Two abstracts presented at the annual meeting of the Society of Critical Care Medicine suggest overweight patients in hospital emergency departments are subject to etomidate and vancomycin underdosing, according to a Pharmacy Practice News report.
Researchers at the University of Arizona Medical Center retrospectively analyzed data on 200 patients who were administered etomidate between March 1, 2008 and June 31, 2010. Etomidate is a commonly used sedative in hospital emergency departments. Their research showed more than two-thirds of patients who were at least 100 kg received underdoses of etomidate compared with 2 percent of patients who were less than 100 kg. While the researchers were unable to conclude whether any complications arose from the underdoses, they did suggest hospital emergency departments use tools such as the Ramsay Sedation Scale to better assess the patient's level of sedation.
In another study, researchers assessed 662 patients who were administered vancomycin in Barnes-Jewish Hospital's emergency department before admission to the ICU. Vancomycin dosage based on weight is recommended for treatment of MRSA infections. The researchers found more than three-quarter of the patients received vancomycin doses outside of appropriate range of 15 to 20 mg/kg. Risk factors for inaccurate doses included increasing age, weight, male sex, non-white race and serum creatinine. In a multivariable model, only increasing weight was a risk factor of inaccurate doses. In fact, for each 10-kg increase in weight, patients saw a 10-fold increase in underdosing risk. Experts suggested providers may feel uncomfortable administering higher doses of vancomycin due to toxicity.
Both studies were limited due to their retrospective nature.
Researchers at the University of Arizona Medical Center retrospectively analyzed data on 200 patients who were administered etomidate between March 1, 2008 and June 31, 2010. Etomidate is a commonly used sedative in hospital emergency departments. Their research showed more than two-thirds of patients who were at least 100 kg received underdoses of etomidate compared with 2 percent of patients who were less than 100 kg. While the researchers were unable to conclude whether any complications arose from the underdoses, they did suggest hospital emergency departments use tools such as the Ramsay Sedation Scale to better assess the patient's level of sedation.
In another study, researchers assessed 662 patients who were administered vancomycin in Barnes-Jewish Hospital's emergency department before admission to the ICU. Vancomycin dosage based on weight is recommended for treatment of MRSA infections. The researchers found more than three-quarter of the patients received vancomycin doses outside of appropriate range of 15 to 20 mg/kg. Risk factors for inaccurate doses included increasing age, weight, male sex, non-white race and serum creatinine. In a multivariable model, only increasing weight was a risk factor of inaccurate doses. In fact, for each 10-kg increase in weight, patients saw a 10-fold increase in underdosing risk. Experts suggested providers may feel uncomfortable administering higher doses of vancomycin due to toxicity.
Both studies were limited due to their retrospective nature.
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