I agree with Ian Watson. 

To the outside world (where medicines are prescribed and taken in mass not
molar quantities)such concerns regarding the reporting of drug
concentrations in mass or molar units must seem exceptionally arcane and
irrelevant, especially where patient safety is involved.

At a time when Pathology is facing a rapidly changing future, this type of
debate is more likely to be used against us, than to provide any lasting
benefit.

David G Williams




-----Original Message-----
From: IAN WATSON [mailto:[log in to unmask]]
Sent: 08 February 2007 13:50
To: [log in to unmask]
Subject: Re: Misinterpretation of units has proved fatal
Importance: High


** High Priority **

Surely the point is that representatives of a wide range of
organisations met, discussed and agreed a consensus giving examples of
fatalities and agreed THAT RATHER THAN WORRY ABOUT PURIST MINUTIAE agree
that FOR PATIENT SAFETY. PRAGMATICALLY, WE SHOULD STANDARDISE. Its mass
units because most of the world literature is in mass units and
therefore new info is more readily assimilable.

PLEASE, PLEASE, CAN WE STOP THIS INTERMINABLE DEBATE AND 

                                 JUST CHANGE TO MASS!!!!

Ian Watson
[Ex-Molar units for drugs champion of 25 years!]
>>> Jonathan Kay <[log in to unmask]> 08/02/2007 13:11 >>>
Thanks for the response.

The extensive work on aviation safety has shown that there is rarely  
a single cause of any accident or a single solution to prevent it  
happening again.

I totally agree about the need for standardisation.

The disagreement is about which are the preferred units. I have two  
reasons for preferring molar units.

1 As I read the relevant standards there is no ambiguity: molar units 

are preferred for this purpose.

2  "Molar thinking" is useful in understanding calculated osmolality, 

calculated anion gap, acid-base chemistry etc.

Jonathan





On 8 Feb 2007, at 12:50, Reynolds Tim wrote:

> Does it matter!
>
> If we were in the aviation industry and crashes were shown to be  
> because
> some repair men used BNF bolts and others used UNF, there would
> immediately be standardisation.
>
> So when instead of 300 people dying at once only one does it, why  
> do we
> endlessly debate how many angels can dance on the head of a pin  
> (depends
> on the molarity or mass of the angel - heavy ones might hurt their
> feet)...
>
> TIM
>
>
> -----Original Message-----
> From: Clinical biochemistry discussion list
> [mailto:[log in to unmask]] On Behalf Of Jonathan Kay
> Sent: 08 February 2007 12:48
> To: [log in to unmask] 
> Subject: Misinterpretation of units has proved fatal
>
>
> Thanks.
>
> 1 Do you know the content of the report from the laboratory?  (Eg
did
> it include units?, had it turned into just a verbal transmission of
a
> number?)
>
> 2 Do you know which treatment guidance the clinician was using? (Eg
> the BNF (which it sounds like))
>
> 3 Do you know how the long the doctor had been working in that
> department?
>
> Jonathan
>
>
> On 8 Feb 2007, at 12:37, Julian Barth wrote:
>
>> Dear Colleagues
>>
>> Further to my previous mailings about the need to standardise the
use
>> of drug units in the UK using the Consensus recommendations, I
would
>> like to bring to your attention a recent fatality due to a
>> misunderstanding directly related to the confiusion of units.
>>
>> A case of paracetamol overdose occurred in which the interval
between
>> the possible paracetamol overdose and the blood sampling was not
>> known.
>> The concentration obtained was 2.29 mmol/L. the doctor who  
>> interpreted
>> the result used the 'mg/L' scale, which suggested that the value
was
>> very low and not requiring action. The mmol/L scale was not used
>> because
>> the value obtained was off this scale (which only goes up to 1.3
>> mmol/L). The patient eventually died.
>>
>> This episode is further evidence that the status quo, with
different
>> labs reporting in different units, is associated with avoidable
>> clinical
>> risk. It adds further support that we must act now or else a
solution
>> will be forced upon us. I sincerely hope that any waverers will be
>> convinced of the need by this case.
>>
>> With best wishes
>> Julian
>>
>>
>> Julian H Barth MD FRCP FRCPath
>> Consultant in Chemical Pathology & Metabolic Medicine Department of
>> Clinical Biochemistry & Immunology Leeds General Infirmary
>> Leeds LS1 3EX
>>
>> tel 0113 392 3416
>> fax 0113 392 5174
>>
>> Editor-in-Chief, Annals of Clinical Biochemistry,
>> journal http://www.ingentaconnect.com/content/rsm/acb 
>> submissions http://mc.manuscriptcentral.com/acb 
>>
>> -

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------ACB discussion List Information--------
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community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.
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