The Annals of pharmacotherapy
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To report a case of successful anticoagulation using a modified dosing weight (DW) for unfractionated heparin (UFH) therapy in a morbidly obese female. ⋯ Further investigation is necessary to determine the optimal DW for UFH in morbidly obese patients presenting with acute thrombosis.
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Review
Can 1 microg of cosyntropin be used to evaluate adrenal insufficiency in critically ill patients?
To evaluate the utility of cosyntropin 1 microg in assessing adrenal function in critically ill patients. ⋯ Use of cosyntropin 1 microg should detect AI in all patients who would have been diagnosed using 250 microg. Unfortunately, all of the clinical trials evaluating the role of corticosteroids in septic shock that used the cosyntropin stimulation test administered 250 microg. Extrapolation of the existing guidelines to treat patients with septic shock testing positive for relative AI using the 1-microg test may provide effective therapy to appropriate patients not diagnosed by the 250-microg testing or may introduce additional adverse effects in patients who should not receive corticosteroids. Large-scale, head-to-head comparison data of steroid effectiveness after 1- and 250-microg ACTH stimulation tests are needed to expand upon these promising results.