ABSTRACT
Therapeutic drug monitoring (TDM) is practiced for a number of frequently used drugs in infants and children. It is believed that monitoring drug levels will increase the probability of a therapeutic response and minimize the probability of adverse drug sequelae. Dose adjustments are based on measured drug levels interpreted relative to published therapeutic ranges which may or may not reflect the true relationship with either therapeutic or adverse effects. Potential errors derive from many sources, some amenable to solutions based on current knowledge, others awaiting improved understanding of the causes and consequences of unreliable therapeutic ranges.
Subject(s)
Drug Monitoring , Drug Therapy , Pediatrics , Child , Drug Delivery Systems , Hospitals, Pediatric , Humans , Infant , Reference Values , Reproducibility of Results , Risk Factors , Sensitivity and Specificity , Therapeutic EquivalencySubject(s)
Ciguatera Poisoning , Adult , Animals , Female , Fishes , Foodborne Diseases/therapy , Humans , Male , Middle Aged , San FranciscoABSTRACT
A case of a severe episode of ciguatera poisoning in a mother during the second trimester is presented. The mother experienced an increase of fetal movements one hour after the poisonous meal. She endured multisystemic symptoms typical of ciguatera for eight weeks. The presence of ciguatoxin in the fish was confirmed by immunoassay and two bioassays. The newborn at term was normal with adequate respiratory and neurological reflexes. The child developed normally in his first 10 months. This is in contrast with another report of a mother exposed to ciguatoxin at term who delivered an infant suffering from facial palsy and possible myotonia of the hands. Dose and gestational timing may explain these observed differences.
