Ketorolac Prescribing Practices in an Acute Care Hospital and the Incidence of Acute Renal Failure
Notice bibliographique
Résumé
Background: Ketorolac has been documented to cause acute kidney injury (AKI) but current data suggest that it is safe for those who have low risk for renal dysfunction. In our facility, there have been cases of AKI in those treated with K etorolac but the incidence is not known. This study describes the prescribing habits of K etorolac in our facility and determines the incidence of AKI while on this therapy. Methods: Electronic medical records of patients who received K etorolac were reviewed during the last 3 months of 2012. AKI was defined as an increase of serum creatinine of 0.3 mg/dL or greater and a decrease in estimated glomerular filtration rate (eGFR) to less than 60 mL/min ute . Results: A total of 633 patient charts were reviewed and 341 patients met the inclusion criteria. The mean age was 45.7 years. Sixty-five percent of the patients were females and 35% were males. The most common diagnosis for prescribing Ketorolac was osteoarthrosis. Thirty milligram IV every 6 hours is the conventional prescribed dose. Of the patients 6.4% developed AKI during treatment with Ketorolac, 68% of those with AKI were 65 or older, 68% had hypertension, 41% were diabetic, 40% were concomitantly receiving either an angiotensin converting enzyme-inhibitor (ACE-I) or an angiotensin receptor blocker ( ARB), 40% were also being given diuretics, 72% received Ketorolac during the time of AKI and 3.8% of all patients who received Ketorolac developed hyperkalemia while on treatment. Conclusions: AKI occurs more commonly than previously anticipated in Ketorolac treated patients even at average doses and short durations. Hypertension and diabetes are the two most common comorbidities in patients who developed AKI. Those who are greater than 65 years old may be at higher risk. Concomitant use of drugs that affect renal function, such as ACE-I, ARBs and diuretics, may increase the risk of AKI. Ketorolac prescribing in the acute care hospital should consider individual comorbidities, and use of other drugs that can increase kidney failure risk. Awareness of current renal function through diligent review of daily labs may help prevent administration of Ketorolac in those with impaired renal function. Medication alerts that notifying the ordering physician of the eGFR may help prevent inadvertent prescription in those with AKI or chronic kidney disease . World J Nephrol Urol. 2014;3(3):113-117 doi: http://dx.doi.org/10.14740/wjnu169w
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».