Question Of The Day

What are the EXTRIP recommendations for extracorporeal removal of lithium? Severe lithium poisoning, impaired kidney function with lithium concentration > 4 mEq/L, decreased level of consciousness, seizures, or life-threatening dysrhythmias. Additionally, it is suggested for lithium concentration > 5 mEq/L, confusion, or if the expected…

What are the proposed Paris criteria for extracorporeal removal of lithium? Serum lithium concentration > 5.2 mmol/L or creatinine > 200 mcmol/L. A retrospective review identified 128 patients with lithium concentration above 1.5 mmol/L managed between 1993-2013 in the ICU of a single institution. Of…

What racial/ethnic disparities were reported regarding antidote use in ED patients? Black patients had 48% lower odds and Hispanic patients had 25% lower odds of receiving any antidote compared to non-Hispanic White patients. An analysis of a prospective cohort of patients presenting to two urban…

A 65-year-old male with a past medical history of DM2 on HD, HTN, and COPD presented to his family physician 3 weeks ago complaining of neuropathy. He was prescribed gabapentin 300 mg TID. What is one potential rare side effect cited in case reports of…

What is meant by the term, “resistant alcohol withdrawal (RAW)?” According to the cited reference, the term describes patients with severe or complicated alcohol withdrawal signs and symptoms despite having received high doses of benzodiazepines. There is not yet agreement in the field regarding the…

According to the 2020 American College of Addiction Medicine clinical practice guideline on alcohol withdrawal management, what tools should be used to monitor alcohol withdrawal delirium? According to the cited reference, structured assessment scales should be used, such as the Confusion Assessment Method for ICU…

In a recent study of 136,605 urine samples, what findings norbuprenorphine:buprenorphine (N:B) ratio can help identify potential cases of tampered urine specimens? According to the cited reference, a N:B ratio of <0.02 in concert with a high naloxone concentration (>1000 ng/mL) can help identify potential…

A recent case series described three patients with loperamide use disorder who were successfully treated with what medication? Long-term buprenorphine. According to the authors, buprenorphine can be used for loperamide use disorder, most effectively when patients are in mild to moderate withdrawal. Brar, Jessica K….

In a recent review article, what strategy was found to improve treatment retention among patients receiving medications for opioid use disorder (MOUD)? Though most studies did not focus on retention as the primary outcome, consistent but sparse evidence supported initiating MOUD in soon-to-be-released incarcerated people…

What strategies can be employed to manage side effects of buprenorphine/naloxone? According to the cited reference, there are several strategies to manage side effects of buprenorphine/naloxone: (1) gradual dose reduction while monitoring for withdrawal, (2) split dosing to minimize side effects related to rapid increases…