Saturday November 24, 2007
Q; Nurse call you with K+ level of 7.8 (lab confirmed - no hemolysis). You ordered 10 units of IV insulin with 2 ampules of D-50, 1 ampule of calcium gluconate and 2 ampules of sodium bicarbonate in series. RT was requested to give 2 nebulizer treatments of albuterol. The final order set is followed ultimately by PO Kayexalate/sorbitol.What is wrong in above orders for the management of hyperkalemia?
A; In the management of hyperkalemia, sodium bicarbonate should be given before calcium. Administrating bicarbonate after calcium will bind calcium and will render it ineffective. This is another reason, we don't prepare "bicarb drip" in LR (Lactated Ringer’s) as it contains calcium which will bind bicarbonate and will make the whole management ineffective .
Saturday, November 24, 2007
Friday November 23, 2007
Q; Which antibiotic may give false positive urine drug screen for opiates ?
A; Gatifloxacin (Tequin) and other fluoroquinolones.
Fluoroquinolones as a class are among compounds that have a propensity to cross-react with enzyme immunoassay urine drug screens for opiates. The exact mechanism is unknown.False-positive results could have negative effects on patient care so analysis with another assay method should be done to verify the urine drug screen.
Editors' note: Tequin has been taken off USA market last year but as mentioned in JAMA's article (reference # 2), 13 quinolones were tested and 11 of the 13 quinolones caused some opiate activity by at least 1 assay system. So be careful with all quinolones. Actually, JAMA report mentioned Levaquin as one of the top 3 !
Q; Which antibiotic may give false positive urine drug screen for opiates ?
A; Gatifloxacin (Tequin) and other fluoroquinolones.
Fluoroquinolones as a class are among compounds that have a propensity to cross-react with enzyme immunoassay urine drug screens for opiates. The exact mechanism is unknown.False-positive results could have negative effects on patient care so analysis with another assay method should be done to verify the urine drug screen.
Editors' note: Tequin has been taken off USA market last year but as mentioned in JAMA's article (reference # 2), 13 quinolones were tested and 11 of the 13 quinolones caused some opiate activity by at least 1 assay system. So be careful with all quinolones. Actually, JAMA report mentioned Levaquin as one of the top 3 !
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