1) Is the clinical calculation for “Patient 2” provided in the article correct?
ID: 126403 • Letter: 1
Question
1) Is the clinical calculation for “Patient 2” provided in the article correct? Why or why not?
Suzanna Estevan is a 36-year-old woman admitted to intensive care
with a hypothyroid coma. e medical team has decided to use liothyronine sodium by slow IV to treat this, as
the patient is unconscious and cannot swallow tablets. According to the BNF, the dose of liothyronine sodium for hypothyroid coma is 5–20 mcg, repeated every 12 hours if necessary. e medical team has prescribed a dose of 15 mcg. Liothyronine sodium injection contains 20 mcg per vial for reconstitution with
1 ml or 2 ml water for injections (EMC, 2014b). Your colleague has added
2 ml water for injection to the vial and calculated that 0.75 ml of solution is required to administer the 15 mcg dose. Is this correct?
Edit: This was the only information given for this particular patient.
Explanation / Answer
The dosage prescribed are not in the format that it should be. The standards are below:
The dosages are described below:
Primary dose: 25 to 50 mcg IV one time
Patients with recognized or doubted cardiovascular illness:
-Initial dose: 10 to 20 mcg IV one time
Administration details and explanation:
-Early and following doses should be grounded on unceasing observing of the patient's medical condition and reaction to treatment.
-At minimum 4 hours should be permissible amid doses to sufficiently measure reaction and no more than 12 hours must intervene amid doses to avoid variations in hormone levels.
-Exercise carefulness when regulating dose due to possible of great vicissitudes to precipitous contrary cardiovascular occasions.
-Reduced death has been stated in patients unloading at least 65 mcg/day in the primary days of management; though, limited clinical involvement with whole daily amounts beyond 100 mcg.
-Usage is for the management of myxedema coma/precoma.
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