toxins. Components of panchakarma include therapeutic vomiting, use of purgatives or laxatives, nasal administration of medications, blood purification (traditionally by blood-letting, now more often with teas), and therapeutic enemas. Therapeutics Approaches can include nutrition, botanicals, homeopathy, Chinese medicine, physical medicine (e.g., ultrasound, massage, manipulation), hydrotherapy (e.g., baths, steams, wraps, colonic irrigation), and various detoxification regimens.
During the nineteenth century, once opiate addiction became familiar to physicians, a debate ensued over whether the continuous use of opium was a habit or a disease over which the patient had little control. The debate was complicated by a belief that abrupt withdrawal from opium could cause death. Three options were proposed and vigorously defended. The first was abrupt withdrawal, recommended almost exclusively as a hospital procedure. The addict was considered to be ingenious in obtaining drugs and to have a will so weakened by addiction and craving for opium that, unless he or she was securely confined, withdrawal would not be successful. It could be assisted by the administration of belladonna-like drugs that counteracted withdrawal symptoms such as sweating. These drugs also caused delirium, which, it was hoped, would have the effect of erasing the addict's memory of the withdrawal. (Scopalamine is given today just before general anesthesia for a similar reason.) The high rate...
The variability of pharmacokinetics of orally administered anticancer drugs can among other things be explained by the affinity for drug-transporting proteins expressed in the intestinal epithelium and directed toward the gut lumen (250). Currently, three major classes of drug pumps, including P-glycoprotein (ABCB1), multidrug resistance-associated protein (MRP1 or ABCC1) and its homolog MRP2 (also known as cMOAT or ABCC2), and BRCP (synonymous for MXR, ABCP1, or ABCG2), have been characterized, that may play a role in mediating transmembrane transport of anticancer agents, including irinotecan and topotecan (250). The abovementioned proteins belong to the large superfamily of ATP-binding cassette transporters that are found in almost all prokaryotic and eukaryotic cells. The characteristic tissue distribution of these drug transporters strengthens the indication that they play an important role in detoxification and protection against xenobiotic substances (250). In vivo studies with...
Abstract Oxidation of lipids can be a blessing or a curse as far as spermatozoa are concerned. Beatitudes are conferred via the oxidative generation of oxysterols, which then drive sperm capacitation by promoting the removal of cholesterol from the sperm plasma membrane. Conversely, the anathema involves peroxidation of polyunsaturated fatty acids (PUFA) to generate lipid peroxides that have a detrimental effect on spermatozoa, disrupting DNA integrity and limiting their competence for fertilization. Spermatozoa actively detoxify and remove toxic lipid peroxides from the sperm plasma membrane, but once these defense mechanisms have been overwhelmed, lipid peroxidation spreads rapidly through the cell leading to membrane damage, leakage of ATP, and a rapid loss of sperm motility and viability. The excessive presence of unesterified PUFA may be instrumental in the genesis of oxidative stress through the ability of these amphiphiles to interfere with the mitochondrial electron transport...
Nonenzymatic antioxidant molecules include a-tocopherol (vitamin E), b-carotene (vitamin A), ascorbate (vitamin C), glutathione, estrogens, creatine (related to carotene) flavonoids (aromatic oxygen heterocyclic compounds widely distributed in higher plants), resveratrol (a botanical antioxidant), metallothionein (cadmium-binding protein involved in heavy metal detoxification), taurine (an aminosulfonic acid) and its precursors, and other thiols such as nonstructural polyunsaturated lipids and melatonin. Oral administration of vitamin E reduced the level of testicular-free radicals in a rat experimental model of varicocele 119 , and the effectiveness of anti-oxidants to treat infertile men has been previously demonstrated in randomized trials 120 . Therefore, antioxidants can be effectively applied to treat heat-inducible oxidative stress in humans.
In the case of heroin addiction, maintaining the addict on a regimen of medically managed, orally administered opioids may be preferred over rapidly detoxifying the patient who has a high likelihood of returning to heroin use when extensive strategies for rehabilitation have not been put in place. In order to allow time for psychosocial strategies to help the addicted individual change his or her overall lifestyle, a period of opioid agonist treatment may be indicated. This strategy has been used to maintain addicts on either orally administered p opioid agonists such as methadone, or partial agonists such as buprenorphine. No matter which method has been used to facilitate detoxification from the abused substance, addicts have a high risk for reusing substances and manifesting their dependence again. In the long term, the most effective mechanisms for maintaining sobriety are psychosocial strategies rather than pharmacologic ones.
Non-enzymatic antioxidative systems consists of co-enzyme Q10 (radical scavenger), dietary vitamins such as vitamins A (P-carotene singlet oxygen quencher), C (ascorbate diverse antioxidant functions) and E (a-tocopherol chain-breaking compound) or other substances such as urate (radical scavenger) or aliphatic polyamines such as spermidine and spermine. Vitamin E is the most efficient compound in the lipid phase 149 . All these substances have in common that they detoxify free radicals 150 . Hence, it is not surprising to find the most important natural antioxidants such as vitamin C and E 151, 152 , uric acid 153 , glutathione 154 in highest concentrations in the seminal fluid. Reportedly, seminal vitamin C and E concentrations are lower in infertile men than in normal patients 155, 156 . In addition, patients with lower seminal ascorbate concentrations showed a higher, though not significant, percentage of sperm DNA fragmentation 155 .
The Gerson regimen is an example of an old alternative cancer treatment that remains popular today. Developed by Max Gerson in the 1930s, it involves eating raw fruit and vegetable juices, eliminating salt from the diet, taking many supplements such as potassium, vitamin B12, thyroid hormone and pancreatic enzymes, and using coffee enemas to detoxify the liver and stimulate metabolism. Scientific research does not support any of these ideas. Moreover, despite proponents' claims of recovery rates as high as 70 to 90 , case reviews by the U.S. National Cancer Institute (NCI) and the New York County Medical Society found no evidence of usefulness for this regimen. An NCI-sponsored study of Gonzalez therapy, which is similar to the Gerson diet and popular today, showed that patients with inoperable pancreatic cancer who underwent standard gemcitabine chemotherapy survived three times longer and had better quality of life than those who chose Gerson-type therapy with pancreatic enzymes,...
In addition to bipolar receptor cells, the olfactory epithelium contains several other major cell types (see Fig. 7-1 (Figure Not Available) ). The sustentacular or supporting cells, whose apical ends have microvilli that extend into the olfactory mucus, span the distance from the epithelial surface to the basal laminae and function to (1) mechanically isolate the bipolar receptor cells from one another, (2) secrete mucopolysaccarides, (3) transport molecules across the epithelium, and (4) detoxify and degrade odorants. Some of the basal cells, located near the basement membrane, serve as precursors for the generation of other cell types within the neuroepithelium. The duct cells of Bowman's glands line passages through which most of the olfactory mucus is secreted, whereas the microvillar cells, located at the surface of the epithelium, send tufts of microvilli into the nasal mucus. The function of these flask-shaped cells is unknown. However, they number about 600,000 in humans'4...
The National Directory of Drug Abuse and Alcoholism Treatment and Prevention Programs DHHS Pub No SMA 013243
SoberRecovery.com An online program based in southern california supported by sponsors, affiliates, and donations from visitors and members, it lists more than 2,500 resources (all with links of their own). This web site provides information on AA, NA, sober Living Homes, Al-Anon and NarAnon, Detox centers, Treatment Facilities, Eating Disorders, and Mental Health Resources.
Although consistently suspected in adult populations, symptoms of alcohol abuse and withdrawal are often overlooked in pediatric patients (Repper-DeLisi et al. 2008). Although benzodiazepines are generally considered the treatment of choice for alcohol withdrawal, guidelines for when to treat and how much medication to give vary considerably. Most protocols recommend an initial benzodiaz-epine dose based on a patient's alcohol use and symptom severity, dose titration to control symptoms, and then a gradual taper for detoxification, in either a fixed amount or a symptom-triggered fashion with dose based on severity (Repper-DeLisi et al. 2008). All benzodiazepines are equally effective, but diazepam (long-acting) and lorazepam (short-acting) are most often used. Lorazepam is metabolized by conjugation, has no active metabolites, and is preferable for patients with impaired hepatic function. Either medication can be administered orally or intravenously (Repper-DeLisi et al. 2008).
Some internal functions of infants and young children differ from adults, making children more vulnerable to exposure. Their mechanisms for detoxifying and excreting environmental chemicals are immature and less efficient. Metabolic pathways may not yet include the same enzymes, or the same amount of a particular enzyme, which an adult would use to metabolize and detoxify the chemicals that enter their bodies (Eskenazi et al. 1999). This means that a dose of a specific chemical, which an adult body could quickly eliminate before damage is caused, has the potential to cause harm to a child.
Remember, the patient needs to want the plan. You may know the patient needs to be weaned, the family may recognize the need for a wean, and the referring doctor may want you to help get the patient out of rebound, but unless the patient is invested in complete detoxification and appropriate treatment, proceeding is futile. You cannot detoxify a patient against their will. Playing tough love is often useful. Another point well made is that unless the patient puts the clinician up against the wall and insists on being detoxified, it is well worth resisting. interventions before ending up, sometimes years later, back in the clinician's office, ready, finally, for the wean and overall plan. There is no spontaneous remission from rebound. Only a carefully planned and implemented treatment strategy that involves complete detoxification from over-used medications will work. Table 11.6 is a summary of education of the patient in MOH.
Arsenic exists in both organic and inorganic forms. The organo-arsenicals are mainly found in marine organisms or as metabolites in the detoxification pathway in mammals. The Food Standards Agency estimate that the average daily intake of arsenic is 65 g in the UK, mostly from fish, and that the bulk of this is in the form of organo-arsenicals (DEFRA and EA 2002). Organo-arsenicals are less toxic than the inorganic compounds and are not considered further in this review.
In addition to treating the obvious needs for relaxation and relief of withdrawal symptoms, acupuncture addresses the addict's general state of physiological imbalance and ill health. Holistic treatment can also support treatment of coexisting psychiatric disorders ranging from depression to paranoia. The Lincoln Recovery Center has found a group setting to be most successful, and has trained clinicians to administer this treatment. The National Acupuncture Detoxification Association (NADA) assists programs interested in applying this treatment modality (www.acudetox.com).
Because of the complexity of liver metabolism, patients with liver disease may develop many complications, including neurological dysfunction. This problem can be expected, considering the important role the liver plays in both nutrient metabolism (glycolysis, nutrient biosynthesis) and detoxification. The term HE refers to diffuse cerebral dysfunction occurring secondary to liver disease. When HE develops acutely in patients with liver disease of less than 8 weeks' duration, the term fulminant hepatic failure (FHF) is used, whereas the term portal-systemic encephalopathy (PSE) is used when HE develops in patients with chronic liver disease. This differentiation has therapeutic implications because a number of treatments exist for patients with PSE, whereas no specific form of treatment has been proved beneficial in FHF, except urgent liver transplantation. Pathogenesis and Pathophysiology. Although neither the responsible toxin nor the pathogenesis of HE is known, it is believed to...
Dosage Insoluble in water, it is ineffective if taken as a tea. (Studies show that less than 10 percent of the active ingredient is available in this form.) Use seed extracts standardized to at least 70 percent silymarin (the antihepatotoxic principle). The suggested daily dose provides 200 mg of concentrated extract three times daily in the treatment of liver disease, representing 140 mg of silymarin per capsule (in total, 420 mg daily). You can use one 200 mg dose as part of a cleansing detoxification program. It might have mild laxative effects in some people.
Metabolic therapy is based on the theory that disease is caused by accumulations of toxic substances in the body. Accordingly, treatment aims to eliminate the toxins. It is believed that this will enhance immune function, which in turn will assist the body to restore itself to health. Metabolic therapies vary from practitioner to practitioner, but typically include the same basic components a special diet high-dose vitamins, minerals and other dietary supplements and detoxification with coffee enemas or irrigation of the colon (see Chapter 41). Detoxification, another major component of metabolic therapy, consists of coffee enemas every four hours. The enemas are claimed to stimulate the excretion of bile from the liver and rid the body of toxins. Meals with predominantly natural and organically grown foods, plus nutritional supplements, are eaten to strengthen the immune system. Meditation, prayer, and additional alternative therapies such as bioelectric stimulation may be used to...
Normal liver function is essential for production of several blood-clotting factors and for the metabolism and detoxification of many drugs. Viral disease also has implications in terms of cross-infection (see Ch. 7). It is important to assess coagulation defects preoperatively to ensure that adequate haemostasis will occur (see Ch. 6), and to be aware of the possibility of reduced drug breakdown when administering or prescribing agents. The British National Formulary contains valuable information on prescribing for such patients and should be consulted appropriately.
The preferred CNS agents for detoxification are the benzodi-azepines, according to U.S. and Scottish guidelines (Asplund et al., 2004 SIGN, 2003) and Cochrane review (Ntais et al., 2005). They provide the best side effect profile and have a better risk benefit profile than other agents. Benzodiazepines are not likely to be fatal in overdose unless mixed with another central depressant (check the urine toxicology screen). Chlor-diazepoxide and diazepam are both effective agents. If liver disease is present, or to treat withdrawal in an older patient, oxazepam or lorazepam may be a safer choice because of shorter half-life. Additionally, beta blockers such as ateno-lol, 50 to 100 mg day, may decrease tremulousness and sym-pathomimetic symptoms if there are no contraindications (Table 49-2). A scheduled regimen of chlordiazepoxide, 100 to 300 mg on day 1, followed by daily 50 dose reductions for 3 to 5 days, rather than as needed or on a symptom schedule, provides for a smooth...
The patient is ready for referral, has hit bottom, or is otherwise ready for change. The physician arranges inpatient or outpatient detoxification and involvement in a treatment program and completes a history and physical examination, with laboratory studies as appropriate.
Acamprosate is recommended in newly detoxified dependent patients as an adjunct to psychosocial interventions. Acamprosate is approved for use in alcohol-dependent and alcohol-abusing patients. Its mechanism of action is not well known, although there is fair evidence of its benefit. Acam-prosate is an analog of homotaurine, a GABA-ergic agonist. The GABA-ergic system appears to affect the action of alcohol-induced behavior. Acamprosate also appears to have effects on glutamate and NMDA receptors. Chronic alcohol exposure is thought to alter the normal balance between neuronal excitation and inhibition, and acamprosate may help restore some of this balance. Several controlled clinical trials have demonstrated the effectiveness of acamprosate as an adjunct to psychosocial therapy for alcoholics who have undergone inpatient detoxification. In these studies, acam-prosate was demonstrated to be superior to placebo. Acam-prosate does not appear to be effective in the treatment of...
Despite no head-to-head randomized controlled trials comparing one bridge therapy with another, DHE treatment is the gold standard of bridging therapy to bring the patient as painlessly as possible through detoxification. This may, in part, be due to the pharmacology of DHE, its long half life, and its low recurrence rate. The Raskin protocol, published by Callaham and Raskin in 1986 for refractory migraine, has been adapted and refined through years of experience. It can be provided to all patients without vascular disease in need of detoxification, whether they are going to go home and taper stop the analgesics, are in an outpatient multidisci-plinary program, or an inpatient program. It can be the jump-start of a detoxification that will be conducted as an outpatient, in a day-hospital intravenous regimen, or inpatient and around the clock every 8 h. Our approach is outlined in Table 12.16. Some alternatives to the 8-h DHE protocol can be found in Tables 12.17 and 12.18, and Table...
-acetyl-cysteine (NAC) is a metabolite of l-cysteine produced within the human body. It helps to synthesize GSH, one of the body's most important and powerful natural antioxidant and detoxification mechanisms. NAC increases GSH levels, subsequently alleviating OS by neutralizing free radicals. GSH is also known to aid in the transport of nutrients to lymphocytes and phagocytes, as well as protect cell membranes. NAC plays a vital role in germ cell survival in human seminiferous tubules. Several studies have indicated an optimistic role of NAC in improving semen parameters (Table 22.3).
General Patient Guidelines for Outpatient Opioid Detoxification When treating opioid with drawal with pharmacologic agents, patient safety is the highest priority. The first step is to educate patients about the course of withdrawal. Symptoms peak at around 5 to 7 days and may last up to 2 weeks. Patients also should be advised regarding the side effects of the drugs used to detoxify. For instance, clonidine causes dizziness from low blood pressure, sedation (which may impair driving or operating heavy machinery), and dry mouth. There is also an overdose potential if clonidine is mixed with opioids or other CNS sedatives or antihypertens-ives. The risk of these adverse events needs to be balanced with potential benefits. The side effects of buprenorphine include constipation (most commonly), sedation, and headaches. It should also be noted that there is a potential for serious overdose when buprenorphine is mixed with benzodiazepines or other sedative-hypnotics. The risk of developing...
Selenium functions as an antioxidant alone in the detoxification of heavy metals in the body and as a cofactor of the antioxidant enzyme glutathione per-oxidase. Dietary selenium deficiency increases tissue oxidative damage and it seems that selenium has a sparing effect on tissue levels of vitamin E. However in experimental studies selenium deficiency does not impair endurance capacity in rats and supplementation in humans has no effect on physical performance 82 . Selenium has also been shown to be important for the immune system. This is of special concern in the Scandinavian countries, which have selenium-poor soils, and has led to specific programs to add selenium to fertilizers in Finland in order to increase the dietary intake of selenium. In this context it is of interest that it has been shown that selenium status in Swedish athletes is subnormal and lower than in Finnish athletes
There is evidence that small water-soluble proteins, termed odorant-binding proteins, assist the movement of some hydrophobic lipid-soluble molecules through the mucus to the receptor proteins of the olfactory cilia. y Such assistance may be selective, and at least some of these proteins may serve to inactivate odorant molecules or filter the number of such molecules reaching the receptors. For example, some odor-induced signals appear to be rapidly abolished by detoxification or biotransformation enzymes within the mucus.y
Detoxify the Body
Need to Detoxify? Discover The Secrets to Detox Your Body The Quick & Easy Way at Home! Too much partying got you feeling bad about yourself? Or perhaps you want to lose weight and have tried everything under the sun?