A retrospective study of sodium nitroprusside use and assessment of the potential risk of cyanide poisoning.

Sodium nitroprusside (SNP) is an effective vasodilator but is potentially dangerous due to its cyanide content. Infusion rates above 2 micrograms/kg/minute may cause cyanide to accumulate to toxic concentrations in critically ill patients. Coadministration of thiosulfate with SNP effectively and safely prevents cyanide toxicity.

Anti-infective agents and hepatic disease.

Numerous factors such as changes in plasma protein binding, tissue binding, hepatic blood flow, hepatic metabolism, and distribution may occur in hepatic disease. The impact of these physiologic changes on pharmacokinetic and pharmacodynamic parameters of anti-infective agents is likely to be clinically significant. Unfortunately, these issues have not been thoroughly investigated.

Physiologic response of stress and aminoglycoside clearance in critically ill patients.

Objective: To examine the relationships between aminoglycoside clearance and physiologic parameters associated with the physiologic response to injury.

Design: Cross-sectional study of surgical patients receiving aminoglycoside pharmacokinetic monitoring and parenteral nutritional support.

Setting: An adult surgical ICU.

Individualizing amikacin regimens: accurate method to achieve therapeutic concentrations.

Amikacin's pharmacokinetics and dosage requirements were studied in 98 patients receiving treatment for gram-negative infections. A wide interpatient variation in the kinetic parameters of the drug occurred in all patients and in patients who had normal serum creatinine levels or normal creatinine clearance. The half-life ranged from 0.

Amikacin pharmacokinetics: wide interpatient variation in 98 patients.

The disposition of amikacin was studied in 98 patients receiving treatment for severe gram-negative sepsis. Several factors were identified which were significantly related to the drug's elimination rate. These included renal function (r = .