Estudio multicéntrico de conciliación de la medicación en onco-hematología pediátrica / Multicentre study of medication reconciliation in paediatric onco-hematology

Objetivo determinar la prevalencia de errores de conciliación (EC) al ingreso hospitalario en la población pediátrica onco-hematológica para comprobar si ésta presenta una susceptibilidad similar a la de los adultos para ser afectados por estos EC y describir las características de los pacientes en los que se producen.Métodoestudio prospectivo y multicéntrico de 12 meses de duración, de conciliación de medicación al ingreso en la población pediátrica onco-hematológica para evaluar la incidencia de EC y describir las características de los pacientes en los que se producen.Resultadosse concilió la medicación de 157 pacientes. En 96 pacientes se detectó al menos una discrepancia de la medicación. De las discrepancias detectadas, el 52,1% fueron justificadas por la nueva situación clínica del paciente o por el médico responsable mientras que el 48,9% se consideraron EC. El tipo de EC más frecuente fue la «omisión de algún medicamento», seguido por «una dosis, frecuencia o vía de administración diferente». Se efectuaron un total de 77 intervenciones farmacéuticas, de las que se aceptaron el 94,2%. En el grupo de pacientes con un número igual o mayor a 4 fármacos en tratamiento domiciliario se observó un incremento de 2,1 veces la probabilidad de experimentar un EC.Conclusionespara evitar o reducir los errores en uno de los puntos críticos de seguridad como son las transiciones asistenciales, existen medidas, como la conciliación de la medicación. En el caso de los pacientes pediátricos crónicos complejos, como los pacientes onco-hematológicos, el número de fármacos como parte del tratamiento domiciliario es la variable que se ha asociado a la presencia de EC al ingreso hospitalario, siendo la omisión de algún medicamento la causa principal de estos errores. (AU)

Objective To determine the prevalence of reconciliation errors (RE) on admission to hospital in the paediatric onco-haematological population in order to check whether they are similarly susceptible to these RE as adults and to describe the characteristics of the patients who suffer them.MethodsA 12-month prospective, multicentre study of medication reconciliation on admission in the paediatric onco-haematological population to assess the incidence of RE and describe the characteristics of the patients in whom they occur.ResultsMedication reconciliation was performed in 157 patients. At least 1 medication discrepancy was detected in 96 patients. Of the discrepancies detected, 52.1% were justified by the patient's new clinical situation or by the physician, while 48.9% were determined to be RE. The most frequent type of RE was the "omission of a medication", followed by "a different dose, frequency or route of administration". A total of 77 pharmaceutical interventions were carried out, 94.2% of which were accepted. In the group of patients with a number equal to or greater than 4 drugs in home treatment, there was a 2.1-fold increase in the probability of suffering a RE.ConclusionsIn order to avoid or reduce errors in one of the critical safety points such as transitions of care, there are measures such as medication reconciliation. In the case of complex chronic paediatric patients, such as onco-haematological patients, the number of drugs as part of home treatment is the variable that has been associated with the presence of medication RE on admission to hospital, with the omission of some medication being the main cause of these errors. (AU)

Multicentre study of medication reconciliation in paediatric onco-hematology. / Estudio multicéntrico de conciliación de la medicación en onco-hematología pediátrica.

OBJECTIVE: To determine the prevalence of reconciliation errors (RE) on admission to hospital in the paediatric onco-haematological population in order to check whether they are similarly susceptible to these RE as adults and to describe the characteristics of the patients who suffer them. METHODS: A 12-month prospective, multicentre study of medication reconciliation on admission in the paediatric onco-haematological population to assess the incidence of RE and describe the characteristics of the patients in whom they occur. RESULTS: Medication reconciliation was performed in 157 patients. At least 1 medication discrepancy was detected in 96 patients. Of the discrepancies detected, 52.1% were justified by the patient's new clinical situation or by the physician, while 48.9% were determined to be RE. The most frequent type of RE was the "omission of a medication", followed by "a different dose, frequency or route of administration". A total of 77 pharmaceutical interventions were carried out, 94.2% of which were accepted. In the group of patients with a number equal to or greater than 4 drugs in home treatment, there was a 2.1-fold increase in the probability of suffering a RE. CONCLUSIONS: In order to avoid or reduce errors in one of the critical safety points such as transitions of care, there are measures such as medication reconciliation. In the case of complex chronic paediatric patients, such as onco-haematological patients, the number of drugs as part of home treatment is the variable that has been associated with the presence of medication RE on admission to hospital, with the omission of some medication being the main cause of these errors.

Persistent dyselectrolytemia in a neonate induced by liposomal amphotericin B. A case report.

Background: Nephrotoxicity is the most frequent serious adverse effect associated with amphotericin B deoxycholate treatment, for this reason, in recent years it has been relegated from routine clinical practice and replaced by the new liposomal formulations that have less nephrotoxicity. Nevertheless, dyselectrolytemia are a frequent adverse effect of the use of liposomal amphotericin B that usually are resolved with the withdrawal of the drug. Case presentation: We present a preterm neonate of 25 weeks gestation, with preserved renal function and most electrolytes within normal limits for gestational age except for mild hyponatremia in the first month of life. Due to an infection of the central nervous system and growth of Candida albicans, he required treatment with endovenous liposomal amphotericin B as well as intrathecal amphotericin B deoxycholate showing severe hydroelectrolyte disturbances and clinical worsening compatible with possible tubulopathy showing hypokalemia and severe hyponatremia a few days after starting treatment that persisted over time even after withdrawal of both drugs. Subsequently to the main alterations described, hypomagnesemia, hypophosphatemia, glycosuria and tubular proteinuria were also observed. Calcium levels remained stable after amphotericin B administration and did not require supplementation. In preterm or low birth weight newborns who present unjustified, severe and difficult to correct hydroelectrolyte disturbances despite the usual treatment, a possible tubulopathy should be considered, whether hereditary, primary or secondary to toxins or drugs. What Is New and Conclusion: We present the first case reported in a neonate in whom dyselectrolithemia has been maintained over time after withdrawal of liposomal amphotericin B.

Harmful excipients in medicines for neonates in Spain.

BACKGROUND: Neonates may respond differently from adults to drug components. Hence, ingredients that seem safe in adults may not be safe in this age group. OBJECTIVE: To describe the content of harmful excipients in drugs used in our neonatal wards and compare the daily dose a neonate may receive with the accepted daily intake (ADI) in adults. METHODS: All drugs included in the hospital's neonatal treatment guide were reviewed, using information from the package inserts or the summary of product characteristics. Those containing at least one harmful excipient (e.g., metabisulfite, sorbitol) were analyzed. Minimum and maximum usual daily drug doses were determined, and excipient exposure was estimated by extrapolation of the minimum and maximum of excipient referred to the active ingredient. These amounts were compared with ADIs for each excipient in adults. RESULTS: In total, 32 % of intravenous and 62 % of oral formulations used in neonates contained at least one harmful excipient. On quantitative analysis, 25 % of intravenous and 19 % of oral drugs contained harmful excipients exceeding the ADI in adults. CONCLUSION: Several drugs commonly used to treat neonates contain harmful excipients in amounts that may exceed the ADI in adults. Clinicians should be aware of this to prescribe appropriate treatment in this population.

Intoxicació per consum lúdic de metanol en sis adolescents / Intoxicación por consumo lúdico de metanol en seis adolescentes / Poisoning due to recreational use of methanol in six adolescents

Introducció: la intoxicació per metanol és rara en pediatria icomporta una elevada morbimortalitat. El metanol és un alcohol utilitzat com a dissolvent. El seu ús fraudulent en mesclesde begudes alcohòliques és la principal forma d'intoxicació. Observació clínica: es presenta una sèrie de sis casosd'adolescents amb intoxicació per metanol amb finalitat lúdica. Dos casos van presentar clínica gastrointestinal ineurològica, els altres es van mantenir asimptomàtics. Esva detectar acidosi metabòlica amb anió gap elevat i ambnivells de metanol detectable en tres casos; aquests vanrebre tractament amb etanol i bicarbonat endovenós, i dosvan necessitar, a més, hemodiàlisi. Comentaris: la intoxicació per metanol ha de formar partdel diagnòstic diferencial de l'acidosi metabòlica amb aniógap elevat. El seu diagnòstic i tractament precoç és essencial, tenint en compte la gravetat del quadre i el risc de seqüeles neurològiques, com ara la ceguesa. L'administracióde bicarbonat i de l'antídot (etanol o fomepizole), i l'hemodiàlisi constitueixen les eines terapèutiques principals

Introducción. La intoxicación por metanol es rara en pediatría y conlleva una elevada morbimortalidad. El metanol es un alcohol usado como disolvente. Su uso fraudulento en mezclas de bebidas alcohólicas es la principal forma de intoxicación. Observación clínica. Describimos una serie de seis casos de adolescentes con intoxicación por metanol con finalidad lúdica. Dos casos presentaron clínica gastrointestinal y neurológica, el resto permanecieron asintomáticos. Se detectó acidosis metabólica con anión gap elevado y con niveles de metanol detectable en tres casos; éstos recibieron tratamiento con etanol y bicarbonato endovenoso, dos de estos casos requirieron, además, hemodiálisis. Comentarios. La intoxicación por metanol debe formar parte del diagnóstico diferencial de la acidosis metabólica con anión gap elevado. Su diagnóstico y tratamiento precoz es esencial, dada la gravedad del cuadro y el riesgo de secuelas neurológicas, como la ceguera. La administración de bicarbonato y del antídoto (etanol o fomepizol), y la hemodiálisis constituyen las principales herramientas terapéuticas (AU)

Introduction. Methanol poisoning is a rare occurrence in children, and it is associated with high morbidity and mortality. Methanol is an alcohol used as solvent; its fraudulent use in mixtures of alcoholic beverages is the main form of poisoning. Case reports. We describe a series of six teenagers with poisoning due to recreational ingestion of methanol. Two cases had neurological and gastrointestinal symptoms, and the others remained asymptomatic. Metabolic acidosis with high anion gap and high levels of methanol was detected in three cases, which were treated with ethanol and intravenous bicarbonate; two of them also required hemodialysis. Comments. Methanol poisoning should be part of the differential diagnosis of metabolic acidosis with elevated anion gap. Early diagnosis and treatment are critical due to the potential severity of symptoms and risk of neurological consequences such as blindness. The administration of bicarbonate, the antidote (ethanol or fomepizole), and hemodialysis, are the main therapeutic tools (AU)