Follow-up observations on 24-hour pharmacotherapy services in the emergency department.

OBJECTIVE: To analyze the impact of 24-hour clinical pharmacy (CP) services in the emergency department (ED). DESIGN: A review of the "on-call report forms" and written consultations provided by CP between July 1985 and December 1987. SETTING: The University of Illinois Hospital. MAIN OUTCOME MEASURES: Patient-related versus non-patient-related cases; solicitor; type of and time per consultation; drug concentration determinations by CP; and comparison with other ED consultation services. RESULTS: Of 3787 consultations 3650 (96 percent) were patient-related, 137 (4 percent) were non-patient-related. Consultations were solicited from another individual in 2774 cases (73 percent); they were initiated by the clinical pharmacists in 831 cases (22 percent). Of the patient-related consultations, 1215 (33.3 percent) involved pulmonary disease, 796 (21.8 percent) toxicology, 635 (17.4 percent) seizures, 411 (11.3 percent) cardiac cases, 268 (7.3 percent) pharmacokinetics, and 325 (8.9 percent) miscellaneous. Consultations were solicited by physicians (1806, 65 percent), nurses (652, 23.5 percent), cardiac arrest page (237, 8.5 percent), patients (45, 2 percent), or pharmacists (34, 1 percent). They averaged 100 minutes each. Of 2197 drug concentrations, 1939 (88 percent) were completed by the clinical pharmacist. Concentrations were obtained for theophylline (1055, 54.4 percent), phenytoin (511, 26.4 percent), phenobarbital (324, 16.7 percent), and acetaminophen (49, 2.5 percent). Compared with other consultation services, CP ranked first in regard to frequency of use. CONCLUSIONS: The CP consultation service in the ED was as well used as most physician consultation services and tended to involve specific therapeutic areas that have implications for the training of emergency department clinical pharmacists.

Protein binding characteristics of bumetanide.

The association constants (k) and binding capacities (np) of bumetanide were determined in pooled venous blood obtained from adults, venous cord blood of healthy full-term infants, and critically ill neonates using ultrafiltration. Bumetanide was highly bound to plasma proteins (approximately 97%) in all three populations studied. Two classes of binding sites were identified, a high-affinity, low-capacity site with k and np in the order of 10(3) M-1 and 10(-3) M, respectively, and a low-affinity, high-capacity site with k and np in the order of 10(2) M-1 and 10(-2) M, respectively. Binding capacities were similar between the three groups studied and were larger than the 'presumed' therapeutic concentration following intravenous administration of the drug, which is on the order of 10(-6) M (less than or equal to 0.5 microgram/ml).