On-call scenario 5: Introduction

Last updated: Tuesday, November 26, 2019

Scenario 5
"Is that the on-call pharmacist? I’m Dr Baker. I’m sorry to phone you so late, but I wondered if I could run a question about ceftriaxone dosing past you. Micro have advised us to double the dose but I’m a bit worried about the drug accumulating."
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You need more information, and you question the doctor accordingly. This is what she tells you...

Caller: Dr Samantha Baker, bleep 1189, locum cardiology consultant.

Patient: Bharti Popat, aged 64.

Medicines: Dopamine, heparin, fentanyl infusions.  No known drug allergies.

Clinical problem: Patient has an infected sternal wound after atrial valve replacement surgery. On ceftriaxone 2 grams daily but the microbiology team want to increase the frequency to BD as the infection seems more severe than was first thought. The patient is receiving continuous venovenous haemofiltration (CVVH) and so the consultant is concerned about the risk of drug accumulation, which can cause fitting. The patient received a dose earlier today at 8am; it’s now 11pm can they give another dose now? No other significant co-morbidities.

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