Literature on Treating Hyperglycemic Hyperosmolar State (HHS)

• American Diabetes Association. (2020). Hyperglycemic Crises in Diabetes: Diabetes Care in the Hospital.
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  This article provides an overview of management strategies for hyperglycemic crises, including HHS, in a hospital setting.

• Kitabchi, A. E., et al. (2009). Hyperglycemic Crises in Adult Patients with Diabetes.
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  This comprehensive article discusses the pathophysiology, clinical presentation, and management of hyperglycemic crises, including both diabetic ketoacidosis (DKA) and HHS.

• Pasquel, F. J., & Umpierrez, G. E. (2014). Hyperosmolar Hyperglycemic State: A Historic Review of the Clinical Presentation, Diagnosis, and Treatment.
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  This historical review details the clinical presentation, diagnosis, and treatment evolution of HHS.

• Umpierrez, G. E., & Palacio, A. (2020). Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.
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  This article focuses on the management strategies for diabetic ketoacidosis and HHS, emphasizing recent advancements in treatment.

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Why are Potassium Phosphate-Sodium Phosphate Tablets Recommended to be Taken with Food?

Potassium phosphate-sodium phosphate tablets are often recommended to be taken with food for several reasons:

• Minimize Gastrointestinal Discomfort: Taking the medication with food can help reduce the risk of stomach upset, nausea, or irritation that some people may experience when taking these tablets on an empty stomach.
• Enhanced Absorption: Food can aid in the absorption of the nutrients and active ingredients in the medication, ensuring that the body makes the most out of the supplement.
• Preventing Potential Side Effects: Food can sometimes help buffer any potential negative effects on the digestive system, such as diarrhea or abdominal cramping, which can occur with phosphate supplements.
• Improved Compliance: Establishing a routine of taking the medication with meals can help patients remember to take their doses consistently, improving overall compliance with the prescribed regimen.

It is important to follow the specific guidance provided by a healthcare professional regarding the use and dosing of potassium phosphate-sodium phosphate tablets. If there are any concerns or side effects, it's advisable to consult with a healthcare provider.

Role of Pharmacists in Code Response Teams

Introduction

Pharmacists play a crucial role in team-based healthcare settings, including code response teams for circulatory and respiratory arrests. Their expertise in medication management, knowledge of drug interactions, and ability to quickly calculate doses are vital during emergency situations. Below is a summary of relevant literature, guidelines, consensus statements, and opinions from professional organizations regarding pharmacists' roles in such teams.

Literature

• Dager, W. E., et al. (2006). "Pharmacist participation on the medical emergency team: The impact on survival from cardiac arrest." Hospital Pharmacy. This study highlights the positive impact of pharmacist involvement in code teams on patient outcomes, including improved survival rates from cardiac arrest.
• Bond, C. A., Raehl, C. L. (2007). "Clinical pharmacy services, pharmacy staffing, and hospital mortality rates." Pharmacotherapy. The research emphasizes the correlation between the presence of clinical pharmacy services and reduced hospital mortality rates.

Guidelines and Consensus Statements

• American Heart Association (AHA) Guidelines for CPR and ECC. The AHA strongly advocates for pharmacist involvement in code teams, emphasizing their role in medication preparation and administration, dose calculation, and post-arrest care.
• American Society of Health-System Pharmacists (ASHP) Guidelines. ASHP guidelines support pharmacists' participation in code responses, highlighting their expertise in ensuring the safe and effective use of medications during emergencies.

Professional Organization Opinions

• American College of Clinical Pharmacy (ACCP). ACCP promotes the active involvement of pharmacists in code response teams, underscoring their potential to enhance clinical outcomes through their pharmaceutical expertise.
• Society of Critical Care Medicine (SCCM). The SCCM supports a multidisciplinary approach to code responses, with pharmacists playing a key role in medication management and protocol development.

Conclusion

Overall, the inclusion of pharmacists in code response teams is widely supported by the literature and professional guidelines. Their unique skills in medication management and rapid decision-making are invaluable during critical events, contributing to improved patient care and outcomes.

Comparison of Cefdinir and Cefpodoxime

Which is Better?

The choice between cefdinir and cefpodoxime depends on specific patient needs, the type of infection, patient tolerance, and potential drug interactions. Both are effective for treating a variety of infections. A healthcare provider should make the decision based on clinical judgment and individual patient circumstances.

Acyclovir IV Dosing in Obese Adults and Pediatrics

Obese Adults

In obese adults, dosing of intravenous acyclovir can be challenging due to variations in body size and composition. The following guidelines are often used:

• Adjusted Body Weight (AdjBW): For dosing purposes, especially for drugs with limited distribution into fat tissue, adjusted body weight is often used. This is calculated as follows:
  AdjBW = IBW + 0.4 × (Actual Body Weight - IBW)
• Ideal Body Weight (IBW): Sometimes, dosing is considered relative to ideal body weight to prevent overdose in obese patients.
• For patients with a body weight of 120% to 140% of their IBW, dosing strategies typically involve the use of adjusted body weight or other modifications depending on the extent of obesity and clinical judgement.

Pediatrics

In pediatric patients, especially those who are obese, dosing adjustments are generally based on clinical guidelines specific to children. Considerations include:

• Adjusted Dosing Based on Body Surface Area (BSA): This method is often used in pediatrics to calculate chemotherapeutic dosing. It can be considered for acyclovir if obesity significantly alters distribution.
• Weight-Based Dosing: Typically, doses are calculated per kilogram of actual body weight, but in the case of obesity, adjustments similar to those in adults may be considered.
• Consultation with Pediatric Pharmacology Resources: Dosage recommendations may vary, and consulting specific pediatric dosing guidelines is recommended.

Note: These are general guidelines. Specific dosing adjustments should be made in consultation with clinical pharmacologists or according to institutional protocols, considering the severity of infection, renal function, and other patient-specific factors.