That price seems about right (I was quoted £600 a vial 3 years ago) and you'd probably need three vials for loading dose and 48 hours treatment. However, if you hit him early with this then he can excrete the toxins himself and the monitoring is easier. iv ethanol needs regularly monitored as the correct plasma level is often difficult to achieve and the patient is more likely to end up on HDU/ITU so the costs will even out in the end, possibly!?
Simon
-----Original Message-----
From: Peter Cutting [mailto:[log in to unmask]]
Sent: 25 April 2005 15:32
To: [log in to unmask]
Subject: Re: Metabolic Acidosis ( & yes the list is still alive)
Fomepizole is only available on a named pt basis according to the BNF and Toxbase........... and is sooooooooo expensive that it doesn't even have a price in the BNF.............. hoever after a lengthy conversation with pharmacy it works out as £3,320 for a box of 4 vials... not sure how much of that you would use........ and we do have it hidden in some bank vault......... but I am not sure DGHs will.
What about alcoholic ketoacidosis?................ would that stop you giving him ethanol
PAC
>>> [log in to unmask] 14:58:59 25/04/2005 >>>
I'm guessing Peter is suggesting iv ethanol rather than the 'A&E Happy Hour'!
-----Original Message-----
From: Andy Webster [mailto:[log in to unmask]]
Sent: 25 April 2005 14:56
To: [log in to unmask]
Subject: Re: Metabolic Acidosis ( & yes the list is still alive)
And its more expensive than a couple of Jack Daniels
Andy Webster
Registrar in Emergency Medicine
Sir Charles Gairdner Hospital
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of McCormick Simon Dr,
Consultant, A&E
Sent: 25 April 2005 21:40
To: [log in to unmask]
Subject: Re: Metabolic Acidosis ( & yes the list is still alive)
...or fomepazole. Easier to give, works quicker and better and gives you
plenty of time to look for the underlying cause (on a CDU/HDU/medical
ward!!).
Simon McCormick
Rotherham
-----Original Message-----
From: Andy Webster [mailto:[log in to unmask]]
Sent: 25 April 2005 13:02
To: [log in to unmask]
Subject: Re: Metabolic Acidosis ( & yes the list is still alive)
I assume the glucose is normal?
Apart from ethanol the other to consider would be haemodialysis
Andy Webster
Registrar in Emergency Medicine
Sir Charles Gairdner Hospital
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Peter Cutting
Sent: 25 April 2005 19:50
To: [log in to unmask]
Subject: Metabolic Acidosis ( & yes the list is still alive)
OK in the interest of...well interest really
55 year old gentleman of the streets/kerb (after 5pm)
Found by paramedics drowsy but rousable surrounded by empty bottles of
?? what
On arrival Pulse 100 ish SR BP 115 ish sytolic, RR 16, GCS E 3 M 6 V
('TTFO' by pt) so 5
pH 7.2, C02 3.5, 02 32, BXS -10, AG 31 ( these are approx figures from
my failing memory)
BM 8
Met Hb 0
COHb insignif
45 mins later after fluid and controlled oxygen therapy
pH 7.2, C02 3.2, 02 18, bxs -20, AG 41
Lactate (borrowed ITU analyser) normal
U&Es Na 150, K 5.1, Urea 4 ish
30 mins later (what do you mean what about the 4/24 wait?)
pH 7.2 C02 3 02 17 BXS -22 AG 39
No urine available.................. without wringing out trousers
No easy access to ethylene glycol nor methanol levels
Would you start this chap on ethanol?
Peter
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