ME Rules Death Of Brooklyn 6-Month-Old ‘Accident’ Resulting From Antibiotic Over
ID: 1024370 • Letter: M
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ME Rules Death Of Brooklyn 6-Month-Old ‘Accident’ Resulting From Antibiotic Overdose Brookdale Hospital Investigating How 17-Pound Baby Got An Adult Dosage October 26, 2011 11:57 PM NEW YORK (CBSNewYork) — A Brooklyn family is dealing with absolute devastation after their only child died following a fatal mistake. Th eir baby boy was taken to the hospital with just a fever and was given what turned out to be a deadly dose of medication. Earlier Wednesday afternoon, the New York City Medical Examiner ruled the death of 6-month-old Amaan Ahmmad an accident. Th e ME said the death was the result of complications following administration of an adult dose of the antibiotic azithromycin, which is commercially known as Zithromax. Instead of looking forward to a lifetime of birthdays, the family is now making funeral arrangements for their child. Ummay Sultana and Amain Ahmmad said their son became ill last Friday, so they took him to Brookdale, where he was born. “He catch cold and we took him to the emergency,” Sultana said. Hospital records showed baby Amaan was brought to the ER “alert and responsive” and with the exception of a fever, which was reportedly around 100, the nursing staff did not list any other visible symptoms. But an examination led to a diagnosis of clinical pneumonia. Amaan was transferred to the pediatric unit and given a dose of the azithromycin through an IV drip in his right arm. According to the nursing notes, at least 36 minutes passed before the hospital staff realized something was wrong. CBS 2’s Jay Dow spoke with the parents Wednesday and asked the boy’s father who he blames for his son’s death. “Hospital management, doctor, nurse—of emergency,” he replied. “I’m like ‘look, look my baby’s dying! My baby’s dying!’ and then nurse came over and said ‘no, you’re baby’s pretty good. He’s sleeping,’” Sultana told CBS 2’s Sean Hennessey. A copy of the hospital’s discharge summary states the child was given “Azithromycin (500mg), in error” — which led to “cardiac shock.” Family pediatrician Dr. Suzanne Loiselle said that dosage is more typical for an adult and not a 17-pound baby like Amaan. “Nobody can feel worse for the family than the doctors and nurses that were involved in this child’s care,” Loiselle said. “About 80 milligrams would be appropriate for a child roughly in his weight class.” Less than 24 hours after the overdose, Ummay and Amain were told their son was brain dead. Amaan was taken off a respirator on Monday. “Th ey told us there is no hope because his head is totally collapsed,” his father told Hennessey. Brookdale Hospital would not answer questions from 1010 WINS or CBS 2, saying only: “We are investigating the circumstances of this tragic incident and express our condolences to the Ahmmad family.” “I never think like that he pass away forever,” Sultana said. “I thought he’s gonna come back.” Th e two fi rst-time parents said they are both devastated and outraged over a fatal medical mistake that cut short their baby’s life just as it was getting started. —Printed with permission of CBS Local
Some medications are formulated such that there is a slow release of the active ingredients. Such formulations are known as “extended release.” Azithromycin ER is a single-dose, extended release formulation. Th e recommended dosage for a child 6 months and older who is brought to the Emergency Room with community acquired pneumonia is 60 mg/kg administered orally. Azithromycin (immediate release) has much faster onset of action and acts almost immediately when administered intravenously (by IV). Clinicians exercise clinical judgment when deciding whether or not to treat a pediatric patient with azithromycin intravenously. If therapy is deemed necessary, a dose of 10 mg/kg for those age 6 months to 16 years is considered reasonable.
(a) Based on the information above, what would be an appropriate dose of azithromycin ER for a baby weighing 17 lbs such as Amaan? (3 points) Note: Th e dosage used in this problem was obtained from the reference: http://www.drugs.com/dosage/azithromycin.html#Usual_Pediatric_Dose_for_Pneumonia
(b) How does the appropriate dose of azithromycin ER for a baby weighing 17 lbs such as Amaan compare with the dose of azithromycin that was given intravenously to Amaan. (3 points)
(c) What would be an appropriate dose of azithromycin (immediate release) administered by IV for a baby weighing 17 lbs such as Amaan? How does your calculated dose compare with that indicated by Dr. Loiselle? (3 points)
Dr. Loiselle indicated that the 500 mg dosage administered for Amaan is more typical for an adult and not a 17-pound baby. If a 500 mg of the medication is administered to an adult male of 190 lbs, what would be the dosage (in mg/kg)? If the same amount of medication is administered to an adult female weighing 140 lbs, what would be the dosage (in mg/kg)? (6 points)
Based on your answers to Question 3 above, why do you think that, as a general practice, when antibiotics (including azithromycin) are prescribed to adults, the same dose is usually given, regardless of weight of the patient? (5 points)
An intravenous dose of azithromycin is usually prepared by injecting a measured small amount of sterile water into a sealed vial containing a specifi c known amount of solid formulation containing the medication and shaking the vial until all of it is dissolved. Th e dosage to be administered to a patient is then removed (with a syringe) and added to a specifi c volume of diluent solution, which is then administered as an IV drip. A diluent solution that is commonly used is 1/2 normal saline (0.45% sodium chloride solution). If an azithromycin formulation contains 500 mg of azithromycin and sterile water is added to make 5 mL of the formulation, how much must be removed with the syringe to add to the diluent solution for a dosage of 80 mg? (3points)
Explanation / Answer
answer1 = Less than 34 kg: 60 mg/kg orally as a single dose for mild to moderate infections
34 kg or more: 2 g orally as a single dose for mild to moderate infections
1 kg = 2.20 lbs
1 lbs = 1/2.20 kg
17 lbs = 17 / 2.20 kg = 7.7272 kg weight of children Amaan
appropriate dose according to weight is
60 mg for 1 kg of weight
for
7.7272 kg = 60mg /'kg * 7.7272 kg = 463.632 mg
answer 2) 463.632 mg is the appropriate dose of azithromycin ER for a baby weighing 17 lbs .
answer 3 =16 years or older: 500 mg orally as a single dose on the first day followed by 250 mg orally once a day on days 2 through 5 for mild infections
5 mg /kg
for 7.2772kg * 5 mg /kg =38.61 mg
If a 500 mg of the medication is administered to an adult male of 190 lbs, what would be the dosage (in mg/kg)?
500 mg /kg
190 lbs * 0.45 kg /lbs = 85.5 kg
500 mg /kg so for 85.5
= 500 mg /kg * 85.5 kg = 42, 570 mg = 42.57 g of dose
what would be the dosage (in mg/kg)? If the same amount of medication is administered to an adult female weighing 140 lbs, what would be the dosage (in mg/kg)
1lbs = 045 kg
140 lbs = 63 kg
dose 500 mg /kg
500 *63 = 31500 mg = 31.5 g of dose for women
when antibiotics (including azithromycin) are prescribed to adults, the same dose is usually given, regardless of weight of the patient?
all answer are given .
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