One Elimination

Pharmacology the elimination or excretion of a drug is understood to be any one of a number of

processes by which a drug is eliminated from an organism either in an unaltered form (unbound
molecules) or modified as a metabolite. The kidney is the main excretory organ although others exist such
as the liver, the skin, the lungs or glandular structures, such as the salivary glands and the lacrimal glands.
These organs or structures use specific routes to expel a drug from the body, these are termed elimination
pathways:

Urine,
Tears,
Perspiration
Saliva
Respiration
Milk
Faeces
Bile
Drugs are excreted from the kidney by glomerular filtration and by active tubular secretion following
the same steps and mechanisms as the products of intermediate metabolism. Therefore, drugs that are
filtered by the glomerulus are also subject to the process of passive tubular reabsorption. Glomerular
filtration will only remove those drugs or metabolites that are not bound to proteins present in blood
plasma (free fraction) and many other types of drugs (such as the organic acids) are actively secreted. In
the proximal and distal convoluted tubules non-ionised acids and weak bases are reabsorbed both actively
and passively. Weak acids are excreted when the tubular fluid becomes too alkaline and this reduces
passive reabsorption. The opposite occurs with weak bases. Poisoning treatments use this effect to
increase elimination, by alkalizing the urine causing forced diuresis which promotes excretion of a weak
acid, rather than it getting reabsorbed. As the acid is ionised, it cannot pass through the plasma
membrane back into the blood stream and instead gets excreted with the urine. Acidifying the urine has
the same effect for weakly basic drugs.
On other occasions drugs combined with bile juices and enter the intestines. In the intestines the drug
will join with the unabsorbed fraction of the administered dose and be eliminated with the faeces or it
may undergo a new process of absorption to eventually be eliminated by the kidney.
The other elimination pathways are less important in the elimination of drugs, except in very specific
cases, such as the respiratory tract for alcohol or anaesthetic gases. The case of mother's milk is of special
importance. The liver and kidneys of newly born infants are relatively undeveloped and they are highly
sensitive to a drugs toxic effects. For this reason it is important to know if a drug is likely to be
eliminated from a womans body if she is breast feeding in order to avoid this situation.

Elimination communication
(EC) is a practice in which a caregiver uses timing, signals, cues, and intuition to address an infant's need
to eliminate waste. Caregivers try to recognize and respond to babies' bodily needs and enable them to
urinate and defecate in an appropriate place (e.g. a toilet). Caregivers may use diapers (nappies) as a back-
up in case of "misses" some or all of the time, or not at all. EC emphasizes communication between the
caregiver and child, helping them both become more attuned to the child's innate rhythms and control of
urination and defecation. The term "elimination communication" was inspired by traditional practices of
diaperless baby care in less industrialized countries and hunter-gatherer cultures.[1] Some practitioners of
EC begin soon after birth, the optimum window being zero to four months in terms of helping the baby
get in tune with their elimination needs,[2] although it can be started with babies of any age. The practice
can be done full-time, part-time, or just occasionally.

Origins
Keeping babies clean and dry without diapers is standard practice in many cultures throughout the world.
While this practice is only recently becoming known in industrialized societies, it remains the dominant
method of baby hygiene in non-industrialized ones.
The terms elimination communication and natural infant hygiene were coined by Ingrid Bauer and are
used interchangeably in her book, Diaper Free! The Gentle Wisdom of Natural Infant Hygiene (2001).
Bauer had traveled to India and Africa, where she noticed that while most mothers carried their diaperless
babies constantly, she saw no elimination "accidents" as would be expected in industrialized countries
where babies wear diapers almost continuously from birth. Subsequently, she raised her own children
with minimal use of diapers, and eventually began to share her approach with other mothers and
caregivers initially through Internet-based parenting support groups and eventually through her book
and website.[3]

Benefits
According to The Diaper-Free Baby by Christine Gross-Loh, EC offers a wide range of advantages.
Because EC lessens families' reliance on diapers, this helps reduce the environmental impact of
discarding disposable diapers and/or washing cloth diapers, and saves families hundreds, if not thousands,
of dollars in disposable diapers. EC babies are free from the problems of conventional diapering such as
diaper rash, diaper change battles, not being able to explore diapered parts of their bodies, vulnerability to
urinary tract infections, and potentially delayed or difficult potty training. Gross-Loh also reports that EC
promotes a unique and wonderful bond between babies and caregivers.[5]

Criticisms
Conventional potty training advice is based on research by Thomas Berry Brazelton, who introduced the
"readiness approach". He writes that "widespread acceptance of readiness and independent toileting have
since been supported by clinical experience and resulted in agreement that a child should be ready to
participate in toilet training at approximately 18 months of age and be trained completely by 2 or 3 years
old." He argues that trying to toilet train before this age could be coercive and therefore psychologically
damaging.[7] Brazelton acknowledges that elimination communication is both possible and desirable, but
he believes it is difficult to perform in Western society. In particular he cites a mother's return to work as
an obstacle to elimination communication.