In this episode, I’ll discuss a case report of enoxaparin overdose. Subscribe on iTunes, Android, or Stitcher A group of authors recently published their experience treating an overdose of 900 mg enoxaparin with a protamine bolus and infusion in the American Journal of Health System Pharmacy. There is little data available on managing large enoxaparin […]

In this episode, I’ll discuss the association of long-term proton pump inhibitor use with adverse events in patients with chronic kidney disease. Subscribe on iTunes, Android, or Stitcher Proton pump inhibitors have many important indications, but they are also notorious for sticking around on a patient’s medication regimen long after their indication for use has […]

In this episode, I’ll discuss possible design flaws in a recent study that suggested cefepime has a mortality benefit over piperacillin-tazobactam. Subscribe on iTunes, Android, or Stitcher In a recent issue of JAMA Internal Medicine, a group of authors used instrumental variable (IV) analysis to conclude that the use of cefepime was associated with a […]

In this episode, I’ll discuss converting inpatients from insulin glargine 300 units/mL to insulin detemir 100 units/mL without causing hypoglycemia. Subscribe on iTunes, Android, or Stitcher A 3-month study comparing insulin glargine 300 units/mL (glargine300) to insulin detemir 100 units/mL (detemir100) found that to achieve similar glucose control, with glargine300 needing a roughly 0.07 units […]

In this episode, I’ll discuss the risk factors for not attaining target beta-lactam levels in ICU patients. Subscribe on iTunes, Android, or Stitcher For beta-lactam antibiotics, an adequate time above the MIC is essential to achieve clinical success. However, critically ill patients undergo physiologic changes that may make achieving adequate time above MIC difficult. This […]

In this episode, I’ll discuss early vs delayed norepinephrine use in patients with septic shock. Subscribe on iTunes, Android, or Stitcher The optimal timing of when to start a vasopressor in patients with septic shock is unknown. While early norepinephrine makes intuitive sense, there are many reasons why a clinician may wish to see if […]

In this episode, I’ll discuss which overdose patients with prolonged QTc are most likely to experience ventricular dysrhythmia. Subscribe on iTunes, Android, or Stitcher Among overdose patients who present to the emergency department, those with a severely prolonged QTc of over 500 milliseconds represent a cohort that is at an elevated risk of a poor […]

In this episode, I’ll discuss hyper and hypokalemia thresholds that are associated with in-hospital cardiac arrest. Subscribe on iTunes, Android, or Stitcher Both hyperkalemia and hypokalemia are potentially reversible causes of cardiac arrest. A group of authors published a registry-based matched case-control study in the journal Critical Care Medicine to determine how the risk of in-hospital […]

In this episode, I’ll discuss treating diphenhydramine overdose in the absence of physostigmine. Subscribe on iTunes, Android, or Stitcher The usual antidote for anticholinergic drug toxicity is physostigmine, however it is no longer available in the US. Even though the FDA has authorized the importation of an equivalent product, pharmacists may face the need to treat […]

In this episode, I’ll discuss whether there is an association between the sedative dose and postintubation hypotension and rapid sequence intubation. Subscribe on iTunes, Android, or Stitcher When a patient who requires sedation for intubation also has hemodynamic instability, a common recommendation is to lower the dose of sedative given in hopes of preventing further […]

In this episode, I’ll discuss sodium bicarbonate to treat metabolic acidosis in ICU patients. Subscribe on iTunes, Android, or Stitcher Sodium Bicarbonate is frequently given to ICU patients to correct metabolic acidosis however, evidence to support this indication has been lacking and sodium bicarb is not a benign intervention without risk of adverse effects. Back in episode […]

In this episode, I’ll discuss parenteral medication considerations for the ketogenic diet. Subscribe on iTunes, Android, or Stitcher A high-fat, low-carbohydrate diet may be prescribed to induce ketosis and help patients with epilepsy that is refractory to medical treatment. While dietary carbohydrate intake is tightly controlled in these patients, small amounts of carbohydrate from non-dietary sources […]