UMEM Educational Pearls

Category: Critical Care

Title:

Keywords: amikacin, Torsades de pointes, QT prolongation (PubMed Search)

Posted: 8/20/2019 by Quincy Tran, MD (Emailed: 8/15/2022)
Click here to contact Quincy Tran, MD

Torsades de pointes and QT prolongation Associated with Antibiotics

 

Methods

The authors queried the United States FDA Adverse Event Reporting System (FAERS) from 01/01/2015 to 12/31/2017 for reports of Torsade de points/QT prolongation (TdP/QT).

Reporting Odd Ratio (ROR) was calculated as the ratio of the odds of reporting TdP/QTP versus all other ADRs for a given drug, compared with these reporting odds for all other drugs present in FAERS

Results

FAERS contained 2,042,801 reports from January 1, 2015 to December 31, 2017. There were 3,960 TdP/QTP reports from the study period (0.19%).

 

Macrolides               ROR 14 (95% CI 11.8-17.38)

Linezolid                  ROR 12 (95% CI 8.5-18)

Amikacin                 ROR 11.8 (5.57-24.97)

Imipenem-cilastatin ROR 6.6 (3.13-13.9)

Fluoroquinolones   ROR 5.68 (95% CI 4.78-6.76)

 

Limitations:

These adverse events are voluntary reports

There might be other confounded by concomitant drugs such as ondansetron, azole anti-fungals, antipsychotics.

 

Bottom Line:

This study confimed the previously-known antibiotics to be associated with Torsades de pointes and QT prolongation (Macrolides, Linezolid, Imipenem and Fluoroquinolones). However, this study  found new association between amikacin and Torsades de pointes/QT prolongation.

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Category: Pediatrics

Title: Apnea and bronchiolitis

Keywords: hospitalization, RSV, bronchiolitis (PubMed Search)

Posted: 12/17/2021 by Jenny Guyther, MD (Emailed: 8/15/2022) (Updated: 8/15/2022)
Click here to contact Jenny Guyther, MD

Typical admission considerations for patients with bronchiolitis are work of breathing, hypoxia, and dehydration.  The patients risk of apnea should also be considered.  Younger infants with bronchiolitis are at a risk for apnea.  Studies have cited anywhere from a 16-25% risk in younger infants.  The problem lies in identifying those patients who are at risk and those who are not.  This older study looked at 691 infants and developed criteria which identified all of the 2.7% of patients who developed apnea.
The high risk criteria used in this study were: 1) Full term and younger than 1 month; 2) Born < 37 weeks gestation and younger than 48 weeks post conception or 3) Parents already noted an episode of apnea with this illness.
Bottom line: Incorporate the infants risk of apnea into your disposition decision for patients with bronchiolitis.

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Category: Toxicology

Title: Hydrofluoric Acid Burns

Keywords: hydrofluoric acid, burn, chemical burn, HFA, calcium gluconate (PubMed Search)

Posted: 9/5/2010 by Dan Lemkin, MD, MS (Emailed: 8/15/2022) (Updated: 10/2/2010)
Click here to contact Dan Lemkin, MD, MS

Hydrofluoric acid is a weak acid used primarily in industrial applications for glass etching and metal cleaning/plating. It is contained in home rust removers. Although technically a weak acid, it is very dangerous and burns can be subtle in appearance while having severe consequences.

Hydrofluoric acid burn

Wilkes G. Hydrofluoric Acid Burns. Jan 28, 2010. 
http://emedicine.medscape.com/article/773304-overview

  • 2 mechanisms that cause tissue damage*
    • corrosive burn from the free hydrogen ions
    • chemical burn from tissue penetration of the fluoride ions
  • Clinical features*
    • Cutaneous burns - absent findings to white-blue appearance
    • Pulmonary edema
    • Hypocalcemia, hyperkalemia, hypomagnesemia
  • Treatment*
    • Decontaminate by irrigation with copious amounts of water.
    • With any evidence of hypocalcemia, immediately administer 10% calcium gluconate IV.
    • Cutaneous burns:
      • Apply 2.5% calcium gluconate gel to the affected area. If the proprietary gel is not available, constitute by dissolving 10% calcium gluconate solution in 3 times the volume of a water-soluble lubricant (eg, KY gel). For burns to the fingers, retain gel in a latex glove.
      • If pain persists for more than 30 minutes after application of calcium gluconate gel, further treatment is required. Subcutaneous infiltration of calcium gluconate is recommended at a dose of 0.5 mL of a 5% solution per square centimeter of surface burn extending 0.5 cm beyond the margin of involved tissue (10% calcium gluconate solution can be irritating to the tissue).
        • Do not use the chloride salt because it is an irritant and may cause tissue damage.

*Extracted from emedicine article.

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