Inappropriate use of high-dose glyburide to treat uncontrolled type 2 diabetes mellitus.

OBJECTIVE: To report a case of chronic glyburide overdose. CASE SUMMARY: A patient with noninsulin-dependent diabetes mellitus (NIDDM) who had previously developed secondary failure while taking a maximal dosage of glipizide was switched to glyburide 5 mg/d. The patient initially experienced adequate glycemic control while taking glyburide, but subsequently experienced deterioration in glycemic control. This necessitated gradual increases in the dosage of glyburide until the maximum dosage of 20 mg/d was reached. Because the patient's diabetic control did not improve with this dosage of glyburide, she decided independently to increase the dosage further. She ingested an average daily dose of 37.7 mg of glyburide over the 18 days that preceded her clinic visit without experiencing any glyburide-related adverse effects. DISCUSSION: Progression of NIDDM may be responsible for the development of secondary sulfonylurea failure in NIDDM patients treated with oral sulfonylurea drugs. Consequently, these patients should be treated as patients dependent on insulin. CONCLUSIONS: NIDDM patients treated with oral sulfonylurea drugs require long-term blood glucose monitoring to detect the development of secondary sulfonylurea failure. Patients who experience secondary failure to a particular sulfonylurea drug do not appear to develop long-term blood glucose control when switched to a different oral sulfonylurea drug. These patients should be treated with insulin therapy.

Drug information sources used by community pharmacists in Louisiana: a preliminary study.

OBJECTIVE: There is a paucity of information in the literature regarding the type of reference sources that are used by community pharmacists to answer drug information questions. This survey was conducted to determine the frequency of use of selected drug information references by independent and chain pharmacists in Louisiana. DESIGN: A study population of 15% of registered pharmacists was obtained by random stratification of all pharmacists on the mailing list of the Louisiana Board of Pharmacy on the basis of zip code and gender. These pharmacists were mailed an uncoded, pretested questionnaire and were asked to complete and return it if they were employed by an independent or chain pharmacy; nonchain and independent pharmacists were asked to return their questionnaires uncompleted. No follow-up was performed. PARTICIPANTS: Ninety-one independent pharmacists (mean age=45 y; mean years of experience=21) and 71 chain pharmacists (mean age=40 y; mean years of experience=16). OUTCOME MEASURES: The frequency of use of selected drug information reference sources by independent and chain pharmacists and the type of drug information questions received by pharmacists were determined. A Statistical Analysis System software program was used to analyze the data. Spearman's rank test was used to determine statistical differences between independent and chain pharmacists. The a priori level of significance was p less than or equal to 0.05. RESULTS: A 54% response rate was obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Ten cases of acute lead intoxication among bridge workers in Louisiana.

We report the cases of ten construction workers who developed acute lead intoxication while repairing a bridge in Louisiana. All but one patient received a five-day course of edetate calcium disodium (calcium EDTA) chelation therapy; one patient received five doses instead of five days of treatment. Calcium EDTA 25 mg/kg q12h was administered for ten consecutive doses by intravenous infusion over two hours. Each dose was diluted in NaCl 0.9% 500 mL. No adverse drug effects were observed during treatment. The posttreatment mean whole blood lead (PbB) concentration was significantly reduced compared with the pretreatment mean PbB (1.48 +/- 0.70 vs. 3.8 +/- 1.68 mumol/L; p = 0.0012, Student's paired t-test). This indicates that the body lead burden of these patients was effectively reduced with calcium EDTA. Eight patients had complaints on admission that were suggestive of lead intoxication. These included malaise, numbness of the extremities, arthralgia, myalgia, abdominal discomfort, sleep disturbance, and lower back pain. Patients had no complaints on discharge. Eight patients had mild anemia that was consistent with acute lead intoxication (mean pretreatment hemoglobin (+/- SD), 128.6(+/- 17.2 g/L), but calcium EDTA therapy did not appear to effect any change in the pretreatment hemoglobin values. The Occupational Safety and Health Administration (OSHA) lead standard requires that manufacturers provide employees at risk for occupational lead exposures with proper respirators and medical surveillance to prevent lead intoxication. The construction industry is exempted from these standards except in Maryland. We believe that amendment of the OSHA lead standards, to provide specific lead regulation of the construction industry, would be helpful in preventing similar cases of occupational lead intoxication.

Successful treatment of neonatal Citrobacter freundii meningitis with ceftriaxone.

Citrobacter meningitis is an uncommon enteric gram-negative infection that afflicts neonates and young children. Approximately 30 percent of children treated or untreated die from the infection. We report a case of C. freundii meningitis that was resistant to ampicillin and was successfully treated with ceftriaxone, a third-generation cephalosporin. A 13-day-old, full-term baby was admitted to the hospital with a one-day history of fever up to 38.8 degrees C. On admission the infant had a temperature of 39.2 degrees C, pulse of 140 beats/min, and a respiratory rate of 32 breaths/min. Except for a slightly bulging fontanelle, the rest of the physical examination was within normal limits. Complete blood count revealed a white blood cell (WBC) count of 12.5 x 10(9)/L, with 0.66 polymorphonuclear cells, 0.10 bands, 0.18 lymphocytes, and 0.06 monocytes. A stat lumbar puncture showed 10 WBCs per high-power field with gram-negative rods. Empiric therapy with ampicillin 225 mg q12h and gentamicin 11 mg q8h was started. Both antibiotics were discontinued after culture and sensitivity results were positive for C. freundii in the blood and spinal fluid. The patient was successfully treated with nine days of ceftriaxone 250 mg q12h.