A 58-year-old male is admitted to the emergency department with chest pain that

Question

A 58-year-old male is admitted to the emergency department with chest pain that is radiating down his right arm. Twenty-four hours earlier, he was seen in the same emergency room for severe indigestion and belching. He has a history of gastroesphogeal reflux disease (GERD). An ECG was performed without revealing any changes.

Almunium/magnesium (Maalox) 30 mL

Belladonna alkaloids/phenobarbital (Donnatal) 5 mL

Xylocaine (Lidocaine Viscous) 20 mL

Is there another name for this combination?

Why were these medications ordered? Do I know how these medications work? What lab work needs to be assessed with these medications?

Explanation / Answer

Presence of chest pain is commonly attributed to having heart disease, but many people with heart disease mention some vague discomfort of "pain" which cannot be taken as final conclusion to state that as a heart disease. In general, chest discomfort related to manifestations of heart diseases are associated with one or more of the following:

In this above mentioned scenario ,the patient complaints of chest pain which radiates to the right arm and he has a history of GERD(Gastro-Esphogeal Reflux Disease). So,possibly the chest pain is due to the GERD and related to Gastro intestinal concern.

Another Name:

The another name for this combination is termed as "Gastrointestinal Cocktail" also known as a GI cocktail or gastric cocktail. It is a generic term for a mixture of liquid antacid, viscous lidocaine, and an anticholinergic primarily used to treat dyspepsia.The GI cocktail may also deceptively mask pain originating from the heart because of its pain controlling properties.

There is a wide variety of GI cocktail recipes in today's medical field with advancement in pharmacology. A very popular one is a mixture of Maalox, viscous lidocaine, and Donnatal, in equal parts. A mixture of 10–30 ml Mylanta or Maalox, 5 - 10 ml Donnatal and 10 ml - 20ml of viscous lidocaine is known as "The Green Goddess", or "Green Lizard".

These medications were ordered because of the characteristics of GERD which are given below;

The combination works effectively to tackle symptoms of GERD in a petient. The efficacy of this mixture for the treatment of dyspepsia is generally considered because of the varied components of the drug combination and its mechanism to give relief from pain.

1) Almunium/magnesium (Maalox) 30 mL -

it comes under the category of Antacid group of Drugs.It is indicated for the Heartburn, acid indigestion, sour stomach, upset stomach

2) Belladonna alkaloids/phenobarbital (Donnatal) 5 mL -

It comes under the categories of anti-cholinergics and anti-spasmodics group of drugs.

Phenobarbital is in a group of drugs called barbiturates which slows the activity of your brain and nervous system. Belladonna alkaloids produce many effects in the body, including reduced muscle spasms in the digestive or urinary tract, and reduced fluid secretions from certain glands or organs.

The combination of belladonna alkaloids and phenobarbital is used to treat irritable bowel syndrome and ulcers in the intestine.

3) Xylocaine (Lidocaine Viscous) 20 mL -

It is a oral tropical solution used for the production of anesthetic effect over the inflammed mucus layers of mouth, pharynx by reversibly blocing the nerve conduction ,thus enabling local pain relief.

Laboratory assessments:

The very basic component to assess with long term use of Antacids are monitoring electrolytes like Magnesium, Phosphorus, Sodium bicarbonate, calcium etc.

Aluminum Antacids : Risk of hypophosphatemia with prolonged administration or large doses, particularly in patients with inadequate dietary intake of phosphorus.Monitoring serum phosphate concentration is necessary.

Calcium Carbonate : May cause gastric hypersecretion and acid rebound. May cause the milk-alkali syndrome (characterized by hypercalcemia, metabolic alkalosis and, rarely, renal insufficiency). Monitor serum calcium concentrations is necessary.

Magnesium Antacids : Commonly cause a laxative effect, and frequent administration of these antacids alone often cannot be tolerated; this can cause cause diarrhea which may cause fluid and electrolyte imbalances.

Sodium Bicarbonate : May cause metabolic alkalosis when given in large doses. Monitoring bicarb levels is necessary.

Blood Urea Nitrogen & Creatinine to be monitored in patients with decreased renal functioning

Areterial Blood Ags monitoring to understand the acid- base balance in the blood and rule out acidosis and alkalosis iif present

ECG- Electro cardiogram to understand any changes in electrical activities because of electrolytes in the medications

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