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The head should be supported by another helper if a cervical spine injury is sus pected generic leflunomide 20mg overnight delivery medications kidney damage. A needle attached to leflunomide 10 mg fast delivery symptoms lupus a saline-filled syringe is introduced 1cm below the junction of the middle and inner thirds of the clavicle purchase leflunomide 10mg on line medications ranitidine. The nee dle is advanced medially and slightly upwards behind the clavicle (aiming for the sternal notch) as the plunger is slowly withdrawn buy leflunomide 10mg with visa medications used for fibromyalgia. When venous blood enters the syringe, the syringe is removed leaving the needle in the vein. If necessary, the central line is then connected to a manometer to measure the central venous pressure. The carotid pulse is felt just anterior to the midpoint of the sternocleidomas toid muscle (the high approach) and a needle is inserted lateral to this, aiming posteroinferiorly and towards the nipple on that side (the internal jugular vein lies posterior to the carotid artery at the base of the skull; the vein then twists around the carotid and lies lateral to it half-way down the neck and in front of it just below the clavicle). In the low approach the needle is inserted between the two heads of sternocleidomastoid just above the clavicle. After the central line has been inserted it is important to get a check X-ray to confirm the position of the line and rule out a pneumothorax. Complications of central line insertion include • Pneumothorax and haemopneumothorax (especially in the subclavian approach) • Arterial puncture (it is easier to apply pressure to the internal jugular if it is hit by mistake, than it is to the subclavian artery which is hidden deeply) • Haematoma formation • Infection Recent evidence has suggested that real-time ultrasound guidance for central line insertion, with or without Doppler assistance, improves catheter insertion success rates, reduces the number of venepuncture attempts prior to successful placement, and reduces the number of complications. The response to volume expansion is monitored by the same signs and symptoms that are used to diagnose it. Here, the patients respond rapidly to the fluids and remain haemodynamically stable once the fluids are stopped or slowed. These patients have usually lost minimal blood volume (20%) and Trauma, Shock, Head Injuries and Burns 59 can be observed but do not necessarily need any further intravenous fluids. There is an initial response with a rise in the blood pressure and a fall in the pulse rate; however, as the fluids are slowed down, the indices used to measure shock start to deteriorate again, indicating that the blood loss is ongoing or resuscitation has been inad equate. The response to the fluid will indicate those patients who are still slowly bleeding (as may other clinical findings). As a last resort, Group O negative blood can be given, which is the universal donor. Failure to respond to the fluid resuscitation and the blood indicate the need for immediate surgical intervention to control the haemorrhage (‘turn off the tap’). If blood is given (usually packed red cells without plasma) it should be warmed to prevent hypothermia and, after a large transfusion, platelets and fresh frozen plasma may be needed to correct the lack of clotting factors. The main aim of transfusion is to correct the oxygen-carrying capacity, since crystalloids and colloids can both correct the lack of intravascular volume but have no oxygen-carrying capacity. The majority of head injuries fall somewhere between these two extremes, and the difficulty for the doctor is in deciding who needs to be admitted for observation and who can be sent home. It is possible to have one without severe brain injury, and likewise, you can have an intracranial injury without accom panying skull fracture, especially in children, whose bones and joints are more supple. The only significance of X-raying head injury patients and looking for a skull fracture is that such patients have a statistically higher probability of developing a bleed into the brain, and hence they get admit ted for observation. The fragment may need to be elevated if depressed more than the thickness of the skull or if there are focal signs. A broad-spectrum antibiotic should be started, the patient taken to theatre for wound debridement and the fracture dealt with. This fracture cannot usually be seen on a plain X-ray of the skull, although it should be suspected if there are fluid levels in the sphenoidal sinuses. The badger sign (bruising around both orbits), together with rhinorrhoea, is associated with a fracture of the cribri form plate. Brain Injury Injuries to the brain can be primary, occurring at the time of impact, or secondary to hypovolaemia, hypoxia, hypo-glycaemia and raised intracra nial pressure. Prevention of primary brain injury can only be brought about by measures to stop the accident happening in the first place, such as having road speed limits and the wearing of motorcycle helmets, etc. The main aim in the management of a head injury is, therefore, to prevent or limit the damage that occurs due to secondary injury. The changes are reversible and are often resolved by the time the patient arrives in hospital. They may have just been confused or dazed at the scene or may have lost consciousness. Afterwards they may complain of a headache, feel dizzy, be amnesic or nauseous, and generally if the patient has been unconscious for more than 5 min it is probably best to admit them to hospital for observation. This is a more severe injury, with microscopic structural damage throughout the brain tissue. Such patients can develop autonomic dysfunction and hence have high fevers, hyperten sion and sweating. They can be coup injuries, where the brain is damaged directly by the skull at the point of impact, or contre coup injuries, where the brain is squashed by the skull at a remote point from the impact. The patient may have a focal neurological deficit, depending on the site of the contusion. The patient is usually managed conservatively; however, due to the risk of delayed bleeding into the contusion, careful observation is needed to observe for deterioration (especially in alcoholics). This is due to a bleed from the arteries that supply the skull and dura — usually the middle meningeal artery, which sits just under the skull in a region called the pterion (or temple). This type of bleed is quite rare, accounting for less than 1% of coma-producing head injuries; however, it can be rapidly fatal. There is usually an associated skull fracture of the parietal or temporal bone, often caused by a direct blow — for example, being hit over the side of the head by a baseball bat.

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Effects of Theraband and lightweight dumbbell training on shoulder rotation torque and serve performance in college tennis players leflunomide 20 mg with amex treatment quad strain. Return to leflunomide 10 mg visa symptoms 0f high blood pressure sport after anterior cruciate ligament reconstruction in professional soccer players leflunomide 10 mg generic symptoms zinc deficiency. No increase in knee laxity purchase leflunomide 20mg on-line medications hard on liver, stronger quadriceps, and return to sports 2 months sooner b. Increase in knee laxity, stronger quadriceps, and return to sports 2 months sooner c. No increase in knee laxity, weaker quadriceps, and return to sports 2 months sooner d. No correlation between subjective knee scores and functional performance testing c. Neuromuscular stability exercises only should be used in the rehabilitation program. The concept of regional interdependency is a popular topic in the present literature. However, one of the first studies to demonstrate this concept used isokinetic testing by doing which of the following Performing total leg isokinetic strength testing of lower extremity muscles and correlating to weaknesses throughout the lower extremity b. Performing total leg isokinetic strength testing of lower extremity muscles and correlating to weaknesses throughout the upper extremity c. Performing total leg isokinetic strength testing of lower extremity muscles and correlating to performance testing d. Summarize the critical demographics of aging in America and the effects on health care. Functional declines, physical disability, and greater use of health care resources are associated with aging. Health care costs are higher per capita among older Americans than any other age group. Estimates project that the population of persons aged 65 and older will double to 92 million by 2060 and the population of persons aged 85 and older will triple to 5. By 2056, the number of people aged 65 and older will be greater than those aged 18 and younger. Projections indicate that non-Hispanic white adults will decline to 56% of the total population. The proportion of Asian Americans will double, and the proportion of Hispanics will nearly triple. Males tend to have higher health care costs than females in the later decades of life. At least 80% of older adults have at least one chronic illness and more than 50% have multiple chronic conditions. Hypertension, diabetes, cardiovascular disease, arthritis, chronic obstructive lung disease, and mental illness is increasing and contributes significantly to disability and reduced quality of life. Heart disease and cancer are the leading causes of death among all adults aged 65 and older, regardless of sex, race, and ethnicity. Other leading causes of death are chronic respiratory disease, stroke, Alzheimer’s disease, diabetes, influenza, and pneumonia. Falls are the leading cause of fatal and nonfatal injury among people over 65 years of age. A multifactorial fall risk assessment should be conducted on all persons who report falling in the previous year or on those who have gait and lower extremity muscle strength or balance abnormalities. Risk factors associated with falls include lower extremity muscle weakness, gait and balance impairments, impaired vision, variable blood pressure, poor vision, cognitive impairment, psychoactive medications or polypharmacy, footwear or foot problems, and environmental hazards. Yes,but it is difficultto determinethe relative contributionortype of exercise fordecreasingthe riskof falls because many studies incorporate exercise into a multifaceted treatment approach. Individual and group exercise programs that include balance, coordination, and gait and strength training have been shown to reduce falls among community-dwelling older people. Caution should be used when initiating exercise among sedentary older persons with limited mobility, as exercise could increase fall rate. Antidepressants and sedatives are most strongly linked to increased risk of falls, but cardiovascular drugs to control hypertension and arrhythmias are also implicated. A significant number of falls are associated with postural hypotension, an adverse side effect of many cardiovascular medications. What is orthostatic (postural) hypotension, and what are common signs and symptoms Orthostatic hypotension is defined as a drop in systolic blood pressure of >20 mm Hg or a drop in diastolic blood pressure of 10 mm Hg with a concurrent rise in pulse rate within 3 minutes of moving from supine or sitting to a standing position. Associated signs and symptoms include dizziness, lightheadedness, blurred vision, and syncope or fainting. Orthostatic hypotension has been association with increased falls among older adults. Treatment strategies include progressive elevation of the head of the bed, progressive sitting on the side of the bed while performing active leg exercises, and deep breathing. The use of lower extremity elastic stockings during physical activity and elevating the bed by 5 to 20 degrees during sleep is recommended. Age-related decline in muscle mass (sarcopenia) begins in the third decade of life and accelerates after age 50.

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In this case order leflunomide 20mg with mastercard medicine mountain scout ranch, the central respiratory events occur a recent ascent to purchase leflunomide 20 mg without prescription medicine questions at least 4 leflunomide 10 mg on line medications 5 rights,000 meters buy leflunomide 10mg without prescription symptoms diverticulitis, or approximately as a secondary disorder. Subjects with this disorder experi or Substance ence hypoventilation during both wake and sleep, with Certain drugs, including methadone and hydrocodone, onset usually at birth. Hypoventilation is typically worse have been known to occasionally cause central respiratory during sleep than during wake. Late-Onset Central Hypoventilation with Primary Central Sleep Apnea of Infancy Hypothalamic Dysfunction is life-threatening disorder a icting infants is char Subjects with late-onset central hypoventilation with acterized by long respiratory events, obstructive or hypothalamic dysfunction are typically healthy until central in nature, lasting at least 20 seconds. Primary approximately age 2, when they develop severe obesity central sleep apnea of infancy is extremely dangerous and central hypoventilation. Diagnostic criteria call for for newborns, and should be diagnosed and treated as an absence of symptoms during the rst few years of quickly as possible. Primary Central Sleep Apnea of Prematurity Central sleep apnea is common in premature infants, and Idiopathic Central Alveolar Hypoventilation sometimes requires ventilator support. After resolu Substance tion of obstructive events during the titration, central is disorder is characterized by hypoventilation during events emerge and persist with at least ve central sleep that can be traced to a medication or other sub events per hour of sleep. Sleep-Related Hypoventilation Due to a Medical Disorder is disorder is characterized by hypoventilation dur Sleep-Related Hypoventilation Disorders ing sleep that can be traced to a medical disorder that is Obesity Hypoventilation Syndrome known to inhibit respiration, and is not primarily caused Also referred to as hypercapnic sleep apnea, obesity by a medication or substance. Snoring is caused by a partial obstruction (measured by kg/m2) greater than 30, and the absence of the upper airway, often including nasal obstruction, of a medical disorder or medication that may cause and in isolation may or may not be considered malig hypoventilation. A common example of automatic behavior to be disruptive to sleepers in adjacent rooms. Snoring is speaking on a subject matter that is completely out of tends to increase with body mass, and may or may not context for the situation. Excessive daytime pull the lower jaw forward, pillar implants inserted into sleepiness can also negatively a ect one’s personal rela the soft tissues of the palate, and adhesive strips to widen tionships. Typically the patient is not a ected by this disor may experience periods of microsleep. Microsleep is a der, but the bed partner’s sleep is often disrupted as a period of sleep that is so brief the individual may not be result. One of the most well-known and disruptive symp Hypersomnolence toms of narcolepsy is cataplexy. Cataplexy is sometimes mistaken not caused by disturbed nocturnal sleep or misaligned 3 for seizure activity, and is characterized by a bilateral loss circadian rhythms. Cataplexy is seen in approximately 70% narke, meaning numbness or stupor, and lepsis, mean ing attack. Very few narcoleptic patients su er from all of the listed symptoms, but many su er from more than one of these. Narcoleptics also may nd and/or hypnopompic hallucinations, which are seen it helpful to discuss their disorder and its associated in approximately 30% of narcoleptic su erers. Doing so can help relieve some of the embarrass experiences occurring at sleep onset or upon awakening. Perhaps the most Sleep paralysis and hypnagogic and hypnopompic signi cant behavioral treatment for narcoleptics is hallucinations may also be seen in subjects other than to practice proper sleep hygiene. Typical niques include practices that are bene cial to the qual onset for narcolepsy is during the late teen years or early ity of one’s sleep, and have been shown to be e ective 20s, and although there is no known cure, there are in improving a patient’s ability to initiate and maintain treatments available that have been shown to be e ec sleep and remain awake and alert during the daytime. Although the Examples of sleep hygiene practices include retiring exact cause of narcolepsy is not known, there appears to and awakening at consistent times from day to day; be a strong genetic component. Additional studies of the sion while in bed; and avoiding greasy, fatty foods and brains of narcoleptic patients have found increased levels snacks. Consistently practicing proper sleep hygiene of norepinephrine, dopamine, and epinephrine. In some techniques can greatly improve the quality of sleep cases, severe head injuries and brain tumors have been and the quality of life for both narcoleptics and normal known to cause narcolepsy. Narcoleptic patients often su er from depression, In addition to behavioral modi cations, narcoleptics possibly as a result of the inability to carry out certain may use certain medications to treat the disorder and normal activities, and are often underachievers. Amphetamine-like stimulants resulting symptoms similar to those of narcolepsy, such as methylphenidate and methamphetamine are diagnosing the disorder may be di cult. Diagnostic criteria for narcolepsy type I also ing these naps can be indicators of narcolepsy. Although these Circadian rhythm sleep–wake disorders are charac symptoms may be common secondary symptoms in other terized by a disturbance or disruption to the normal disorders, the diagnostic criteria for this disorder require circadian rhythm, which causes the patient to experi the absence of other sleep disorders causing them. When the sleep schedule is not a consistent part of the Kleine-Levin Syndrome circadian rhythm, it can greatly disturb the ability to Also referred to as recurrent hypersomnia or periodic initiate or maintain sleep, or the ability to achieve restful, hypersomnolence, Kleine-Levin syndrome occurs when restorative sleep. Patients may sleep 16–18 hours a Delayed Sleep–Wake Phase Disorder day during these periods, and have associated symptoms Delayed sleep–wake phase disorder is characterized by including hallucinations and confusion. A patient with hypersomnia may last as long as four weeks, and recur at this disorder is unable to fall asleep at the desired time least once a year. A typical episode lasts approximately or at a time that is considered normal, but is able to at 10 days, with some rare cases lasting several weeks. Patients with this diagnosis have the symptoms of hypersomnia, but the Advanced Sleep–Wake Phase Disorder daytime sleepiness occurs as a result of a medical disorder. Advanced sleep–wake phase disorder is character ized by an earlier sleep time than expected or desired. Hypersomnia Due to Drug or Substance A patient with this disorder has di culty staying awake is disorder is present when the use or abuse of a drug until the normal or expected bedtime, but then awak or medication is responsible for extended periods of ens early in the morning. Hypersomnia Associated with a Psychiatric Irregular Sleep–Wake Rhythm Disorder Disorder Irregular sleep–wake rhythm disorder is character Patients with this disorder meet the diagnostic criteria ized by abnormal sleep and wake times. Although the for hypersomnolence, but the daytime sleepiness is asso total sleep time during the 24-hour cycle is comparable ciated with a psychiatric disorder.

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On physical examination discount leflunomide 10 mg mastercard symptoms 4 months pregnant, the vital signs are—blood pressure 135/80 mm Hg discount leflunomide 10mg fast delivery symptoms kidney failure dogs, pulse 72/min best leflunomide 10 mg treatment anal fissure, and respiratory rate 10/min purchase 20 mg leflunomide with mastercard medicine 2020. An 18-year-old woman develops weakness, weight gain, amenorrhea, abdominal striae, and behavioral abnormalities. Which of the following is the most common pattern of dyslipidemia in Type 2 diabetes A previously asymptomatic 62-year-old woman presents with sudden onset of severe midback pain. Other vertebral bodies show decreased mineral density and prominent vertical striations. A 70-year-old man, with no evidence of heart disease, develops transient right arm and leg weakness, which resolves within 1 hour. A 60-year-old woman being investigated for menorrhagia is found on history to have lethargy, constipation, cold intolerance, and muscle stiffness. A 20-year-old patient with asymptomatic lymphadenopathy in the right supraclavicular area is found to have nodular sclerosing Hodgkin disease on biopsy. A 45-year-old man presents to the emergency department with weakness, fever, weight loss, and abdominal pain. On examination, he is hypertensive, the heart sounds are normal, and lungs are clear. A 45-year-old man presents to the emergency department with new onset of jaundice. An ultrasound of the liver reveals that the cause of his jaundice is due to extra-hepatic biliary obstruction. A 19-year-old man presents to the clinic because he is concerned about a pigmented skin lesion. Which of the following characteristics suggests a dysplastic nevus (atypical mole) rather than a benign acquired nevus A 73-year-old man is brought to the emergency department because of decreased urine output for the past 2 days. Which of the following urine values distinguishes prerenal azotemia from other causes of acute kidney injury A 27-year-old-man is brought to the emergency room because he is feeling unwell, and endorses symptoms of chest discomfort and shortness of breath. He has experienced similar symptoms in the past during times of stress, but this is the first presentation to the emergency room. His past medical history is negative and he is not taking any medications or recreational drugs. On physical examination, he looks well, blood pressure is 157/88 mm Hg, pulse 110/min, and respiratory rate 22/min. The lungs are clear on auscultation, the heart sounds are normal, and there is no pericardial or pleural rub. Which of the following blood gas results is most likely seen in a patient with hyperventilation due to anxiety A 57-year-old woman presents to the hospital with a 2-hour history of retrosternal chest pain and dyspnea. A 34-year-old man is brought to the emergency room by his family because of extreme lethargy. After further questioning, he admits to taking a large number of phenobarbital tablets. A 45-year-old man was exposed to high levels of radiation after an accident at a nuclear reactor 5 years ago. A 67-year-old-woman presents to the clinic complaining of feeling lightheaded every time she stands up. Her past medical history is significant for hypertension, gout, and increased cholesterol. She reports no symptoms of chest discomfort, shortness of breath, or palpitations. Which of the following diuretics will continue to induce significant diuresis after return of blood volume to normal levels He has finished 4 months of therapy without any complications but now complains of numbness in his feet. A 28-year-old-man is seen in the clinic complaining of intermittent bouts of joint discomfort involving his knees. The illness resolved on its own but he did notice a round flat red rash on his abdomen around the same time. His physical examination is entirely normal, and there is no evidence of any active joints. Further history reveals that he went camping in the Northeastern United States last year prior to the onset of his symptoms. A 28-year-old-woman is seen in clinic for routine follow-up of her pregnancy at 32 weeks’ gestation. On physical examination, her vital signs are blood pressure 156/92 mm Hg, pulse 88/min, and respiratory rate 16/min. Her liver edge is not tender, the fundus is palpable above the umbilicus, and the neurologic examination including reflexes is normal. Which of the following statements concerning hypertension during pregnancy is correct A 31-year-old-woman is seen in clinic at 36 weeks’ gestation because she is concerned about infections that her baby may acquire during pregnancy and birth. She states that her immunizations are up to date and she is not experiencing any febrile illness or genitourinary symptoms. A 35-year-old man presents with severe left-sided periorbital headaches associated with nasal stuffiness and tearing of the eye.

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Histological evidence of metastatic calcium deposits in renal tubules and long-bone periosteum and endosteum generic leflunomide 10 mg line medications quotes. Acute inflammation or pelvic lesions in some of the rats (number not stated) fed 2% in diet buy cheap leflunomide 20 mg online medications not to be crushed. Significantly increased liver weight in males and females of 500 and 1000 mg/kg/day groups generic leflunomide 10mg line symptoms 4 months pregnant. Growth cheap leflunomide 20 mg on line treatment statistics, average lifespan, and + Potassium Metaphosphate preparation containing Feeding continued through 2nd kidney weight normal. Growth and average lifespan + Potassium Metaphosphate preparation containing Feeding continued through 2nd normal. Nephrocalcinosis and 67% Tetrasodium and 3rd generations slight increase (significant Pyrophosphate and increase only in males) in 33%Potassium kidney weight observed. Repeated Dose Oral Toxicity Studies Ingredient Test Animals Results Concentration/Dose (number stated, if available from source) Tetrasodium Pyrophosphate 2. Nephrocalcinosis and 67% Tetrasodium and 3rd generations increased kidney weight Pyrophosphate and 33% observed. Growth retardation, increased + Potassium Metaphosphate preparation containing Feeding continued through 2nd kidney weight, and 67% Tetrasodium and 3rd generations nephrocalcinosis observed. Statistically significant 42 days (males) and for reductions in red blood cells in 42 to 54 days (females) females, but not in males. Significantly lower relative liver and heart weights observed not considered toxicological findings, due to absence of histopathological changes. Repeated Dose Oral Toxicity Studies Ingredient Test Animals Results Concentration/Dose (number stated, if available from source) Dipotassium Phosphate Diet providing 800 15 Beagle dogs Renal damage consisted of mg/kg/day for 14 and 38 disseminated tubular atrophy weeks (usually of the proximal tubules), focal scar tissue, and nephrocalcinosis. Renal morphological changes in all dogs after 14 and 38 weeks; renal damage greater after 38 weeks. Dicalcium Phosphate Doses of 0, 250, 500, or Rats (10 per sex in control and No treatment-related clinical, 1000 mg/kg/day by highest dose groups; 5 per sex hematological, or necropsy gavage for 28 days in other groups) findings. Statistically significant increase in relative liver weight in males of the 250 mg/kg group, but no morphological findings in the liver. Repeated Dose Oral Toxicity Studies Ingredient Test Animals Results Concentration/Dose (number stated, if available from source) Tricalcium Phosphate Doses of 0, 250, 500, or Rats (10 per sex in each group) No deaths or toxicologically 1000 mg/kg/day by significant findings. Reproductive and Developmental Toxicity Studies Ingredient Test Protocol Animals/Embryos Results Acids Phosphoric Acid 0. Reproductive and Developmental Toxicity Studies Ingredient Test Protocol Animals/Embryos Results Pentasodium Triphosphate Oral doses (in water) up Groups of 13 to 16 pregnant No clearly discernible treatment to 250 mg/kg/day on female Dutch-belted rabbits related effect on nidation or on gestation days 6-18 maternal or fetal survival. Number of abnormalities (in soft or skeletal tissues) in test animals did not differ from number occurring in sham treated controls. Doses of 10 to 15 and dose of 30 mg) into mg had lethal effect after 24 h of air chamber of chick incubation. Embryos of 2nd and embryo after 24 h and 3rd brooding day had 72 h of incubation characteristic misshapes of the brain, heart primordium, and somites. Serious terata determined and gross reported, including one examination for observation of ectopia cordis. No difference in diet) containing 67% and 3rd generations incidence of abnormalities Tetrasodium between treated and control Pyrophosphate and 33% animals. Reproductive and Developmental Toxicity Studies Ingredient Test Protocol Animals/Embryos Results Tetrasodium Pyrophosphate 5% commercial Rats (10 males, 10 females). Growth and fertility were + Potassium Metaphosphate preparation (in Sherman Feeding continued through 2nd normal. No difference in diet) containing 67% and 3rd generations incidence of abnormalities Tetrasodium between treated and control Pyrophosphate and animals. Reproductive and Developmental Toxicity Studies Ingredient Test Protocol Animals/Embryos Results days total). Females dosed once daily for weeks prior to mating, throughout gestation, and 4 days after delivery Tricalcium Phosphate Doses of 0, 250, 500, or Rats (10/sex/dose) No treatment-related adverse 1000 mg/kg/day by effects on reproductive gavage. Males dosed parameters and no externally from 2 weeks before malformed neonates in any dose mating to end of mating. Genotoxicity Studies Ingredient/Similar Chemical Strain/cell type Assay Dose/Concentration Results Disodium Pyrophosphate Male mice Mouse translocation up to 1400 mg/kg Negative. Skin Irritation/Sensitization Studies Ingredient (test Test Protocol Non-humans/Humans Results concentration, if available) (number stated, if available from source) Acids Non-human Studies Phosphoric Acid (5% and Intracutaneous Juvenile white mice 5% concentration moderately 30%) application (intact skin). Skin Irritation/Sensitization Studies Ingredient (test Test Protocol Non-humans/Humans Results concentration, if available) (number stated, if available from source) occlusion) to intact skin Diammonium Phosphate 4-h application (under Rabbits Mildly irritating. Skin Irritation/Sensitization Studies Ingredient (test Test Protocol Non-humans/Humans Results concentration, if available) (number stated, if available from source) Tetrasodium Pyrophosphate 24-h application (under Rabbits Irritating. Skin Irritation/Sensitization Studies Ingredient (test Test Protocol Non-humans/Humans Results concentration, if available) (number stated, if available from source) Potassium Phosphate 4-h application (under Rabbits Non-irritating. Skin Irritation/Sensitization Studies Ingredient (test Test Protocol Non-humans/Humans Results concentration, if available) (number stated, if available from source) Magnesium Salts Non-human Studies Magnesium Phosphate 4-h application (under Rabbits Non-irritating. Ocular Irritation/Toxicity Studies Ingredient Test Protocol Animals Results (number stated, if available from source) Acids Phosphoric Acid (119 mg) Not stated Rabbits Irritating. Ocular Irritation/Toxicity Studies Ingredient Test Protocol Animals Results (number stated, if available from source) Tetrasodium Pyrophosphate Draize Test Rabbits Minimally irritating (rinsed eyes) and extremely irritating (unrinsed eyes). Tissues treated with 30 mg for 10 minutes Calcium Phosphate Draize Test Rabbits Practically non-irritating (rinsed eyes) and moderately irritating (unrinsed eyes). Ocular Irritation/Toxicity Studies Ingredient Test Protocol Animals Results (number stated, if available from source) Dicalcium 0. Final report on the safety assessment of sodium metaphosphate, sodium trimetaphosophate, and sodium hexametaphosphate. Summary review of health effects associated with elemental and inorganic phosphorus compounds: Health issue assessment. Chemical and physical evaluations of commercial dicalcium phosphates as sources of phosphorus in animal nutrition.

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