Ceftazidime-induced thrombocytopenia. / Trombocitopenia inducida por ceftazidima.

Ceftazidime is an antibiotic belonging to the group of third generation cephalosporins, frequently used in clinical practice for its broad antibacterial spectrum. A case report is presented on a 78-year-old man who entered the intensive care unit due to respiratory failure secondary to nosocomial pneumonia in the postoperative period of a laparoscopic hepatic bisegmentectomy for a hepatocarcinoma. It required invasive mechanical ventilation and was treated with ceftazidime, developing a progressive decrease in platelet count after the onset of this drug and after re-exposure to it, not coinciding with the introduction of other drugs. The adverse reaction was reported to the Spanish pharmacosurveillance system and according to the Naranjo algorithm the causal relationship was probable. Since no case of ceftazidime-induced thrombocytopenia was found in the literature, we consider knowledge of it relevant as an adverse effect to be taken into account given its potential severity, especially when it cannot be explained by other causes.

[Dilution volume of intravenous drugs in patients under fluid restriction therapy]. / Volumen de dilución de fármacos intravenosos en pacientes con restricción de fluidos.

INTRODUCTION: A fluid and electrolyte balance is essential for human health. There are some situations in which fluid imbalance occurs, causing fluid overload and consequent associated problems. Patients with these problems, may benefit from the administration of parenteral drugs in the smallest possible volume. Patients in critical condition typically require a large number of drugs intravenously, and high doses of these diluted in large quantities of serum. Therefore, it seems useful to seek an optimization strategy of parenteral drug admi - nistration. OBJECTIVE: To review and collect data on minimum dilution volumes. Besides administration s routes, reconstitution, compatible diluents, infusion times. METHODS: The study included those drug substances frequently used in critically ill patients. A search through multiple sources of information has been made: technical data for Propietary medicinal products, Handbook on Injectable Drugs, Trissel L., American Society Healh-System Pharmacists, 15thEd., 2009, Thomson Micromedex® Healthcare Series, or by phone calls to the manufacturers of the product. RESULTS: RESULTS are shown in a table. 65 drugs were revised. CONCLUSIONS: It is considered useful the collection of these data to optimize parenteral administration in critically ill patients, or in those who require restrictive fluid therapy, because information has been collected from different sources, not always found it in the technical data of the drugs.

Pyruvate protects cerebellar granular cells from 6-hydroxydopamine-induced cytotoxicity by activating the Akt signaling pathway and increasing glutathione peroxidase expression.

Parkinson disease (PD) is the second-most common age-related neurodegenerative disease and is characterized by the selective destruction of dopaminergic neurons. Increasing evidence indicates that oxidative stress plays a crucial role in the pathogenesis of idiopathic PD. Anti-oxidant agents including catalase, manganese porphyrin and pyruvate confer cytoprotection to different cell cultures when challenged with 6-hydroxydopamine (6-OHDA). Herein we used rat cerebellar granular cell cultures to ascertain the plausible cellular pathways involved in pyruvate-induced cytoprotection against 0.1 mM 6-OHDA. Pyruvate provided cytoprotection in a concentration-dependent manner (2-10 mM). Consistent with its well-established anti-oxidant capacity, pyruvate (10 mM) prevented 6-OHDA-induced lipid peroxidation by blocking the rise in intracellular peroxides and maintaining the intracellular reduced glutathione (GSH) levels. Further experiments revealed that pyruvate increased Akt, but not extracellular signal-regulated kinase phosphorylation. Moreover, phosphatidylinositol 3-kinase (PI3K) inhibitors attenuated pyruvate-induced cytoprotection indicating that PI3K-mediated Akt activation is necessary for pyruvate to induce cytoprotection. On the other hand, pyruvate also up-regulated glutathione peroxidase mRNA levels, but not those of the anti-oxidant enzymes superoxide dismutase-1 and -2, catalase or the anti-apoptotic oncogenes Bcl-2 or Bcl-xL. In summary, our results strongly suggest that pyruvate, besides the anti-oxidant properties related to its structure, exerts cytoprotective actions by activating different anti-apoptotic routes that include gene regulation and Akt pathway activation.

Volumen de dilución de fármacos intravenosos en pacientes con restricción de fluidos / Dilution volume of intravenous drugs in patients under fluid restriction therapy

Introducción: El mantenimiento del equilibrio hidroelectrolítico es esencial para el buen funcionamiento del organismo. Existen situaciones en las que se producen desequilibrios en los líquidos corporales, originando sobrecargas de fluidos, y sus consecuentes problemas asociados. Los pacientes con esta problemática, pueden beneficiarse de la administración de fármacos parenterales en el menor volumen posible. Los pacientes en estado crí- tico suelen requerir un gran número de fármacos por vía intravenosa, y altas dosis de éstos a diluir en grandes cantidades de suero. Por todo ello, parece útil buscar una estrategia de optimización de la administración de los fármacos parenterales. Objetivo: Revisar y recopilar datos referentes a volúmenes mí- nimos de dilución. Además de las vías de administración, reconstitución, diluyentes compatibles, tiempos de infusión. Método: Se incluyeron en el estudio aquellos principios activos utilizados con más frecuencia en pacientes críticos. Se realizó una búsqueda en varias fuentes de información: fichas técnicas de las especialidades farmacéuticas, Handbook on Injectable Drugs, Trissel L., American Society Healh-System Pharmacists, 15thEd., 2009, Thomson Micromedex® Healthcare series, o vía telefónica con el laboratorio fabricante del producto. Resultados: Los resultados se muestran en forma de tabla. Se revisaron 65 especialidades farmacéuticas. Conclusiones: Consideramos útil la recopilación de estos datos para optimizar la administración parenteral en pacientes críticos o que requieran una terapia restrictiva en fluidos ya que la información ha tenido que ser recopilada de distintas fuentes no encontrándose siempre en la ficha técnica. (AU)

Introduction: A fluid and electrolyte balance is essential for human health. There are some situations in which fluid imbalance occurs, causing fluid overload and consequent associated problems. Patients with these problems, may benefit from the administration of parenteral drugs in the smallest possible volume. Patients in critical condition typically require a large number of drugs intravenously, and high doses of these diluted in large quantities of serum. Therefore, it seems useful to seek an optimization strategy of parenteral drug administration. Objective: To review and collect data on minimum dilution volumes. Besides administration s routes, recons - titution, compatible diluents, infusion times. Methods: The study included those drug substances frequently used in critically ill patients. A search through multiple sources of information has been made: technical data for Propietary medicinal products, Handbook on Injectable Drugs, Trissel L., American Society Healh-System Pharmacists, 15thEd., 2009, Thomson Micromedex® Healthcare Series, or by phone calls to the manufacturers of the product. Results: Results are shown in a table. 65 drugs were revised. Conclusions: It is considered useful the collection of these data to optimize parenteral administration in critically ill patients, or in those who require restrictive fluid therapy, because information has been collected from different sources, not always found it in the technical data of the drugs (AU)