In this episode, I’ll discuss the problem with hypo-osmolar solutions in neurological patients. Subscribe on iTunes, Android, or Stitcher The administration of hypo-osmolar IV solutions causes an increase in water into the brain.  This is because an intact blood-brain barrier is permeable to water but not electrolytes.  When the blood brain barrier is intact, and […]

In this episode, I’ll discuss the impact of giving a full-dose cephalosporin challenge to patients with a moderate, severe, or unknown beta-lactam allergy. Subscribe on iTunes, Android, or Stitcher The label of “penicillin allergic” usually sticks to a patient’s medical record forever. The trouble is that many recorded allergies are actually intolerances, such as nausea, […]

In this episode, I’ll discuss the impact of achieving an aggressive PK/PD target for beta-lactams in critically ill patients. Subscribe on iTunes, Android, or Stitcher Therapeutic drug monitoring for beta-lactams has not yet made it to the mainstream in all hospitals, but data continues to accumulate that I believe will eventually compel clinicians to check […]

In this episode, I’ll discuss the 4 categories of interventions to treat medication overdose and why antidote is not #1. Subscribe on iTunes, Android, or Stitcher I consider the 4 categories of interventions to treat medication overdose to be: #1 Supportive care #2 Antidote therapy #3 Decontamination #4 Enhance elimination As pharmacists, it is easy […]

In this episode, I’ll discuss the rare case when a very hypotonic solution may be indicated. Subscribe on iTunes, Android, or Stitcher A recent commentary published in AJHP argues for abandoning the use of extremely hypo-osmolar intravenous solutions to treat hypernatremia. The authors consider extremely hypotonic solutions to be 0.225% sodium chloride (also called one-quarter […]

In this episode, I’ll discuss oral vs IV phosphate replacement for critically ill patients with mild to moderate hypophosphatemia. Subscribe on iTunes, Android, or Stitcher IV phosphate is frequently used to replace low serum phosphate levels in critically ill patients. However this often requires the administration of significant amounts of IV fluid, which can complicate […]

In this episode, I’ll discuss the efficacy tradeoff when reducing apixaban dose in patients with end-stage renal disease. Subscribe on iTunes, Android, or Stitcher The prescribing information for apixaban recommends not reducing the dose when being used in patients with end-stage renal disease and atrial fibrillation. However, renal elimination accounts for 27% of apixaban clearance. […]

In this episode, I’ll discuss whether standard doses of apixaban are as effective as warfarin in severe obesity. Subscribe on iTunes, Android, or Stitcher Initial studies for apixaban such as ARISTOTLE had a median weight of 82 kg and did not focus on determining efficacy in a severely obese patient population. Because of the lack […]

In this episode, I’ll discuss the risk of bacteremia in patients with asymptomatic bacteriuria and altered mental status. Subscribe on iTunes, Android, or Stitcher Perhaps one of the most frustrating scenarios dealing with antimicrobial stewardship is that of a patient with asymptomatic bacteriuria (meaning no systemic signs of infection) but altered mental status. Many clinicians […]

In this episode, I’ll discuss how to judge whether a journal is reputable. Subscribe on iTunes, Android, or Stitcher There are dozens of well-established journals that when we read an article in them, the thought never comes to mind “Is this journal reputable?” But there are also journals with little or even no peer review, […]

In this episode, I’ll discuss a novel metric for antibiotic stewardship. Subscribe on iTunes, Android, or Stitcher Days of Therapy (DOT) is probably the most common metric to track antimicrobial stewardship efforts related to antibiotic consumption. DOT is not a perfect metric as it is calculated by calendar day regardless of the number of doses […]

In this episode, I’ll discuss the consolidated CHEST guidelines on antithrombotic therapy for venous thromboembolism disease. Subscribe on iTunes, Android, or Stitcher The CHEST guidelines on venous thromboembolism disease are an invaluable resource, but one flaw that has persisted since 2016 has made referencing the guidelines awkward and inconvenient. When the 1st updated to the […]