Biomedical subjects

Eran Kozer

Publications and source records attributed to Eran Kozer.

At least 19 recordsLinked to original sources

PubMed2006

The effect of a short tutorial on the incidence of prescribing errors in pediatric emergency care.

BACKGROUND: In the paediatric emergency department (ED) trainees are more likely to commit prescribing errors. OBJECTIVE: To determine whether a short educational intervention reduces the incidence of prescribing errors among trainees in a pediatric ED. METHODS: A prospective cohort study at the ED of a tertiary paediatric hospital. All fellows and residents arriving at the ED at the beginning of the academic year were invited to participate in a 30-minute tutorial focusing on appropriate methods for prescribing medications, followed by a written test. Eighteen days were selected randomly during July 2001. All the charts from these days were reviewed for medication errors. Two reviewers, blinded to whether or not a particular physician attended the tutorial, independently decided whether or not an error had occurred. The main outcome measure was the number of prescribing errors. RESULTS: Twenty-two trainees worked in the ED during July 2001. Of these, 13 trainees attended the tutorial. Eight hundred and ninety nine orders given by trainees were evaluated. We identified 66 (12.4%) errors in 533 orders given by those who attended tutorial, and 46 (12.7%) errors in 363 orders given by those who did not attend tutorial. The adjusted odds of a medication error was not significantly different between those who did not attend the tutorial and those who did (OR: 1.07 95% CI: 0.66-1.70). CONCLUSIONS: A short tutorial, followed by a written test, administered to trainees before entering their rotation in the paediatric ED, did not appear to reduce prescribing errors.

Clinical Competence↗

PubMed2006

Medication errors in children.

Medication error is a major source of iatrogenic injuries in children. Dosing errors are the most common type of medication errors in pediatrics. Sicker patients in intensive care units and emergency departments are more often harmed by such errors. Strategies that have been found to be effective in reducing medication errors include the use of computerized physician order entry systems, preprinted order forms, and color-coded systems. Adopting the "systems approach" to medication errors is crucial to every health system where practitioners seek to enhance patient safety.

Child↗

PubMed2006

Repeated supratherapeutic doses of paracetamol in children--a literature review and suggested clinical approach.

UNLABELLED: The safety of paracetamol when given in the recommended dosage is well documented. However, in recent years there have been many reports of liver failure associated with repeated exposure to supratherapeutic doses of paracetamol. This paper reviews the literature on chronic supratherapeutic paracetamol exposure in children and the different dosing guidelines. Based on which, we suggest the following approach: liver injury secondary to repeated dosing of paracetamol should be considered when a child has received more than 75 mg/kg/d for at least 2 d, or if risk factors for paracetamol toxicity have been identified. Liver transaminases, coagulation factors, and paracetamol serum concentrations should be measured in these children and in symptomatic children with vomiting, right upper quadrant abdominal pain, and jaundice who have taken paracetamol. Treatment with N-acetyl cysteine should be started regardless of paracetamol concentrations if transaminases or INR are elevated. CONCLUSION: Liver injury secondary to repeated dosing of paracetamol is rare but may result in severe morbidity and mortality. The cumulative dose of paracetamol should not exceed 75 mg/kg/d. Children treated with higher doses for more than 2 d should be evaluated for possible liver injury and treated with N-acetyl cysteine if evidence of liver injury is found.

Acetaminophen↗

PubMed2006

Civilian adult self injections of atropine-trimedoxime (TMB4) auto-injectors.

INTRODUCTION: The clinical effects of self injections of atropine-trimedoxime auto-injectors distributed to the civilian population as a field antidote for nerve agent attack were assessed. METHODS: Data on self injections by adults (> or = 18 years) were collected from the Israel Poison Information Center and a hospital Emergency Department's records during a 2-year period. The data included demographics, time interval from injection, type of auto-injector, clinical manifestations and atropinization score. RESULTS: Sixty-five patients, all with unintentional self injections, were reported. Systemic atropine effects were observed in 24 patients, but no severe atropinization. The atropinization score was significantly higher in the 2 mg atropine dose group than in the two lower dose groups, which were in the normal range. No specific adverse effects attributable to trimedoxime were observed. Intravenous fluids and physostigmine were not required. CONCLUSION: Only mild reactions were observed following self-injection of atropine trimedoxime auto-injectors in adults, attesting to their relative safety under these conditions.

Accidents↗

PubMed2006

Pain in infants who are younger than 2 months during suprapubic aspiration and transurethral bladder catheterization: a randomized, controlled study.

OBJECTIVE: Proper diagnosis of urinary tract infections depends on obtaining an uncontaminated urine sample for culture. Suprapubic aspiration and transurethral catheterization are the 2 recommended procedures for obtaining specimens for urine culture from young infants. The objective of the current study was to compare the pain that is experienced during these 2 procedures when performed in young infants. METHODS: A prospective, single-blind, randomized, controlled study was conducted at a university-affiliated hospital in Israel. Institutional Research Ethics Board approved the study. Infants who were 0 to 2 months of age and presented to the emergency department with fever and therefore required urine collection for culture were randomly assigned evenly into 2 sample collection groups: suprapubic aspiration or transurethral catheterization. Patients were excluded when they were born prematurely or had had a previous sepsis workup or other painful procedures or an anomaly of the urogenital system or abdominal wall. Eutectic mixture of local anesthetic cream that contained lidocaine and prilocaine was applied 1 hour before the procedure. The urethra was catheterized using a 5-Fr latex-free feeding tube that was lubricated with sterile water-soluble jelly that contained 2% lidocaine hydrochloride. Pediatric residents who were experienced with the procedures performed both suprapubic aspiration and transurethral catheterization. The parents were instructed to use any comfort strategies that they wished, including verbal or physical comforting and pacifiers. Pain during collection was assessed on a 100-mm visual analog scale by a nurse and a parent. In addition, the infant's upper part of the body was videotaped during the procedure. An investigator, who was blinded to the procedure, assigned a point score according to the Douleur Aigue du Nouveaune neonatal acute pain scale. For ensuring a successful blinding process, the following steps were taken. First, camera recording started 30 seconds before the procedure to prevent the possibility of distinguishing between the procedures on the basis of their duration. Second, the physician and the nurse were asked not to speak during the procedure to avoid revealing the nature of the procedure. Third, the person who videotaped the procedure watched the tape before it was analyzed to ensure the impossibility of identifying the procedure from the tape. The Student's t test was used to compare the groups. The primary outcome was the mean Douleur Aigue du Nouveaune score. Secondary outcomes were the mean visual analogue scale for pain as estimated by the parents and by the nurse. We estimated that 25 patients would be needed in each group to detect a difference in the mean Douleur Aigue du Nouveaune score of at least 2 points with a power of 80% and alpha of .05. RESULTS: The study was conducted between April 1, 2004, and April 30, 2005. Fifty-eight infants were recruited; 29 were randomly assigned to suprapubic aspiration, and 29 were randomly assigned to transurethral catheterization. Seven infants were excluded because of consent withdrawal (3 patients), because of technical difficulties during videotaping (3 patients), or because the child voided during the procedure (1 patient). Twenty-seven infants in the suprapubic aspiration group and 24 in the transurethral catheterization group completed the study. All male infants were circumcised. An adequate urine sample was obtained in 18 (66%) of 27 patients in the suprapubic aspiration group and in 20 (83.3%) of 24 in the transurethral catheterization group. The mean Douleur Aigue du Nouveaune score was significantly higher in patients who were randomly assigned to suprapubic aspiration compared with patients who were randomly assigned to transurethral catheterization (7 and 4.5, respectively). The differences in Douleur Aigue du Nouveaune score also were significant in a subgroup analysis of boys and girls. Mean visual analogue scale scores by parents was higher in the suprapubic aspiration group compared with transurethral catheterization (63 +/- 27 mm vs 46 +/- 26, respectively). Similarly, mean visual analogue scale scores by nurses was higher in the suprapubic aspiration group compared with transurethral catheterization (3 +/- 18 mm vs 43 +/- 25 mm, respectively). CONCLUSIONS: In infants who are younger 2 months, suprapubic aspiration is more painful than transurethral catheterization. Health professionals should consider these differences when choosing a method for obtaining a urine sample from young infants.

Crying↗

PubMed2006

The effect of detection approaches on the reported incidence of tenfold errors.

BACKGROUND: Tenfold errors in calculation of paediatric drug doses are often life threatening. The magnitude and characteristics of this phenomenon have not been fully described. OBJECTIVES: The objective of this study was to describe the incidence and nature of paediatric tenfold errors and to describe the effect of different detection approaches on the detection of such errors. METHODS: To evaluate the incidence of tenfold errors, data were collected from three different studies on medication errors all conducted at a large tertiary care paediatric hospital: (i) a study investigating medication event reports to the hospital's Medication Incident Committee; (ii) a study auditing the charts of 1532 patients in the emergency department (ED) and; (iii) a prospective study of medication errors occurring during mock code resuscitations in the ED. RESULTS: In the first study, 20 tenfold errors were reported during the surveyed period. Almost all errors were prescribing errors. The calculated incidence was 1 per 22 500 doses prescribed. In chart auditing study in the ED, two tenfold errors where found in 1678 orders. In the prospective study, four tenfold errors were identified in eight mock resuscitations (125 orders for drugs). CONCLUSION: The incidence of tenfold errors in paediatrics varies dramatically when different detection approaches are used. The rate of tenfold errors may be especially high in resuscitation situations and is underestimated by spontaneous reporting.

Child↗

PubMed2005

Pediatric poisoning from trimedoxime (TMB4) and atropine automatic injectors.

OBJECTIVE: To describe the effects of combined trimedoxime (TMB4) and atropine poisoning from automatic injectors (AI) in children. STUDY DESIGN: Data was collected from two sources: calls to the Israel Poison Information Center (IPIC) during a 1-year period and a cohort of children who presented to pediatric emergency departments (EDs) after unintentional injection of an AI. Demographic data and data regarding the type of AI, site and time of injection, and the clinical manifestations were abstracted. RESULTS: Data were available for 142 patients. The median age was 8.5 years (range 1.25-18 years). The dose of atropine and TMB4 was higher than the recommended dose for age in 22 (15.5%) cases. There were few side effects attributable to atropine: dilated pupils (26.7%), dryness of mucous membranes (24.6%), and tachycardia (22.5%). Compared with children injected with an age-appropriate dose, children injected with an AI that contained a dose that exceeds the recommended one were more likely to be symptomatic ( P = .029). There were no side effects characteristic to oximes, and no specific medical intervention was required. CONCLUSIONS: Unintentional pediatric atropine and TMB4 injection, even an adult dose in a small child, does not cause significant side effects.

Adolescent↗

PubMed2005

Scopolamine treatment for severe extra-pyramidal signs following organophosphate (chlorpyrifos) ingestion.

BACKGROUND: The use of competitive inhibitors of acetylcholine other than atropine, for patients with organophosphate poisoning is controversial. Because scopolamine ability to cross the blood-brain barrier is better than that of atropine, it has been suggested that it should be used in patients with organophosphate poisoning who have central nervous system manifestations. CASE DESCRIPTION: A 17-year-old girl was admitted to the pediatric ward after ingesting chlorpyrifos as a suicidal attempt. She reported vomiting three times. She had no other symptoms for 12 hours and then over the course of 36 hours gradually developed extrapyramidal signs and became comatose. She was treated with intravenous scopolamine. Within 3 minutes the patient started to respond to verbal commands and answered simple questions rigidity subsided, and she was able to sit in bed. She was discharged after 4 days with no neurological sequelae. CONCLUSIONS: We suggest, that in patients with organophosphate poisoning who have mainly central nervous system toxicity scopolamine administration might be considered.

Adolescent↗

PubMed2005

Using a preprinted order sheet to reduce prescription errors in a pediatric emergency department: a randomized, controlled trial.

OBJECTIVE: Medication errors are common among pediatric patients and in emergency departments (EDs). Such errors may lead to prolonged hospitalization, unnecessary diagnostic tests and treatments, and death. The objective of this study was to determine whether the use of a structured order sheet reduces the incidence of medication errors in a pediatric ED. METHODS: The study was a randomized, controlled study that was conducted in a tertiary care pediatric hospital. Eighteen days were randomized into 2 study groups: days during which the regular blank order sheets were used and days during which preprinted, formatted, order sheets were used. All patients' charts from these days were reviewed by 2 medical students, who extracted demographic, clinical, and therapeutic data into a database. Two pediatric emergency physicians, blinded to the form used, reviewed the database and independently decided whether an error had occurred and the severity of the error. RESULTS: Within the study period, there were 2157 visits to the ED. A total of 2058 (95.4%) charts were available for review. A total of 411 (52.2%) orders for drugs in the ED were ordered on the regular form, and 376 (47.8%) were given on the new form. Drug errors were identified in 68 (16.6%) orders when the regular form was used and in 37 (9.8%) of the orders on the new form. Using the new form was associated with a significant reduction in the risk for an error (odds ratio: 0.55; 95% confidence interval: 0.34-0.90). CONCLUSIONS: The use of a preprinted structured order form significantly reduces medication errors among pediatric patients in the ED.

Child↗

PubMed2004

Prospective observational study on the incidence of medication errors during simulated resuscitation in a paediatric emergency department.

OBJECTIVES: To characterise the incidence and nature of medication errors during paediatric resuscitations. DESIGN: A prospective observational study of simulated emergencies. SETTING: Emergency department of a tertiary paediatric hospital. PARTICIPANTS: Teams that included a clinician who commonly leads "real" resuscitations, at least two assisting physicians, and two or three paediatric nurses. INTERVENTIONS: The teams conducted eight mock resuscitations, including ordering medications. Exercises were videotaped and drugs ordered and administered during the resuscitation were recorded. Syringes and drugs prepared during the resuscitation were collected and analysed for concentrations and actual amounts. MAIN OUTCOME MEASURES: Number and type of drug errors. RESULTS: Participants gave 125 orders for medications. In 21 (17%) of the orders the exact dose was not specified. Nine dosing errors occurred during the ordering phase. Of these errors, five were intercepted before the drug reached the patient. Four 10-fold errors were identified. In nine (16%) out of 58 syringes analysed, measured drug concentrations showed a deviation of at least 20% from the ordered dose. A large deviation (at least 50%) from the expected dose was found in four (7%) cases. CONCLUSIONS: Medication errors commonly occur during all stages of paediatric resuscitation. Many errors could be detected only by analysing syringe content, suggesting that such errors may be a major source of morbidity and mortality in resuscitated children.

Child↗

PubMed2004

Child neurodevelopmental outcome and maternal occupational exposure to solvents.

BACKGROUND: Many women of reproductive age are employed in industries involving exposure to organic solvents. Animal toxicological studies and human case reports demonstrate that high exposure to solvents causes neurodevelopmental toxicity in exposed offspring. Data from occupationally exposed women and their children are few. OBJECTIVE: To compare the cognitive, language, and motor performance and the behavioral achievements of children whose mothers were exposed occupationally to organic solvents during pregnancy with those of a matched unexposed control group. PARTICIPANTS: Thirty-two pregnant women occupationally exposed to organic solvents were recruited during pregnancy and followed up. Their offspring (age range, 3-9 years) were tested for cognitive functioning (IQ), language, visual-motor functioning, and behavioral functioning and were compared with a matched unexposed control group that was recruited and tested in a similar manner. Examiners were blinded to the exposure status. RESULTS: Mothers occupationally exposed to organic solvents did not differ significantly from matched controls in demographic variables. After controlling for potential confounding because of maternal IQ and maternal education, children exposed in utero to organic solvents obtained lower scores on subtests of intellectual, language, motor, and neurobehavioral functioning. CONCLUSIONS: In utero exposure to organic solvents is associated with poorer performance on some specific subtle measures of neurocognitive function, language, and behavior. Reducing exposure in pregnancy is merited until more refined risk assessment is possible. Further studies that address exposure to specific solvents, dose, and gestational timing of exposure are needed.

Case-Control Studies↗

PubMed2004

Fundus anomalies: what the pediatrician's eye can't see.

BACKGROUND: With increasing workloads for hospital doctors, routine funduscopy may be abandoned. It is not known how often pediatricians perform funduscopy and how skilled they are in performing it. OBJECTIVE: To assess hospital pediatricians' ability to diagnose abnormalities of the ocular fundi and to determine whether a short tutorial can improve their skills. METHODS: Physicians working at the pediatric division of a university-affiliated hospital participated in the study. All participants completed an anonymous questionnaire regarding their experience and skills in performing funduscopy. A pictorial quiz containing 20 fundus pictures of common findings in children was given. After completing the quiz, a 45-minute tutorial on common fundus anomalies was given. At the end of the lecture, the same quiz was given again. The percentage of correct answers for each quiz was scored. RESULTS: Sixteen physicians completed the study (11 pediatric residents and five senior pediatricians). Most participants did not feel competent at performing a fundus examination [mean score on a visual analog scale 1.96; range 0 (not competent at all) to 7]. The mean score for the fundus pictures quiz given before the tutorial was 48% (range 37-58%). The average score of the residents (47%) did not differ significantly from that of the senior pediatricians (42%). After the tutorial the mean grade increased significantly to 60% (P = 0.002). This was true both for residents (63%; P = 0.001) and seniors (55%; P = 0.004). CONCLUSIONS: Our study shows that funduscopy is being neglected by pediatricians. Even a short tutorial may significantly improve the diagnostic value of this test.

Child↗

PubMed2004

Intratympanic gentamicin for Menière's disease: a meta-analysis.

OBJECTIVES: To systematically review the published experience on intratympanic gentamicin treatment for intractable Menière's disease. STUDY DESIGN: Meta-analysis using a random effect model. METHODS: A comprehensive literature search was performed for articles using intratympanic gentamicin as a sole treatment modality with reporting of results according to the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) guidelines for Menière's disease. Two reviewers independently assessed trial quality and extracted data. RESULTS: Fifteen trials with 627 patients met the inclusion criteria. All trials reported "before-after" outcome measures, using patients as their own controls. No double-blind or blinded prospective control trials were identified. Complete (class A) vertigo control was achieved in 74.7% (confidence interval [CI]95% 67.8-81.5%) of patients, and complete or substantial (class B) control was achieved in 92.7% (CI95% 89.5-96.0%). The success rate was not affected by gentamicin treatment regimen (fixed vs. titration). Hearing level and word recognition were not adversely affected, regardless of gentamicin treatment regimen. Analysis of functional level was not performed because of lack of data in the selected articles. CONCLUSIONS: Intratympanic gentamicin treatment for intractable Menière's disease appears to be effective in the relief of vertigo. Cochleotoxicity and ototoxicity is unlikely to be a major side effect. However, the level of evidence reflected from the eligible articles is insufficient, especially because of relatively poor study design. Therefore, it is prudent that patients eligible for this type of treatment should be selected carefully and titrated with low-dose gentamicin. Further investigation with this treatment modality with control subjects is warranted.

Audiometry↗

PubMed2004

Malformation rates in children of women with untreated epilepsy: a meta-analysis.

BACKGROUND: It is widely quoted that women with epilepsy have a higher than baseline risk for giving birth to a child with malformations, independent of the effects of antiepileptic drugs. OBJECTIVE: To determine, based on available evidence, if epilepsy per se represents a teratogenic risk. To systematically review all studies investigating the occurrence of major malformation rates among children of treated or untreated women with epilepsy and non-exposed controls who do not have epilepsy. METHODS: A meta-analysis, using a random effects model, was conducted of all cohort and case-control studies reporting malformation rates in children of women with epilepsy exposed or unexposed to antiepileptic drugs compared with that of children of nonepileptic women. Medline (1966-2001), EMBASE, the Cochrane database as well as REPROTOX (an information system on environmental hazards to human reproduction and development) databases were accessed. RESULTS: We found ten studies reporting results of untreated epilepsy (n = 400) and their non-epileptic healthy controls (n = 2492). Nine out of ten studies also reported results on 1443 patients exposed to antiepileptic drugs and their 2526 unexposed healthy controls. The risk for congenital malformations in the offspring of women with untreated epilepsy was not higher than among nonepileptic controls (odds ratio [OR] = 1.92; 95% CI 0.92-4.00). There was evidence of publication bias, thus with bias removed the OR was 0.99 (95% CI 0.49-2.01). In contrast, the offspring of epileptic women who received antiepileptic drugs had higher incidences of malformation than controls (OR 3.26; 95% CI 2.15-4.93). CONCLUSION: Our study does not support the commonly held view that epilepsy per se represents a teratogenic risk. Our study suggests that this view is the result of a publication bias, with several small (< 100 participants) positive studies leading to a premature conclusion.

Abnormalities, Drug-Induced↗

PubMed2003

Bioavailability of a pediatric amlodipine suspension.

Currently, a suspension of crushed tablets of amlodidpine is widely used in children with hypertension without knowledge of its bioavailability. A comparative bioavailability study of a tablet and suspension formulation of amlodipine was completed in 20 healthy adult volunteers. Bioequivalence of the suspension was not different from the tablets. These results support the use of the suspension in children who cannot take the tablet.

Adult↗

PubMed2003

Effects of aspirin consumption during pregnancy on pregnancy outcomes: meta-analysis.

BACKGROUND: We assessed the effects and safety of aspirin treatment during pregnancy on fetal and neonatal outcomes. METHODS: We searched MEDLINE (1966-2001), EMBASE (1980-2000), TOXLINE (1994-2000), EB M Cochrane Database of Systematic Reviews (1991-2000), Reproductive Toxicology (2001), teratology texts, and bibliographies of all the included studies. We looked for published randomized controlled studies reporting aspirin treatment to improve outcomes of moderate- and high-risk pregnancies. The key words used to search for articles about exposure to aspirin were salicylic acid, pregnancy, and pregnancy complications; key words used to search for outcome were neonatal diseases and abnormalities. Based on our search strategy, 1904 citations were identified; their titles and abstracts were reviewed by one reviewer. Of these citations, 182 papers were selected for detailed review. Two reviewers independently determined whether a study should be included in the final analysis. In cases of disagreement, the decision was based on the assessment of a third reviewer. RESULTS: Data were extracted independently by each reviewer. We calculated the pooled relative risk (RR) or weighted mean difference and 95% confidence intervals (CI), assuming a random-effect model. Thirty-eight studies met the inclusion criteria. The risk for miscarriage did not differ between women treated with aspirin andplacebo (seven studies; RR, 0.92; 95% CI, 0.71-119). Women who took aspirin had a significantly lower risk of preterm delivery than did those treated with placebo (22 studies; RR, 0.92; 95% CI, 0.86-0.98). There was no significant difference in perinatal mortality (20 studies; RR, 0.92; 95% CI, 0.81-1.05) and in the rate of small-for-gestational-age infants (12 studies; RR, 0.96; 95% CI, 0.87-1.07) among offspring of mothers treated with aspirin and those of mothers treated with a placebo. CONCLUSION: For women with moderate- and high-risk pregnancies, aspirin treatment seemed to have a small but significant effect on reducing the rate of preterm deliveries, but did not reduce the rate of perinatal death.

Abnormalities, Drug-Induced↗

PubMed2003

Glutathione, glutathione-dependent enzymes and antioxidant status in erythrocytes from children treated with high-dose paracetamol.

AIM: To investigate glutathione and antioxidant status changes in erythrocytes from febrile children receiving repeated supratherapeutic paracetamol doses. METHODS: Fifty-one children aged 2 months to 10 years participated in the study. Three groups were studied: group 1 (n = 24) included afebrile children who did not receive paracetamol; and groups 2 (n = 13) and 3 (n = 14) included children who had fever above 38.5 degrees C for more than 72 h. Patients in group 2 received paracetamol at a dose of 50 +/- 15 (30-75) mg kg(-1) day(-1) and those in group 3 received paracetamol above the recommended therapeutic dose, ie 107 28 (80-180) mg kg(-1) day(-1). A blood sample was taken for the measurement of liver transaminases, gammaglutamil transferase (GGT), reduced glutathione (GSH), glutathione reductase (GR), glutathione peroxidase (GPX), glutathione S-transferase (GST), superoxide dismutase (SOD) and antioxidant status. RESULTS: Aspartate aminotransferase activity in group 3 was higher than in the other groups (P = 0.027). GSH, SOD and antioxidant status were significantly lower in group 3 compared with groups 1 and 2 (mean differences: for GSH 3.41 micromol gHb(-1), 95% confidence interval (CI) 2.10-4.72, and 2.15 micromol gHb(-1), 95% CI 0.65-3.65, respectively; for SOD 856 U min(-1) gHb(-1), 95% CI 397-1316, and 556 U min(-1) gHb(-1), 95% CI 30-1082, respectively; and for antioxidant status 0.83 mmol l(-1) plasma, 95% CI 0.30-1.36, and 0.63 mmol l(-1) plasma, 95% CI 0.02-1.24, respectively). GR activity was significantly lower in groups 3 and 2 in comparison with group 1 (mean differences 3.44 U min(-1) gHb(-1), 95% CI 0.63-6.25, and 5.64 U min(-1) gHb(-1), 95% CI 2.90-8.38, respectively). Using multiple regression analysis, paracetamol dose was found to be the only independent variable affecting GR, GST and SOD activities (P = 0.007, 0.003 and 0.008, respectively). CONCLUSIONS: In febrile children, treatment with repeated supratherapeutic doses of paracetamol is associated with reduced antioxidant status and erythrocyte glutathione concentrations. These significant changes may indicate an increased risk for hepatotoxicity and liver damage.

Acetaminophen↗

PubMed2003

Utility of antiepileptic drug monitoring in the pediatric emergency department.

Convulsive disorders are common in the pediatric age group, and measurement of serum concentration of an antiepileptic drug (AED) is frequently ordered for epileptic patients in the emergency department (ED). The objective of this study was to develop a better understanding of the indications for, and consequences of, monitoring AED serum concentrations in the pediatric ED. Charts of 116 patients who visited the ED and were tested for blood levels of AED were retrospectively reviewed. Main outcome measures were number and percentage of levels outside the therapeutic range, discontinuation of an AED or introduction of a new one, dosage modifications, and admission to hospital. Two pediatricians and a pediatric neurologist aware only of patients' age, weight, diagnosis, history, clinical presentation, and drug details reviewed each case and on the basis of predetermined criteria decided whether measurement of AED was indicated. Mean age (+/- SD) of the study population was 7 +/- 5 years (range, 2 months-17 years). Forty-two patients (36%) were on monotherapy, and 74 (64%) were on polytherapy. Sixty-eight patients (59%) presented with increased seizure frequency, 7 (6%) with status epilepticus, and 13 (11%) with suspected AED toxicity. The remainder of the children presented with problems unrelated to epilepsy. No significant difference was found between patients with AED levels within the therapeutic range and those with levels outside it in the proportion of children needing dosage change, change in medication, or hospital admission (P = 0.5, 0.8, and 0.8, respectively). None of the patients presenting with status epilepticus and only 15% of those with increased seizure activity had subtherapeutic levels. Review of the cases suggested that measuring serum AED level was not indicated in 57 (49.1%) patients. In the pediatric ED, abnormal AED levels do not correlate with clinical management. Before ordering tests, physicians should consider whether their results would alter patient treatment.

Adolescent↗