The Annals of pharmacotherapy
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To characterize the multiple continuous renal replacement therapy (CRRT) techniques available for the management of critically ill adults, and to review the indications for and complications of use, principles of drug removal during CRRT, drug dosage individualization guidelines, and the influence of CRRT on patient outcomes. ⋯ The use of CRRT has expanded to encompass the treatment of disease states other than just acute renal failure. Since there is great variability among treatment centers, it is premature to conclude that there is enhanced survival in CRRT-treated patients compared with those who received conventional hemodialysis. This primer may help clinicians understand the need to individualize these therapies and to prospectively optimize the pharmacotherapy of their patients receiving CRRT.
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Case Reports
Antacid-induced hypermagnesemia in a patient with normal renal function and bowel obstruction.
To report a case of severe hypermagnesemia caused by magnesium hydroxide in a woman with normal renal function. ⋯ This case of severe hypermagnesemia from magnesium hydroxide ingestion illustrates many of the risk factors for hypermagnesemia in patients with normal renal function. People using magnesium-containing medications for relief of gastrointestinal distress may be at increased risk for hypermagnesemia. A brief review of magnesium physiology, clinical effects, and treatment is provided. Frequent use of the laboratory to identify hypermagnesemia is encouraged because it is often a clinically unexpected finding and responds well to early treatment.
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To describe the use of a continuous fentanyl infusion in an adult cancer patient. ⋯ Continuous fentanyl infusion should be considered for the treatment of cancer pain in patients requiring high doses who become refractory to other opioids, when other opioids cause intolerable adverse effects, when patients have a true morphine allergy, or when high-dose requirements threaten to deplete existing stock of alternate opioids.
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Case Reports
Prolonged central intravenous ketorolac continuous infusion in a cancer patient with intractable bone pain.
To report the case of a prolonged intravenous ketorolac continuous infusion given via a central line in a cancer patient with intractable bone pain. ⋯ A prolonged central intravenous ketorolac continuous infusion was successful in treating a cancer patient with intractable bone pain secondary to widely metastatic non-small-cell lung cancer.
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Review Comparative Study
The role of zinc lozenges in treatment of the common cold.
To summarize and critique the medical literature on the use of zinc lozenges for treatment of the common cold. ⋯ Treatment of the common cold with zinc gluconate lozenges, using adequate doses of elemental zinc, may be effective in reducing duration and severity of cold symptoms. The benefit appears to be maximal if the lozenges are started immediately after the onset of symptoms. The formulation of the lozenges also appears to be important because the addition of citric acid or tartaric acid may reduce efficacy due to chelation of zinc ion. Although zinc gluconate lozenges have dominated clinical trials thus far, further studies are needed to demonstrate the efficacy of zinc acetate lozenges and to determine whether their adverse effect profile is more favorable to that of zinc gluconate lozenges. Patients should play an important role in the decision-making process and must decide whether the benefit gained from treatment with zinc lozenges outweighs the potential adverse effects.