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Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

My daughter bled into the brain. She lived for another two years and ultimately died.

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C 11 choline - a Radiopharmaceutical Imaging Agent

C 11 Choline is a precursor molecule. Choline is an essential molecule in the biosynthesis of membrane phospholipids. It is a radiopharmaceutical imaging agent that is used in conjunction with PET (positron emission tomography) for patients with suspected prostate cancer recurrence and inconclusive bone scintigraphy, computerized tomography (CT), or magnetic resonance imaging (MRI).

C-11 Choline Dose in Adults

Note: The total injection volume per patient will vary based on the characteristics of the image acquisition system and the patient body dimensions.

Dose in Prostate imaging:

10 - 20 mCi intravenously (370 to 740 MBq)

C-11 Choline Dose in Childrens

Not indicated in children.

Pregnancy Risk Factor X

Not indicated for use inn women

C 11 Choline use in breastfeeding:

Excretion in breastmilk is not known. It is not indicated in women.

C-11 Choline Dose in Renal Disease:

Dose adjustement has not been recommended by the manufacturer in patients with renal disease.

C-11 Choline Dose in Liver Disease:

Dose adjustement has not been recommended by the manufacturer in patients with liver disease.

Common Side Effects Of C-11 Choline Include:

Local:
- Mild injection site reactions may occur

Contraindication to C-11 Choline include:

Manufacturer has not provided any information about contraindications for C-11 Choline Injectons.

Warnings and Precautions

Hypersensitivity
- Anaphylactic reactions can occur.
- Allergy treatment should be immediately available

Malignancy
- To protect patients and healthcare workers from radiation exposure, the smallest dose is recommended.
- Radiation-emitting products can increase the likelihood of developing cancer, especially in children.

C-11 choline: Drug Interaction

Note: Drug Interaction Categories:

Risk Factor C: Monitor When Using Combination
Risk Factor D: Consider Treatment Modification
Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy).
Antiandrogens	Choline C 11 may have a less therapeutic effect.
Colchicine	Choline C 11 may have a less therapeutic effect.
Analogs for Luteinizing Hormone Releasing Hormones	Choline C 11 may have a less therapeutic effect.

Monitoring Parameters:

Monitor for clinical features of hypersensitivity.

How to administer C-11 Choline?

It is radiopharmaceutical and should be treated and disposed of with radiation shields and waterproof gloves.
The intravenous bolus should be administered via a peripheral vein catheter.
It is important to obtain static emission images within 0-15 minutes of injection.
To minimize interference of radioactivity with dietary choline, the patient should fast for at least 6 hours prior to its administration.
Patients should be sufficiently hydrated for four hours prior to imaging.
They should also be instructed not to drink after each session, and often for an hour after the completion of the PET/CT scan.

Mechanism of action of C-11 Choline:

It is a radiolabeled analogue of choline and is essential for the biosynthesis cell membrane phospholipids.
An increase in choline uptake has been linked to cellular proliferation and the transformation seen in tumor cells.

The Beginning of ActionIt takes less than five minutes, and it lasts more than 30 minutes. It is distributed throughout the body to the liver, pancreas and colon. It is excreted through urine.

C-11 Choline Brands in Pakistan:

No Brands available in Pakistan