Randomized prospective evaluation of cimetidine and antacid control of gastric pH in the critically ill

Joseph Clarke Stothert Jr, D. A. Simonowitz, E. Patchen Dellinger, M. Farley, W. A. Edwards, A. D. Blair, R. Cutler, C. J. Carrico

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Abstract

One hundred forty-four critically ill patients admitted to an intensive care setting were randomly assigned to cimetidine or antacid treatment groups. Gastric pH was monitored hourly. One hundred twenty-three (85%) patients demonstrated a fall in pH to <4 and were considered to require prophylaxis. Prophylaxis was considered adequate if the measured pH could then be maintained at ≥4. Fifty-eight patients received antacids alone, the average requirement being 41 cc/hour. Sixty-five patients received cimetidine. Seventeen (26%) of the cimetidine prophylaxis patients failed to raise their pH and were then placed on hourly administration of antacid with successful elevations of pH to ≥4 in all cases on an average supplementary dose of 53 cc/hour. Risk factors, including sepsis, hypotension, head injury, respiratory failure, degree of trauma, and age, were not statistically different in the two treated groups. Using these same criteria, responder to cimetidine could not be differentiated from nonresponders. All patients were protected from significant stress bleeding while on this study. Significant complications of either treatment were minimal. Antacids offered consistent protection against gastric acidity and were 100% effective. A routine schedule of 300 mg every six hours of cimetidine was effective in only 47% of patients, and the maximum dose of cimetidine was effective in only 74% of patients. Hourly measurement of intragastric pH is required for monitoring the response to prophylaxis of stress bleeding in severely ill patients.

Original languageEnglish (US)
Pages (from-to)169-174
Number of pages6
JournalAnnals of surgery
Volume192
Issue number3
StatePublished - Oct 10 1980

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Antacids
Cimetidine
Critical Illness
Stomach
Hemorrhage
Critical Care
Craniocerebral Trauma
Respiratory Insufficiency
Hypotension
Sepsis
Appointments and Schedules

ASJC Scopus subject areas

  • Surgery

Cite this

Stothert Jr, J. C., Simonowitz, D. A., Patchen Dellinger, E., Farley, M., Edwards, W. A., Blair, A. D., ... Carrico, C. J. (1980). Randomized prospective evaluation of cimetidine and antacid control of gastric pH in the critically ill. Annals of surgery, 192(3), 169-174.

Randomized prospective evaluation of cimetidine and antacid control of gastric pH in the critically ill. / Stothert Jr, Joseph Clarke; Simonowitz, D. A.; Patchen Dellinger, E.; Farley, M.; Edwards, W. A.; Blair, A. D.; Cutler, R.; Carrico, C. J.

In: Annals of surgery, Vol. 192, No. 3, 10.10.1980, p. 169-174.

Research output: Contribution to journalArticle

Stothert Jr, JC, Simonowitz, DA, Patchen Dellinger, E, Farley, M, Edwards, WA, Blair, AD, Cutler, R & Carrico, CJ 1980, 'Randomized prospective evaluation of cimetidine and antacid control of gastric pH in the critically ill', Annals of surgery, vol. 192, no. 3, pp. 169-174.
Stothert Jr JC, Simonowitz DA, Patchen Dellinger E, Farley M, Edwards WA, Blair AD et al. Randomized prospective evaluation of cimetidine and antacid control of gastric pH in the critically ill. Annals of surgery. 1980 Oct 10;192(3):169-174.
Stothert Jr, Joseph Clarke ; Simonowitz, D. A. ; Patchen Dellinger, E. ; Farley, M. ; Edwards, W. A. ; Blair, A. D. ; Cutler, R. ; Carrico, C. J. / Randomized prospective evaluation of cimetidine and antacid control of gastric pH in the critically ill. In: Annals of surgery. 1980 ; Vol. 192, No. 3. pp. 169-174.
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