[Contribution of a hospital pharmacy team to critical care of patients infected with SARS-CoV-2]. / Contribution d'une équipe de pharmacie hospitalière à la prise en charge en réanimation des patients infectés par le SARS-CoV-2.

With regard to the hospital drug supply chain, the safest system is the individual automated drug dispensing one provided by the pharmacy. For several years we have been trying to convince hospital decision-makers to set it up. In the meantime, to mitigate the risks of medication errors incurred by patients and caregivers, we have set up several work teams within the care units. These teams, made up of one pharmacist and one or two hospital pharmacy technicians, who notably manage the medicine cabinets in care units. The close collaboration with doctors and nurses developed over the years was a determining factor when it became necessary to provide the newly created additional intensive care units with drugs and medical devices (MDs) in order to cope with the crisis triggered by the SARS-CoV-2 epidemic. Daily monitoring of the drugs consumed by each patient, particularly neuromuscular blocking agents and MDs was a key element in managing stocks and anticipating changes of drugs, packaging and/or devices references. These facts give weight to the Claris report published in France which recognizes that the interactions of pharmacy technicians and pharmacists in the care units have positive effects in terms of quality and safety of patient care. They highlight the dangers to which patients and caregivers are exposed on Saturdays, Sundays and holidays when the pharmacy is closed. They legitimize the question of extending the opening of the pharmacy with a full team 365 days a year.

Flutamide-induced methemoglobinemia.

The authors report a case of clinical methemoglobinemia occurring one year after a patient began receiving flutamide 750 mg/d for prostate cancer with bone metastasis. The patient presented with severe cyanosis involving his lips and proximal extremities and moderate dyspnea. Methemoglobinemia was 16.2 percent of the total hemoglobin and intravenous ascorbic acid was administered. Clinical examination and laboratory analysis revealed no other cause. There was no biochemical evidence of congenital methemoglobinemia and no other regular drug use or chemical exposure was found. Moreover, clinical improvement and normalization of the methemoglobin level after the drug was discontinued is highly suggestive of flutamide-induced methemoglobinemia. Due to its chemical structure derived from anilide, flutamide may be considered as a potential methemoglobin-inducing agent.

Acute renal failure in a child after chewing of match heads.

A few days after ingestion of 40 match heads, a 3-year-old boy was admitted to hospital with oliguric acute renal failure (ARF) requiring peritoneal dialysis during 9 days. A renal biopsy showed acute tubulointerstitial nephritis; the outcome was rapidly favorable and the child recovered normal GFR. It seems to be the first published case of ARF after match poisoning, probably because of the presence of potassium bichromate.

[Manchineel poisoning. Report of a case]. / Intoxication par le mancenillier. A propos d'un cas.

Clinical signs of poisonings by beach-trees are reviewed following a recent case report. Painful symptoms are the main features owing to the caustic effect of the plant liquid. However the prognosis is usually good.