A review of protease inhibitor-induced hyperglycemia.

Hyperglycemia is an adverse effect that occurs with all protease inhibitors, although few cases have been reported in the literature. Most patients with human immunodeficiency virus infection receiving antiretroviral therapy are also taking at least one protease inhibitor. Patients with a family history of diabetes mellitus may be at a greater risk of developing this adverse effect. It is therefore prudent to monitor all patients starting protease inhibitor therapy for the onset of diabetes or hyperglycemia, particularly those with a family history of diabetes. Baseline fasting plasma glucose or serum glucose level should be measured with follow-up measurements every 3 months for approximately 6-12 months.

Bone and tissue changes following prostaglandin therapy in neonates.

OBJECTIVE: To review case reports describing prostaglandin-induced bone changes and tissue swelling in neonates. DATA SOURCES: An Index Medicus and bibliographic search of the English-language literature pertaining to prostaglandin-induced bone changes and tissue swelling in neonates. DATA SYNTHESIS: Short- and long-term prostaglandin infusion in neonates is associated with cortical proliferation throughout the skeletal system. Total resolution of these changes has occurred in seven patients described to date; other reports did not note either the time or the regression of these changes. Skeletal changes may occur within 9 days of initiation of prostaglandin therapy and include widened fontanelles, pretibial and soft-tissue swelling, and swelling of the upper and lower extremities. These reactions may last up to 38 weeks following discontinuation of therapy. Alkaline phosphatase (AP) concentrations have been shown to be increased in four cases, as well as in one retrospective analysis. Although these were not prospective studies, evaluation of AP may provide a means to monitor neonates receiving prostaglandin therapy. CONCLUSIONS: Pharmacists need to be aware of the potentially serious skeletal changes, encourage dosage titration as soon as possible, and limit the duration of time neonates are exposed to prostaglandin therapy. Monitoring of AP concentrations during therapy with prostaglandins may be beneficial in predicting or preventing further complications.

Physicians' liability for adverse drug reactions.

Although the Food and Drug Administration's spontaneous reporting system for adverse drug reactions has been collecting reports since 1960, the number of adverse drug reactions reported is low. One of the perceived deterrents to reporting adverse drug reactions is physicians' fear of involvement in litigation. We discuss the basis for physicians' liability and review the standard of care concept regarding physicians' liability associated with adverse drug reactions. Examination of the elements of a professional negligence case and "informed consent" shows what physicians can do to avoid malpractice related to adverse drug reactions.

Portuguese man-of-war envenomation.

Portuguese man-of-war and jellyfish stings are common occurrence in the coastal waters of the southern United States. Signs and symptoms of Portuguese man-of-war envenomation usually appear immediately following a sting but may be delayed for several hours. Reactions are commonly localized and comprise pain, paresthesia, and intense burning with a linear, red, papular eruption or urticaria at the contact site. Systemic signs may include nausea, myalgia, headache, chills, or pallor. Cardiovascular collapse and death have been reported. Venom can be inactivated with dilute acetic acid (vinegar), proteolytic meat tenderizer, or baking soda. Tentacle debris should be removed. Resolution of symptoms usually occurs within 72 hours, without sequelae.