[Case of colchicine intoxication caused by tubers of Gloriosa superba].

Gloriosa superba is one of the poisonous plants growing in Japan. It contains potent alkaloid such as colchicine which binds to tubulin and prevents it from forming microtubules that are part of the cytoskeleton in human cells. Ingestion of Gloriosa superba tubers causes severe and potentially fatal toxic effects. We report here a case of colchicine intoxication caused by tubers of Gloriosa superba. A 58-year-old male ingested about 25 g of Gloriosa superba tubers by mistake. He believed that it was wild yam. He developed abdominal pain, vomiting and diarrhea 30 minutes after the ingestion of the plant. Forty five hours later he was taken to the emergency department. Unfortunately he died due to progressive multiple organ failure about one hour after the admission. It was two days after Gloriosa superba ingestion. The clinical features and the aspect of the poisonous plants should be acquainted with people.

[Hospital pharmacists prevented advance of lithium intoxication through pharmaceutical interventions].

Lithium carbonate is used to treat depressive episodes in patients with manic depressive disorder. Lithium toxicity is closely related to serum levels of lithium, and can occur with doses of lithium carbonate close to those used in therapy. Herein we report a case in which pharmaceutical intervention led to a patient's early recovery. The patient was hospitalized with a complaint of dyspnea, and clinical findings revealed signs of bradyarrhythmia. We investigated the medications the patient brought with him and the record of his prescribed medications in his drug notebook. From this we found that he had been taking imidapril (an angiotensin-converting enzyme inhibitor) in addition to lithium carbonate, and surmised that lithium toxicity may have occurred from the drug interactions between the lithium carbonate and imidapril in this patient. To prevent the level of toxicity from advancing, we proposed to the physician in charge that the patient's serum lithium levels be measured immediately and that all drugs be discontinued. By receiving care centered on detoxification, the patient avoided measures such as placement of a permanent pacemaker and thereby made a quick recovery from a dangerous state. This is a good example of a case in which pharmaceutical intervention improved the patient's quality of life (QOL) and contributed to conserving limited medical resources. As shown by this case, regular checks of patients' current medications and drug notebooks at the time of hospitalization are an effective means of implementing pharmaceutical interventions that can contribute to medical care.

[Proposal for a new tool to evaluate clinical pharmacy practice based on the percentage of pharmaceutical interventions that influence medical treatments].

Clinical pharmacy practice needs quality safeguards and proper evaluation to ensure good performance of hospital pharmacists. We propose a method for evaluating performance using the indicator of whether pharmaceutical interventions conducted in clinical practice affect the treatment carried out by the physician. To illustrate the usefulness of this method, we report one example of the response of a physician to our clinical practice. We first designed a worksheet on which information related to pharmaceutical interventions would be recorded. The worksheet included sections for the details of the pharmaceutical intervention, whether decisions about interventions were active (pharmacists' decisions) or passive (requests from the physician), the timing of the intervention (before or after prescription), the grounds for the intervention, and whether it had any influence on the treatment, as well as a detailed record of the course of the intervention. These worksheets were used to record pharmaceutical interventions from July to December 2005. During that period, a total of 347 pharmaceutical interventions for 164 patients were recorded. Each intervention was examined from the different perspectives of type of intervention, timing (before or after prescription was issued), and reason for the intervention. Overall, it was found that 91.6% of all interventions had some influence on treatment. Because numerical results can be obtained with this method, it has the benefit of being an objective means of evaluating the contribution of pharmaceutical services. Furthermore, the validity of even those interventions that had no influence on treatment can be examined using medical and pharmaceutical findings and may improve the quality of pharmacists.