Let’s start with a
patient case. An elderly patient has
recently arrived from Italy and you are performing the medication
reconciliation from their home medication list.
Their medication list includes Flomax which may frequently be continued
without hesitation. In this example,
however, Flomax is NOT the brand name for tamsulosin in Italy but rather the
identical name for a different medication.
HughesMedicine - Pharmacotherapy Pearls from the Internal Medicine Clinical Pharmacist
Sunday, August 25, 2013
Sunday, August 18, 2013
Interpreting serum phenytoin concentrations
Let’s start with a
patient case. Patient is an 80 year
old female hospitalized for pneumonia with sepsis who during this admission
experienced a seizure likely secondary to imipenem/cilastatin. She has since been on phenytoin for one week
and is currently extremely confused, pulling out IV lines, and striking out at
the staff. Serum total phenytoin
concentration = 16.4 mg/L. Her SCr = 2.3
(acutely elevated) and albumin = 1.8 g/dL.
At first glance this phenytoin concentration appears therapeutic (10-20
mg/L). What is the issue with
interpreting this lab?
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