Annals of Pharmacotherapy最新文献

{"title":"Impact of Pharmacist-Managed Diabetes Care on Clinical Outcomes in Rural Health Clinics.","authors":"Sarah E Wheeler, Abby Lennon, David Switzer","doi":"10.1177/10600280261446051","DOIUrl":"https://doi.org/10.1177/10600280261446051","url":null,"abstract":"<p><strong>Background: </strong>Centers for Medicare & Medicaid Services (CMS)-designated Rural Health Clinics (RHCs) play a critical role in addressing diabetes in medically underserved areas. To address care gaps, 2 RHCs implemented an innovative collaborative pharmacist care model.</p><p><strong>Objective: </strong>This IRB-exempt retrospective study evaluated the impact of integrated pharmacist care on clinical outcomes for patients referred for diabetes management in 2 RHCs.</p><p><strong>Methods: </strong>Outcomes were analyzed for people receiving collaborative pharmacist-managed diabetes care between August 2021 and October 2023. Changes in pre-/postclinical outcomes and medication management were evaluated for patients who received pharmacist-provided care. The primary outcome was change in A1C from baseline to the end of the episode of care.</p><p><strong>Results: </strong>Ninety-three patients received care over a median (IQR) of 247 (143, 405.5) days. Mean A1C significantly decreased from 9.3% to 7.7% (<i>P</i> < 0.001). Guideline-directed medication optimization improved significantly for patients with concomitant atherosclerotic cardiovascular disease, chronic kidney disease, and obesity. Heart failure medication optimization showed improvement but was not statistically significant. Significant increases were observed in continuous glucose monitor (CGM) and statin use.</p><p><strong>Conclusion and relevance: </strong>A collaborative pharmacist care model in RHCs significantly improved glycemic control and increased utilization of guideline-directed medication therapy for diabetes and cardiometabolic comorbidities. These findings add to the growing body of literature demonstrating positive clinical outcomes of pharmacist services in rural clinics and underscore the need for financial models that recognize the clinical value of pharmacist services in the RHC setting.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280261446051"},"PeriodicalIF":2.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Crushed Posaconazole Delayed-Release Tablets Have Reduced Bioavailability and Interaction With Tacrolimus Relative to Other Administration Routes.","authors":"Kathryn Flynn, Haley Hixson, Samuel L Aitken, Jennifer Hagopian, Michael Combs, Kevin Chan, Dennis Lyu, Elizabeth Belloli, Krysta Walter","doi":"10.1177/10600280261434694","DOIUrl":"https://doi.org/10.1177/10600280261434694","url":null,"abstract":"<p><strong>Background: </strong>Prior studies suggest that posaconazole delayed-release tablet (DRT) may be crushed for feeding tube administration. It is unknown whether this decreases posaconazole absorption, subsequently impacting its interaction with tacrolimus relative to oral (PO) or intravenous (IV) administration.</p><p><strong>Objective: </strong>This study aimed to assess the impact of posaconazole administration route on posaconazole and tacrolimus trough concentration-to-dose ratio (C/D) in lung transplant recipients (LTR).</p><p><strong>Methods: </strong>Single-center retrospective study of adult LTR transplanted between December 2021 and August 2024 who received tacrolimus-based immunosuppression and posaconazole prophylaxis. The primary outcome was posaconazole C/D across posaconazole administration routes (noncrushed PO DRT, IV, and crushed DRT). Secondary outcomes included tacrolimus C/D, achievement of initial therapeutic posaconazole level, and a paired analysis of tacrolimus C/D in LTR converting from crushed to noncrushed PO posaconazole DRT.</p><p><strong>Results: </strong>Sixty-one posaconazole levels were analyzed for 42 LTR. Median posaconazole C/D were 4.2 for IV, 4.1 for noncrushed PO DRT, and 2.1 for crushed DRT (<i>P</i> < 0.01) with 40% of LTR having initial therapeutic posaconazole levels on crushed DRT regimens versus 94% for IV and 86% for noncrushed PO DRT(<i>P</i> < 0.01). Median tacrolimus C/D for IV, noncrushed PO DRT, and crushed DRT posaconazole regimens were 4.0, 5.0, and 6.8, respectively (<i>P</i> = 0.72). Seven LTR were switched from crushed posaconazole DRT to noncrushed PO DRT and median tacrolimus C/D increased following route change (7.8 vs 9.5; <i>P</i> = 0.04).</p><p><strong>Conclusion and relevance: </strong>Posaconazole C/D was lower in LTR receiving crushed posaconazole DRT versus other routes. LTR switching from crushed to noncrushed posaconazole DRT had increased tacrolimus C/D. Clinicians using crushed posaconazole DRT via feeding tubes should be aware that 1:1 conversion with other routes may result in subtherapeutic posaconazole and tacrolimus levels.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280261434694"},"PeriodicalIF":2.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Pneumocystis jirovecii</i> Pneumonia in Non-HIV, Non-HCT Adults: Real-World Patterns of Overlapping Immunosuppression and PJP-Active Therapy.","authors":"Daniel B Chastain, Dustin M Solorzano-Salazar, Aditya Mantha, Reed Van Hook, James Maloney, George R Thompson, Chia-Yu Chiu, Leland Shapiro, Niyah Brown, Andrés F Henao-Martínez","doi":"10.1177/10600280261443794","DOIUrl":"https://doi.org/10.1177/10600280261443794","url":null,"abstract":"<p><strong>Background: </strong><i>Pneumocystis jirovecii</i> pneumonia (PJP) is increasingly recognized among immunocompromised adults without HIV, yet prophylaxis use remains inconsistent. Data describing cumulative and overlapping immunosuppressive exposures before PJP diagnosis are limited.</p><p><strong>Objective: </strong>To characterize immunosuppressive exposure patterns and evaluate use of PJP-active therapy among non-HIV, nonhematopoietic cell transplant (non-HCT) adults with PJP.</p><p><strong>Methods: </strong>This retrospective cohort study (2011-2024) used the TriNetX Research Network. Adults without HIV or prior HCT with laboratory-confirmed PJP (positive polymerase chain reaction or antigen from respiratory specimens) were included. Demographics, comorbidities, and exposure to glucocorticoids (GCs), antineoplastics (ANs), and immunosuppressants (ISs) within 90 days before diagnosis were assessed. Overlapping immunosuppressive regimens and their associations with receipt of PJP-active therapy were evaluated. Because prescribing indication and dosing were unavailable, prescriptions for trimethoprim/sulfamethoxazole, atovaquone, dapsone, or pentamidine were grouped as PJP-active therapy, representing prophylactic, preemptive, or empiric use.</p><p><strong>Results: </strong>Among 578 adults with PJP, 87% received GCs, 37% ANs, and 26% ISs. More than half (54%) were exposed to 2 or more drug classes, whereas 10% had no identifiable immunosuppressive medication exposure. Despite frequent multidrug immunosuppression, only 32% received PJP-active therapy before diagnosis. GC exposure was more common among patients who received PJP-active therapy (97% vs 82%, <i>P</i> < 0.001), while AN and IS exposures did not differ between groups.</p><p><strong>Conclusion and relevance: </strong>PJP in non-HIV, non-HCT adults commonly occurs in the setting of frequent multidrug immunosuppression. These findings reveal a disconnect between cumulative immunosuppressive risk and prophylaxis practices and support approaches that incorporate overall immunologic burden rather than single-agent thresholds.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280261443794"},"PeriodicalIF":2.3,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Suspected Heparin Resistance Among Patients in the Cardiac Intensive Care Setting.","authors":"Anna E Tam, Kevin R Donahue, Aliya Abdulla, Sylvia S Stefanos, Donna Barakeh, Celia Morton","doi":"10.1177/10600280261435674","DOIUrl":"https://doi.org/10.1177/10600280261435674","url":null,"abstract":"<p><strong>Background: </strong>Heparin resistance (HR) poses the risk for significant complications, as subtherapeutic anticoagulation may lead to thrombotic events; however, there remains a lack of guidance on standardized management strategies in cardiac intensive care unit (CICU) patients and those with mechanical circulatory support (MCS) devices.</p><p><strong>Objective: </strong>The purpose of this study is to describe current management strategies for patients with suspected HR and provide insights into its definition among critically ill cardiac patients.</p><p><strong>Methods: </strong>This retrospective study evaluated intensive care unit (ICU) patients receiving greater than or equal to 25 units/kg/h of unfractionated heparin (UFH) that failed to achieve 2 consecutive therapeutic activated partial thromboplastin time (aPTT) values. The primary outcome was incidence of patients transitioned to a direct thrombin inhibitor (DTI). Secondary outcomes included major bleeding, thrombosis, and antithrombin III supplementation. A subgroup analysis compared anticoagulation characteristics by agent (UFH vs. DTI), including anticoagulant infusion volume, and time to goal aPTT.</p><p><strong>Results: </strong>Of 76 patients receiving titratable UFH, 62 (81.6%) met inclusion criteria. Transition to a DTI occurred in 4 (6.5%) patients, all who received bivalirudin. Major bleeding occurred in 4 (6.5%) patients and thrombosis in 2 (3.2%) while receiving UFH. Median time to goal aPTT was 88 (interquartile range [IQR] = 55.3-123.3) hours with UFH vs. 6 (IQR = 3.7-11.3) hours with bivalirudin (<i>P</i> = 0.002). Median daily anticoagulant volume was 578 (IQR = 404.0-770.4) mL with UFH vs. 190 (IQR = 147.3-218.5) mL with bivalirudin (<i>P</i> = 0.001).</p><p><strong>Conclusion and relevance: </strong>Our findings describe current management practices for suspected HR among critically ill cardiac patients. Although the small subset of patients transitioned to DTI limits generalizability, earlier recognition and individualized anticoagulation strategies may be warranted in MCS patients given their inherent thrombotic risk. Future studies are needed to further define HR and evaluate anticoagulation strategies in this population.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280261435674"},"PeriodicalIF":2.3,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Fixed Versus Variable Rates of Regional Citrate Anticoagulation in Critically Ill Adult Patients on Continuous Kidney Replacement Therapy.","authors":"Nhi TranHuynh, Jenna Holzhausen, Lisa Hall Zimmerman","doi":"10.1177/10600280251369657","DOIUrl":"10.1177/10600280251369657","url":null,"abstract":"<p><strong>Background: </strong>The Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline recommends regional citrate anticoagulation during continuous kidney replacement therapy (CKRT) to prolong circuit lifespan. Limited data directly compare citrate dosing strategies.</p><p><strong>Objective: </strong>Evaluate effectiveness and safety of fixed (FIX) versus variable (VAR) citrate rates in CKRT.</p><p><strong>Methods: </strong>This single-center, retrospective study evaluated adult ICU patients (≥18 years) receiving CKRT with regional citrate anticoagulation for ≥24 hours between July 2018 and June 2024. Patients with COVID-19 or whose citrate rate was inconsistent with the prescribed order were excluded. FIX versus VAR groups were case-matched based on ICU service, citrate duration, and age. The primary outcome was time from citrate initiation to first filter change. Secondary outcomes included hyper- and hypocalcemia, citrate toxicity, bleeding, and thrombosis.</p><p><strong>Results: </strong>Of 534 patients screened, 48 (24 FIX, 24 VAR) met inclusion criteria and matched closely in ICU service, citrate duration, and age. Time to first CKRT filter change was similar, 1.5 [0.7, 3.0] FIX versus 1.9 [0.5, 3.1] VAR, days, <i>P</i> = 0.89. Fewer hypocalcemia episodes were associated with FIX (72 vs 141 VAR, episodes, <i>P</i> < 0.0001), as was less calcium supplementation (36 FIX vs 142 VAR, grams, <i>P</i> = 0.0113). Bleeding and thrombosis events were similar between groups, 33% FIX vs 50% VAR (<i>P</i> = 0.19) and 25% FIX vs 13% VAR (<i>P</i> = 0.46), respectively.</p><p><strong>Conclusion and relevance: </strong>Fixed and variable citrate rates showed similar effectiveness in CKRT. However, the fixed rate was associated with less hypocalcemia and calcium supplementation without a significant increase in bleeding or thrombosis. These findings contribute new comparative data to help guide citrate anticoagulation strategies and suggest that a fixed rate may help minimize electrolyte disturbances and simplify supplementation needs. Given that the study was potentially underpowered, further studies are needed to validate these findings and guide the development of optimal citrate rate guidelines.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"466-472"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Crinecerfont: CRF1R Antagonist Approved for Treatment of Congenital Adrenal Hyperplasia.","authors":"Lihui Yuan","doi":"10.1177/10600280251396594","DOIUrl":"10.1177/10600280251396594","url":null,"abstract":"<p><strong>Objective: </strong>To review the pharmacology, efficacy, and safety profile of crinecerfont as adjunctive therapy in treating classic congenital adrenal hyperplasia (CAH).</p><p><strong>Data sources: </strong>A literature search was conducted in PubMed from January 2008 to August 2025. The relevant manuscripts, abstracts, and clinical trials (ClinivalTrials.gov) were reviewed. The keywords used were crinecerfont, CYP21A2, androstenedione, 17 hydroxyprogesterone, glucocorticoids, CAH, and clinical trials.</p><p><strong>Data extraction: </strong>All crinecerfont-related publications, abstracts, packet inserts, and clinical trials were reviewed.</p><p><strong>Data synthesis: </strong>Crinecerfont is a specific CRF1R antagonist used as adjunctive therapy to treat classic CAH. Crinecerfont led to over a 50% reduction in adrenocorticotropic hormone (ACTH) and 17OHP levels in both adult and pediatric participants during phase II trials. Testosterone levels decreased by 32% to 74% in adults and 61% to 76% in pediatric participants. In phase III trials, Crinecerfont reduced glucocorticoid doses by 27.3% in adults and 18% in pediatric participants (both <i>P</i> < 0.001). In general, crinecerfont is well tolerated with adverse effects that are mild to moderate.Relevance to patient care and clinical practice in comparison to existing drugs:Crinecerfont is an orphan drug used as adjunctive therapy for patients with classic CAH. It can effectively decrease supraphysiological levels of glucocorticoids and control androstenedione levels, thereby reducing complications related to supraphysiological glucocorticoids in classic CAH.</p><p><strong>Conclusion: </strong>Crinecerfont is the first approved adjunctive therapy for classic CAH that effectively decreases supraphysiological glucocorticoids levels and associated symptoms.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"512-520"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting TROP2 Across Solid Tumors: The Clinical Profile and Role of Datopotamab Deruxtecan.","authors":"Rachel Lucky, Lauren Thornburg, Zachery Halford","doi":"10.1177/10600280251393259","DOIUrl":"10.1177/10600280251393259","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the pharmacology, efficacy, safety, and clinical use of datopotamab deruxtecan (Dato-DXd), a recently approved trophoblast cell-surface antigen 2 (TROP2)-directed antibody-drug conjugate (ADC), in the treatment of advanced solid tumors.</p><p><strong>Data sources: </strong>A comprehensive English-language literature search was conducted on PubMed and ClinicalTrials.gov from January 2010 through September 2025 using the search terms <i>datopotamab, datroway, breast cancer</i>, or <i>nonsmall cell lung cancer</i>.</p><p><strong>Study selection and data extraction: </strong>Evidence was gathered from clinical trials, relevant articles, guidelines, abstracts, and package inserts.</p><p><strong>Data synthesis: </strong>Dato-DXd received accelerated approval by the Food and Drug Administration (FDA) in 2025 for hormone receptor-positive, HER2-negative (HR+/HER2-) breast cancer, and epidermal growth factor receptor (EGFR)-mutant nonsmall cell lung cancer (NSCLC). In the TROPION-Breast01 trial, Dato-DXd demonstrated superior efficacy with a response rate of 36.4% versus 22.9% for chemotherapy and median progression-free survival of 6.9 versus 4.9 months. In NSCLC, TROPION-Lung01 showed a response rate of 26.4% with Dato-DXd compared with 12.8% with docetaxel. For the approved EGFR-mutant NSCLC indication, the TROPION-Lung05 trial demonstrated a response rate of 35.8% with Dato-DXd. Treatment-related adverse events included stomatitis, nausea, alopecia, and ocular events, with interstitial lung disease/pneumonitis representing the most clinically significant safety concern.</p><p><strong>Relevance to patient care and clinical practice: </strong>The TROP2-directed ADC appears to be a viable therapeutic alternative for select patients with previously treated HR+/HER2- breast cancer or EGFR-mutant NSCLC after progression on targeted therapy.</p><p><strong>Conclusions: </strong>Dato-DXd offers a promising treatment option for heavily pretreated patients with HR+/HER2- breast cancer and EGFR-mutant NSCLC, providing meaningful clinical benefit with a manageable safety profile. Optimal sequencing and positioning within the rapidly shifting ADC landscape requires further investigation.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"486-499"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Glucose Reduction in Diabetic Emergencies (OG-RIDE).","authors":"Francisco Ibarra, Felicia Hung, Lakshyaa Balakrishnan, Cameron DeLaere, Benjamin Falkenstein","doi":"10.1177/10600280251378525","DOIUrl":"10.1177/10600280251378525","url":null,"abstract":"<p><strong>Background: </strong>To minimize the risk of cerebral edema in the management of hyperglycemic emergencies, guidelines recommend gradually decreasing serum glucose levels, but there is limited literature validating these reduction goals or evaluating outcomes associated with different correction rates.</p><p><strong>Objective: </strong>This study evaluated cerebral edema rates associated with 2 different serum glucose correction rates in adults with hyperglycemic emergencies.</p><p><strong>Methods: </strong>This retrospective study's primary endpoint was the incidence of cerebral edema. Secondary endpoints included average hourly changes in sodium, potassium, chloride, bicarbonate, anion gap, glucose, blood urea nitrogen, creatinine, and calculated osmolality, over the treatment course. Patients were divided into 2 groups based on their average hourly serum glucose correction rate (> 75 mg/dL and ≤ 75 mg/dL), and their outcomes were compared. Patients were included if they were ≥18 years old, received the institutions' diabetic ketoacidosis or hyperglycemic hyperosmolar state insulin infusion order set within 12 hours of presenting to the hospital, and had a pre-insulin infusion glucose > 600 mg/dL.</p><p><strong>Results: </strong>One hundred thirty-four patients had a slow correction rate, and 51 had a rapid correction rate. The median time from starting the insulin infusion to achieving a glucose < 300 mg/dL in the slow and rapid correction rate groups was 9.9 and 6.1 hours, respectively (p < 0.001). In the total population, 2 (1.5%) cerebral edema events occurred. Both patients were in the slow correction rate group and had radiographic evidence of cerebral edema on post-return of spontaneous circulation imaging. There were significantly larger decreases in glucose and osmolality levels in the rapid correction rate group at several time points during treatment.</p><p><strong>Conclusion and relevance: </strong>Rapid serum glucose correction rates were not associated with increased cerebral edema events. Our findings suggest glucose and osmolality levels can be corrected faster than what is currently recommended.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"473-478"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Treatment Modalities on Intensive Care Unit Length of Stay for Patients Admitted With Severe Hyponatremia.","authors":"William H Harris, Komal Safdar, Frances Hung, Hui-Jie Lee, Daniel Edmonston, Matthew A Sparks, Daniel Gilstrap, Bridgette Kram","doi":"10.1177/10600280251360371","DOIUrl":"10.1177/10600280251360371","url":null,"abstract":"<p><strong>Background: </strong>The diversity in presentation and cause of hyponatremia leads to a wide array of treatment modalities which are selected based on severity, chronicity, volume status, and putative cause. Due to the variability in treatment selection, it is pertinent to identify the clinical impact of the various treatment modalities and rescue therapies to inform future care.</p><p><strong>Objective: </strong>To evaluate the association between treatment modality and length of stay for patients with severe hyponatremiaMethods:This single-center, retrospective study included patients 18 years of age or older with glucose-corrected serum sodium levels of <125 mEq/L upon admission to the intensive care unit (ICU). The primary endpoint was ICU length of stay, and its association with treatment modality was assessed using multivariable Poisson regression with the following explanatory variables: 3% sodium chloride, 1.8% sodium chloride or isotonic fluids, diuretics, proactive therapy, rescue therapy, nephrology consultation, baseline volume status, and pretreatment sodium level.</p><p><strong>Results: </strong>Eighty-two patients were included with a median age of 65 years old (Q1, Q3: 57, 72). The median glucose-corrected serum sodium was 116.3 mEq/L (Q1, Q3: 112.9, 120.5) and the median ICU length of stay was 3 days (Q1, Q3: 2, 4). Multivariable analysis, adjusting for baseline serum sodium levels, revealed the use of proactive and early reactive therapy (incidence rate ratio [IRR] 1.38, 95% confidence interval [CI] 1.11-1.71) and nephrology consultation (IRR 1.22, 95% CI 1.01-1.46) were associated with increased length of ICU stay.</p><p><strong>Conclusions and relevance: </strong>Nephrology consultation and the use of proactive therapies were associated with increased ICU length of stay. Accurate identification of patients at high risk for osmotic demyelination syndrome that may benefit from proactive therapies is imperative, as use of proactive therapies in low-risk patients may prolong length of stay.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"479-485"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145437022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Comparative Dose Response of Diazepam, Lorazepam, and Phenobarbital for Alcohol Withdrawal in the Emergency Department\".","authors":"Steven J Weintraub","doi":"10.1177/10600280251390916","DOIUrl":"10.1177/10600280251390916","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"524-525"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145487466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}