Contributor: Nick Tsipis, MD

Educational Pearls:

• PO medications are less frequently used in the ED due to their longer onset of action
• The position the patient is in when given PO medications may affect how quickly the medication is absorbed
• The quicker the medication passes through the stomach into the small intestine, the quicker it can be absorbed and metabolized
• Recent study used in silico gastric biomechanics model to compare the length of time it took PO medications to pass through the stomach based on the patient's positioning
• Compared the medication transit time in a stomach model placed in right lateral, left lateral, upright, and supine positions
• Right lateral positioning resulted in the fastest time for medication to pass through the stomach and enter the duodenum
• Likely due to the direction of gravity aligning with the antrum and pylorus of the stomach
• Left lateral positioning had the slowest time for the pill to enter the small intestine
• Likely due to gravity not aligning with stomach anatomy
• The time to absorption in the right and left lateral position were significantly faster and slower respectively than that seen in the upright and supine positions
• These results indicate that placing a patient in the right lateral position when giving PO medications may result in faster rate of medication onset than if the patient is in another position

References

Lee JH, Kuhar S, Seo JH, Pasricha PJ, Mittal R. Computational modeling of drug dissolution in the human stomach: Effects of posture and gastroparesis on drug bioavailability. Phys Fluids (1994). 2022;34(8):081904.

Summarized by Mark O'Brien, MS4 | Edited by John Spartz MD & Erik Verzemnieks, MD

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