NEW YORK (CBSNewYork) — A Brooklyn family is dealing with absolute devastation a
ID: 3504984 • Letter: N
Question
NEW YORK (CBSNewYork) — A Brooklyn family is dealing with absolute devastation after their only child died following a fatal mistake. Their baby boy was taken to the hospital with just a fever and was given what turned out to be a deadly dose of medication.
Earlier Wednesday afternoon, the New York City Medical Examiner ruled the death of 6-month-old Amaan Ahmmad an accident. The ME said the death was the result of complications following administration of an adult dose of the antibiotic azithromycin, which is commercially known as Zithromax.
Instead of looking forward to a lifetime of birthdays, the family is now making funeral arrangements for their child. Ummay Sultana and Amain Ahmmad said their son became ill last Friday, so they took him to Brookdale, where he was born.
“He catch cold and we took him to the emergency,” Sultana said.
Hospital records showed baby Amaan was brought to the ER “alert and responsive” and with the exception of a fever, which was reportedly around 100, the nursing staff did not list any other visible symptoms.
But an examination led to a diagnosis of clinical pneumonia. Amaan was transferred to the pediatric unit and given a dose of the azithromycin through an IV drip in his right arm.
According to the nursing notes, at least 36 minutes passed before the hospital staff realized something was wrong.
CBS 2’s Jay Dow spoke with the parents Wednesday and asked the boy’s father who he blames for his son’s death.
“Hospital management, doctor, nurse—of emergency,” he replied.
“I’m like ‘look, look my baby’s dying! My baby’s dying!’ and then nurse came over and said ‘no, you’re baby’s pretty good. He’s sleeping,’” Sultana told CBS 2’s Sean Hennessey.
A copy of the hospital’s discharge summary states the child was given “Azithromycin (500mg), in error” — which led to “cardiac shock.”
Family pediatrician Dr. Suzanne Loiselle said that dosage is more typical for an adult and not a 17-pound baby like Amaan.
“Nobody can feel worse for the family than the doctors and nurses that were involved in this child’s care,” Loiselle said. “About 80 milligrams would be appropriate for a child roughly in his weight class.”
Less than 24 hours after the overdose, Ummay and Amain were told their son was brain dead. Amaan was taken off a respirator on Monday.
“They told us there is no hope because his head is totally collapsed,” his father told Hennessey.
Brookdale Hospital would not answer questions from 1010 WINS or CBS 2, saying only: “We are investigating the circum- stances of this tragic incident and express our condolences to the Ahmmad family.”
“I never think like that he pass away forever,” Sultana said. “I thought he’s gonna come back.”
The two first-time parents said they are both devastated and outraged over a fatal medical mistake that cut short their baby’s
life just as it was getting started.
QUESTIONS:
1) Some medications are formulated such that there is a slow release of the active ingredients. Such formulations are known as “extended release.” Azithromycin ER is a single-dose, extended release formulation. The recommended dosage for a child 6 months and older who is brought to the Emergency Room with community acquired pneumonia is 60 mg/kg administered orally. Azithromycin (immediate release) has much faster onset of action and acts almost immediately when administered intravenously (by IV). Clinicians exercise clinical judgment when deciding whether or not to treat a pediatric patient with azithromycin intravenously. If therapy is deemed necessary, a dose of 10 mg/kg for those age 6 months to 16 years is considered reasonable.
(a) Based on the information above, what would be an appropriate dose of azithromycin ER for a baby weighing 17 lbs such as Amaan?
(b) How does the appropriate dose of azithromycin ER for a baby weighing 17 lbs such as Amaan compare with the dose of azithromycin that was given intravenously to Amaan.
(c) What would be an appropriate dose of azithromycin (immediate release) administered by IV for a baby weighing 17 lbs such as Amaan? How does your calculated dose compare with that indicated by Dr. Loiselle?
2)Based on your answers to Question 1 above, why do you think that, as a general practice, when antibiotics (including azithromycin) are prescribed to adults, the same dose is usually given, regardless of weight of the patient?
3)An intravenous dose of azithromycin is usually prepared by injecting a measured small amount of sterile water into a sealed vial containing a specific known amount of solid formulation containing the medication and shaking the vial until all of it is dissolved. The dosage to be administered to a patient is then removed (with a syringe) and added to a specific volume of diluent solution, which is then administered as an IV drip. A diluent solution that is commonly used is 1/2 normal saline (0.45% sodium chloride solution). If an azithromycin formulation contains 500 mg of azithromycin and sterile water is added to make 5 mL of the formulation, how much must be removed with the syringe to add to the diluent solution for a dosage of 80 mg?
Got stuck on these problems, will greatly appreatiate the help!
Explanation / Answer
1.a) 17 pound= wt in kg×2.2. So, wt in kg= 17÷ 2.2 = 7.7kg
Dose for 7.7kg baby is = 60mg/kg × 7.7= 462 mg Azithromycin ER
b) there is difference between Azithromycin ER and Azithromycin (immediate release) IV. IV dose is only 10mg/kg it means only 77mg Azithromycin would be enough Iv and not 500mg which was given to the child. Around 4 times heavy fose is most likely going to produce side effects.
c) Azithromycin IV dise per kg is 10mg
And weight of child was 7.7 kg . So 10×7.7 = 77mg was the dose required Iv
2. Adult dose of a drug is same mostly beacuse they have same amount of blood in body and the major organs perform same amount of function in most of them. But in children this is not true. They have different blood volumes, different organ maturity and absorption capacity. So drug dose is calculated in them according to their weight.
3. 500mg requires 5mL of nirmal saline. It imples 1mg will require 5/500 mL of normal saline.
For 80mg, 5×80/500 mL = 0.8mL of normal saline
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