Therapeutic drug monitoring of inhaled tobramycin in a patient with chronic kidney disease.

This case report investigates elevated serum concentrations of inhaled tobramycin in a patient with chronic kidney disease. The patient, a man in his early 80s with complex comorbidities, underwent tobramycin inhalation therapy for chronic respiratory infections caused by Pseudomonas aeruginosa Despite the strategic localised treatment approach, unexpectedly high plasma tobramycin concentrations were observed. After a dosage adjustment guided by a pharmacokinetic-pharmacodynamic model, a final inhalation dose of 300 mg of tobramycin was determined at a 24-hour interval. This case report underscores the need for rigorous monitoring of plasma tobramycin levels in patients with renal impairment undergoing inhaled tobramycin therapy, advocating for enhanced pharmacokinetic models to improve the safety and efficacy of the treatment.

Comparación entre bioimpedancia espectroscópica y fórmula de Watson para medición de volumen corporal en pacientes en diálisis peritoneal / Comparison of bioimpedance spectroscopy and the Watson formula for measuring body volume in patients on peritoneal dialysis

Introducción: Conocer el volumen corporal total (V) es fundamental en los pacientes en diálisis peritoneal (DP). Habitualmente calculado mediante fórmula de Watson, el empleo de bioimpedancia espectroscópica (BIS), cada vez está más generalizado. Frecuentemente, al medir el V con ambos métodos surgen amplias diferencias. Objetivo: Evaluar si aparecen diferencias entre ambas formas de medir el V en una unidad de DP y analizar qué factores clínicos se asocian a estas diferencias. Métodos: Estudio observacional. Se incluyó a 74 pacientes en DP. Medimos el V empleando BIS (Vbis) y fórmula de Watson (Vw); se recogieron 271 mediciones por cada método. Calculamos diferencia entre volúmenes en cada medición y los clasificamos en 2 grupos: diferencia mayor o igual a10% o <10% de Vbis. Evaluamos la presencia de una serie de parámetros clínicos en nuestros pacientes. Analizamos si existen diferencias entre Vbis y Vw (de Student). Valoramos si existe asociación entre las diferencias entre volúmenes y la presencia de los parámetros clínicos analizados (chi cuadrado). Resultados: V fue 2,15 l mayor medido con fórmula de Watson que con BIS. El 58,67% de las mediciones tenían diferencia entre Vw y Vbis mayor o igual a10%. Aparecen diferencias significativas al comparar la presencia de diferencia entre volúmenes y la presencia o no de diabetes (p=0,03), hipertensión (p=0,036), hipoalbuminemia (p<0,01), hipoprealbuminemia (p<0,01), bajo ángulo de fase a 50Hz (p<0,01), proteína C reactiva elevada (p<0,01), obesidad (p=0,027), exceso de grasa corporal (p<0,01), E/I ratio (cociente entre agua extracelular y agua intracelular)mayor o igual a1 (p<0,01) y diuresis residual (p=0,029). Conclusiones: Existen diferencias en el V de los pacientes de una unidad de DP según sea calculado por fórmula de Watson o por BIS. La presencia de hipertensión, diabetes, hipoalbuminemia, obesidad, malnutrición, inflamación, E/I ratio mayor o igual a1 y la ausencia de diuresis residual se asocia con la aparición de estas diferencias (AU)

Introduction: Knowing total body volume (V) is crucial in patients on peritoneal dialysis (PD). It is usually calculated by the Watson anthropometric formula, although the use of bioimpedance spectroscopy (BIS) is becoming increasingly widespread. Measuring V with both methods can at times produce quite different results. Objective: We aimed to identify differences between the 2 forms of measuring volume in a PD unit and determine which clinical factors are associated with these differences. Methods: Ours is an observational study of 74 patients on PD. We measured V using BIS (Vbis) and the Watson formula (Vw); 271 measurements were made with each method. We calculated the difference between Vbis and Vw in each patient and classified them into 2 groups: Difference between volumes greater than or equal to10% or <10% Vbis. We assessed the presence of several clinical parameters in our patients. We assessed whether there were any differences between Vbis and Vw (Student t-test). We determined whether there was any association between the difference in volumes and the presence of the clinical parameters analysed (chi square test). Results: V was 2.15 l higher measured by the Watson formula than with BIS (P<.01). In 58.67% of the measurements, the difference between Vbis and Vw was greater than or equal to10%. Significant differences were found when comparing the presence of difference between volumes and the presence or not of diabetes mellitus (DM) (p=0,03), hypertension (HTN) (p=0,036), hypoalbuminemia (p<0,01), hypoprealbuminemia (p<0,01), low phase angle at 50 Hz (p<0,01), high C reactive protein (p<0,01), obesity (p=0,027), E/I ratio (ratio between extracellular and intracellular water) greater than or equal to1 (p<0.01) and residual diuresis (p=0.029). Conclusions: There are significant differences in the V of PD Unit patients when obtained by Watson formula or by BIS. A difference between the measurements is associated with the presence of DM, HTN, hypoalbuminaemia, obesity, malnutrition, inflammation, E/I ratio greater than or equal to1 and the absence of residual dieresis (AU)

Comparison of bioimpedance spectroscopy and the Watson formula for measuring body volume in patients on peritoneal dialysis.

INTRODUCTION: Knowing total body volume (V) is crucial in patients on peritoneal dialysis (PD). It is usually calculated by the Watson anthropometric formula, although the use of bioimpedance spectroscopy (BIS) is becoming increasingly widespread. Measuring V with both methods can at times produce quite different results. OBJECTIVE: We aimed to identify differences between the 2 forms of measuring volume in a PD unit and determine which clinical factors are associated with these differences. METHODS: Ours is an observational study of 74 patients on PD. We measured V using BIS (Vbis) and the Watson formula (Vw); 271 measurements were made with each method. We calculated the difference between Vbis and Vw in each patient and classified them into 2 groups: Difference between volumes ≥10% or <10% Vbis. We assessed the presence of several clinical parameters in our patients. We assessed whether there were any differences between Vbis and Vw (Student t-test). We determined whether there was any association between the difference in volumes and the presence of the clinical parameters analysed (chi square test). RESULTS: V was 2.15 l higher measured by the Watson formula than with BIS (P<.01). In 58.67% of the measurements, the difference between Vbis and Vw was ≥10%. Significant differences were found when comparing the presence of difference between volumes and the presence or not of diabetes mellitus (DM) (p=0,03), hypertension (HTN) (p=0,036), hypoalbuminemia (p<0,01), hypoprealbuminemia (p<0,01), low phase angle at 50 Hz (p<0,01), high C reactive protein (p<0,01), obesity (p=0,027), E/I ratio (ratio between extracellular and intracellular water) ≥1 (p<0.01) and residual diuresis (p=0.029). CONCLUSIONS: There are significant differences in the V of PD Unit patients when obtained by Watson formula or by BIS. A difference between the measurements is associated with the presence of DM, HTN, hypoalbuminaemia, obesity, malnutrition, inflammation, E/I ratio ≥1 and the absence of residual diuresis.