Pharmacotherapy
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To compare the international normalized ratio (INR) measured by a point-of-care testing device with that measured by a reference laboratory method for patients receiving either warfarin only or warfarin plus low-molecular-weight heparin (LMWH). ⋯ The INR measured with the point-of-care device in patients receiving concurrent LMWH and warfarin therapy may be inaccurate. Patients receiving LMWH in addition to warfarin should have INRs checked by means of the standard reference laboratory method.
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To determine the frequency of adverse effects, clinical outcomes, and possible dose-response relationships associated with inadvertent extra doses of bupropion. ⋯ Adverse effects were common with extra doses of bupropion, and clinically significant effects occurred in approximately 10% of patients. Seizures were present twice as often as reported with therapeutic dosing. Extra doses of bupropion appear to increase the risk of adverse effects. Patients should be educated about these risks to minimize them.
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To characterize the frequency, severity, risk factors, and clinician response to propofol-associated hypertriglyceridemia and hypertriglyceridemia-associated pancreatitis. ⋯ Hypertriglyceridemia and hypertriglyceridemia-associated pancreatitis are often seen in intensive care patients receiving propofol. Serum triglyceride concentrations should be routinely monitored in these patients. In addition, alternative sedation strategies should be considered when hypertriglyceridemia is detected.
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Clinical Trial
Pain evaluation in patients receiving intravenous patient-controlled analgesia after surgery.
To evaluate the effectiveness of intravenous patient-controlled analgesia (PCA) in patients after surgery. ⋯ Successful postoperative pain management using PCA is difficult to achieve on a consistent basis unless treatment is individualized. Our data support the hypothesis that small fixed doses fail to achieve adequate relief in many patients.
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Epinephrine overdose induces many negative complications in adults because of its alpha- and beta-adrenoreceptor activity. However, complications in newborns or children are rarely described. A 4-day-old, 2004-g female newborn was inadvertently given epinephrine at 100 times the usual dose; she developed hypokalemia and rhabdomyolysis. ⋯ No obvious long-term sequelae were observed. Effective ventilation, proper hydration, electrolyte maintenance, and early detection were assumed responsible for the positive outcome. Medication errors are common with pediatric inpatients, and efforts to reduce them are needed.