Thursday August 9, 2007
Choice of IVF in Thyroid storm

In Thyroid storm, solutions that contain dextrose (some experts recommend even 10% dextrose solution) should be given as IVF. The hepatic glycogen reserve is usually depleted in thyroid storm and dextrose will help replenishing it and to cope with continuously high metabolic demand. Naturally, electrolyte monitoring is recommended with dextrose solution infusion.


Bonus Pearl: Aspirin is contraindicated for control of pyrexia in thyroid storm and tylenol is the prefered agent.


Related pearl: Iodide in Thyroid Storm


Reference:

1. Thyroid Storm: Recognizing the signs and symptoms of this life-threatening complication. AJN, American Journal of Nursing. 102(5):33-35, May 2002.

Wednesday August 8, 2007
Vasoconstrictor extravasation

Antidote for vasoconstrictor extravasation in skin and tissues (dopamine, epinephrine, or norepinephrine) is PHENTOLAMINE.

Infiltrate 5-15 mg of PHENTOLAMINE in 10 ml of normal saline into the area of extravasation as soon as possible. Treatment may be applied and effective up to 12 hours post extravasation of vasoconstrictor. Keep yourself ready for fluid bolus post treatment.

Mechanism of action: Phentolamine is a nonspecific alpha-adrenergic blocking agent which inhibits vasoconstriction and allow improved blood circulation through the affected area.


References: Click to get abstract or article

1. Drug Monographs - Phentolamine - lhsc.on.ca
2. Treating Extravasation Injuries - extravasation.org
3. The use of phentolamine in the prevention of dopamine-induced tissue extravasation - J Crit Care 1998 Mar;13(1):13-20