Number Of Milligrams Research Articles

Treatment patterns and adherence to lipid-lowering drugs during 8 years of follow-up after a cardiovascular event

Abstract Introduction In previous research using nationwide prescription data we demonstrated that a considerable proportion of statin users in Norway had treatment gaps or discontinuation in treatment, with 20% of patients having gaps exceeding 180 days. Yet, evidence for treatment practice and long-term adherence to lipid lowering drugs among patients with atherosclerotic cardiovascular disease is limited. Purpose To investigate long-term treatment patterns and adherence to lipid lowering drugs following hospitalization for an acute cardiovascular event. Secondary, to investigate the association between patient characteristics and adherence. Methods Consecutive patients admitted to two hospitals in Norway with acute myocardial infarction or angina undergoing revascularization from 2011-2014 (N=1094) were included in this study. Data on clinical and psychosocial factors were linked to prescription registry data from 2010 to the date of death or end-of follow-up (2020). We evaluated treatment adherence from time of hospital admission to end of follow-up by estimating proportion of days covered (PDC) and gaps in statin treatment. Risk of gaps in statin treatment of >180 days were evaluated across different patient subgroups. Treatment practice after hospital discharge was assessed by the proportion of patients with atorvastatin 40/80 mg or rosuvastatin 20/40 mg, and the proportion of patients with a subsequent ezetimibe prescription. Results Median age was 63 years (SD 9.6) at time of hospital admission. 96% of the patients were discharged with a statin at the index event. During a median of 8 years (SD 2.5) of follow-up, 16% had a gap in their statin treatment exceeding 180 days, and 22% had a PDC < 0.8. LDL-cholesterol target achievement at follow-up was poor and psychosocial distress was prevalent (Table 1). The proportion of patients with gaps ≥180 days was quite similar in all patient subgroups, however somewhat more prevalent among patients who reported statin side-effects (Figure 1). Less than two out of three patients were prescribed high intensity statin therapy during follow-up, while 25% received additional treatment with ezetimibe (Figure 1). Mean number of milligrams redeemed during follow-up was 43 for atorvastatin, 36 for simvastatin and 18 for rosuvastatin. Conclusion In this study of patients hospitalized for an atherosclerotic cardiovascular event, long-term follow-up over 8 years showed that a considerable proportion of patients have poor statin adherence, with gaps in treatment exceeding 180 days. Furthermore, many patients are treated with suboptimal statin therapy, and only 1 out of 4 patients were prescribed ezetimibe. There is a considerable potential for improving long-term adherence and optimizing lipid lowering therapy in secondary prevention.Patient characteristics (N=1094)Proportion of patients with gap>180 days

The Association of Prehospital End-Tidal Carbon Dioxide with Survival Following Out-of-Hospital Cardiac Arrest

Objective End tidal carbon dioxide (ETCO2) is often used to assess ventilation and perfusion during cardiac arrest resuscitation. However, few data exist evaluating the relationship between ETCO2 values and mortality in the context of contemporary resuscitation practices. We aimed to explore the association between ETCO2 and mortality following out-of-hospital cardiac arrest (OHCA). Methods We used the 2018–2021 ESO annual datasets to query all non-traumatic OHCA patients with attempted resuscitation. Patients with documented DNR/POLST, EMS-witnessed arrest, ROSC after bystander CPR only, or < 2 documented ETCO2 values were excluded. The lowest and highest ETCO2 values recorded during the total prehospital interval, in addition to the pre- and post-ROSC intervals for resuscitated patients, were calculated. Multivariable logistic regression models adjusted for age, sex, initial rhythm, witnessed status, bystander CPR, etiology, OHCA location, sodium bicarbonate administration, number of milligrams of epinephrine administered, and response interval were used to evaluate the association between measures of ETCO2 and mortality. Results Hospital outcome data were available for 14,122 patients, and 2,209 (15.6%) were classified as surviving to discharge. Compared to patients with maximum prehospital ETCO2 values of 30–40 mmHg, odds of mortality were increased for patients with maximum prehospital ETCO2 values of <20 mmHg (aOR: 3.5 [2.1, 5,9]), 20–29 mmHg (aOR: 1.5 [1.1, 2.1]), and >50 mmHg (aOR: 1.5 [1.2, 1.8]). After 20 minutes of ETCO2 monitoring, <12% of patients had ETCO2 values <10 mmHg. This cutpoint was 96.7% specific and 6.9% sensitive for mortality. Conclusion In this dataset, both high and low ETCO2 values were associated with increased mortality. Contemporary resuscitation practices may make low ETCO2 values uncommon, and field termination decision algorithms should not use ETCO2 values in isolation.

Treatment for infantile subglottic hemangioma with oral propranolol

Objective:To investigate the clinical characteristics of infantile subglottic hemangioma（SGH）, and to observe the safety and efficacy of propranolol in the treatment of SGH. Methods:The data of 13 children diagnosed with SGH and treated with propranolol in Shanghai Children's Hospital from November 2015 to March 2020 were retrospectively analyzed and followed up. All 13 cases underwent laryngoscopy and 10 cases underwentcontrastenhanced CT. Laryngeal exploration under general anesthesia was performed in 2 cases. Propranolol was started at 1 mg/（kg·d） divided into 3 doses. Heart rate and blood pressure were monitored during treatment. If no side effects were observed, then the dose was increased to 1.5 mg/（kg·d） on the second day. It was suggested to maintain this starting dose at diagnosis（1.5 mg/kg body weight）, and not increase the number of milligrams as the child gained weight. Results:The age at therapy termination ranged from 9 months to 38 months, only 2 cases beyond 2 years old, with an average of （19.3±7.7） months. The treatmentduration ranged from 6 to 21.3 months, with an average of （13.3±4.9） months. The follow-up time ranged from 21 to 71 months, with an average of （46.8±14.9） months. All 13 cases were cured. Conclusion:Infants under 2 years old with stridor have poor effect or repeated condition after routine treatment, SGH should be considered at this moment. Laryngoscopy combined with contrastenhanced CT is recommended. Oral propranolol is safe and effective in the treatment of SGH. It is suggested to oral propranololbeyond 19 months old to reduce recurrence, furthermore, 2 years old may be the best time for therapy termination.

Population Pharmacokinetics and Outcomes of Critically Ill Pediatric Patients Treated with Intravenous Colistin at Higher Than Recommended Doses.

Limited pharmacokinetic (PK) data suggest that currently recommended pediatric dosages of colistimethate sodium (CMS) by the Food and Drug Administration and European Medicines Agency may lead to suboptimal exposure, resulting in plasma colistin concentrations that are frequently <2 mg/liter. We conducted a population PK study in 17 critically ill patients 3 months to 13.75 years (median, 3.3 years) old who received CMS for infections caused by carbapenem-resistant Gram-negative bacteria. CMS was dosed at 200,000 IU/kg/day (6.6 mg colistin base activity [CBA]/kg/day; 6 patients), 300,000 IU/kg/day (9.9 mg CBA/kg/day; 10 patients), and 350,000 IU/kg/day (11.6 mg CBA/kg/day; 1 patient). Plasma colistin concentrations were determined using ultraperformance liquid chromatography combined with electrospray ionization-tandem mass spectrometry. Colistin PK was described by a one-compartment disposition model, including creatinine clearance, body weight, and the presence or absence of systemic inflammatory response syndrome (SIRS) as covariates (P < 0.05 for each). The average colistin plasma steady-state concentration (Css,avg) ranged from 1.11 to 8.47 mg/liter (median, 2.92 mg/liter). Ten patients had Css,avg of ≥2 mg/liter. The presence of SIRS was associated with decreased apparent clearance of colistin (47.8% of that without SIRS). The relationship between the number of milligrams of CBA per day needed to achieve each 1 mg/liter of plasma colistin Css,avg and creatinine clearance (in milliliters per minute) was described by linear regression with different slopes for patients with and without SIRS. Nephrotoxicity, probably unrelated to colistin, was observed in one patient. In conclusion, administration of CMS at the above doses improved exposure and was well tolerated. Apparent clearance of colistin was influenced by creatinine clearance and the presence or absence of SIRS.

How much allopurinol does it take to get to target urate? Comparison of actual dose with creatinine clearance-based dose

ObjectiveAllopurinol dosing has frequently been limited based on creatinine clearance (CrCL), resulting in failure to achieve target serum urate (SU). The aim of this analysis was to determine how many milligrams of allopurinol above the recommended CrCL-based dose (R+) are required to achieve target SU and to investigate the factors that influence R+.MethodsWe analysed data from participants in a 24-month open, randomized, controlled, parallel-group, comparative clinical trial. Data obtained during the 12-month dose escalation (DE) phase of the study (year 1 for DE/DE and year 2 for control/DE) were combined. R+ dose was defined as the number of milligrams of allopurinol above the CrCL-based dose at the final visit.ResultsOf the 132 participants, R+ allopurinol dose at the final visit was ≤ 100 mg/day in 38 (28.8%), 101–200 mg/day in 46 (34.8%) and > 200 mg/day in 48 participants (37.1%). There was no significant difference between the R+ groups in the number of participants achieving target SU. There was an increase in plasma oxypurinol and a larger percentage and absolute change in SU as R+ increased. Multivariate analysis revealed CrCL, weight, baseline SU and allopurinol dose, were significantly positively associated with allopurinol dose at 12 months. There were no significant differences across R+ groups in renal or liver function adverse events, although there were numerically more serious adverse events in the higher R+ groups.ConclusionA wide range of R+ doses are required to achieve target SU. Four easily obtained clinical variables (baseline SU, CrCL, weight, and allopurinol dose) may be helpful to predict allopurinol dose.Trial registrationANZCTR, ACTRN12611000845932. Registered on 10 August 2011.

Paediatric Off-Label Use of Melatonin--A Register Linkage Study between the Norwegian Prescription Database and Patient Register.

The aims were, for the entire Norwegian population aged 4-17years, to study the prevalence of melatonin use during 2004-2012, recurrent use in incident users and psychiatric and neurological morbidity in recurrent users. Data on dispensed melatonin were retrieved from the Norwegian Prescription Database and linked to diagnostic data from the Norwegian Patient Register. Outcome measures were the following: 1-year prevalence of use, proportion of recurrent use (use over three consecutive 365-day periods among incident users in 2009) and annual number of milligrams and number of prescriptions dispensed in recurrent users. The prevalence of registered ICD-10 diagnoses during the period of 2008-2012 was given for the recurrent users. The prevalence of melatonin use increased annually in both genders during 2004-2012 (boys: 3.4-11.0 per 1000; girls: 1.5-7.7 per 1000). Twenty-nine per cent of boys and 23% of girls were recurrent melatonin users, with highest level of recurrent use among the youngest (aged 4-8years; boys: 47%, girls: 42%). In the third year, the median annual amount of melatonin dispensed was 1080 (IQR 586-1800) milligrams in boys and 900 (IQR 402-1620) milligrams in girls. Among recurrent users, 91% had a diagnosis of either psychiatric (84%) or neurological (32%) disorder. Off-label recurrent use of melatonin seems to have acquired a role mainly in treating secondary sleep problems in children and adolescents with psychiatric and neurological disorders. Once melatonin has been started, a large proportion of patients continue for at least 3years, in doses corresponding to daily use in the majority.

The cosmetic dose: how much are you getting?

One of the biggest differences between drugs and cosmetics is the amount of information available to determine the constituents of the product. Drugs are explicitly labeled with the number of milligrams contained in the pill. Tight quality control is enforced globally by government regulatory agencies to insure that manufacturers adhere to ingredient purity and formulation accuracy. While there are many rules that apply globally to cosmetics, dose is an issue that has not been felt to be pertinent. Now with the development of active cosmetics, better known to dermatologists as cosmeceuticals, the amount of the active ingredient in the formulation has become more important. It is necessary to recognize that the concept of dose is foreign to cosmeceuticals because cosmeceuticals is a regulatory unrecognized term and unrecognized category in the United States. Many cosmeceuticals use botanical ingredients to provide skin benefits such as antioxidant, anti-inflammatory, emolliency, and moisturization. While cosmetics are required to disclose ingredients in order of decreasing concentration, it is not possible to determine the exact amount of any individual ingredient. Even the cosmetic manufacturer may not know the exact concentration and type of catechin in a green tea extract. Raw material suppliers develop and manufacture extracts, but characterization is difficult, given the variability of substances grown in an outdoor environment. The amount of sun, water, and soil nutrients can affect the amount of catechins present in a green tea. Further, the location of the farm and the season of harvesting can have additional effects. It would be challenging to standardize plant materials in the same manner as drugs. It is my belief, however, that cosmeceuticals cannot scientifically advance until the dose is better characterized and standardized. The development of plant bioreactors has made the ability to determine the “dose” for plant extracts within reach. Plant bioreactors use stem cells as living machines to generate botanicals in a controlled environment allowing more accuracy in the characterization of these plant materials. Stem cells are pluripotential cells that can differentiate into many different structures derived from many different plant parts including berries, leaves, stems, twigs, and roots. Antioxidant botanicals are commonly derived from plant leaves, as the leaves are the site of photosynthesis and require excellent oxidative stress protection. Plant materials obtained from outdoor cultivation may contain a variety of contaminants to include heavy metals, pesticides, and fungal toxins. When the plant material is concentrated, so are the contaminants. One of the biggest concerns with frequent green tea consumption is the possibility of pesticide intake, as pesticides are used to prevent leaf damage in the fields. It is not possible to remove the pesticides completely from the leaves, and tea represents a concentrated use of the dried leaves. Utilizing stem cells eliminates this type of concern by allowing the plant material to grow under controlled laboratory conditions increasing purity. Stem cell-derived materials also have greater consistency of contents. The plant materials are cultured under optimal conditions to yield a more standard composition than those grown outdoors that may vary based on weather, soil condition, fertilizer application, etc. Consistency is key to obtaining botanical materials that have a standardized dose of ingredients. This is an important step in moving the science of cosmeceuticals forward. This new technology will be very important to cosmetic dermatology as active cosmetics advance in their efficacy and safety. Only through this type of ingredient development can dermatologists better understand how much patients are getting by using botanical extracts in skin care products.

Estudio de adecuación a la ficha técnica de las prescripciones de trastuzumab en un hospital de tercer nivel

This study compares trastuzumab's actual conditions of use in clinical practice with those officially described on its summary of product characteristics. We also measure the cost associated with its use. Observational study of the prescription/indication of trastuzumab in a tertiary hospital from January 2006 to 31 December 2007. We analysed whether trastuzumab use in clinical practice complied with its summary of product characteristics, concerning the following: HER2 over expression, indication (breast cancer), treatment plan, line of treatment, dosage, frequency and number of cycles. To measure cost, we calculated the total number of milligrams used and then multiplied it by the laboratory's sale price per milligram plus VAT. All patients (n=77) used trastuzumab for breast cancer. Sixty-two point two percent of patients presented with HER2+++ over expression. Twenty-nine treatment plans were used, that were not authorised on the summary of product characteristics. The total trastuzumab cost during the study period was €1537622.73. Although trastuzumab is always used for breast cancer, it is used in conditions other than those described on its summary of product characteristics, both for HER2 over expression and treatment plans.

A Randomized Controlled Trial of Ketamine/Propofol Versus Propofol Alone for Emergency Department Procedural Sedation

We compare the frequency of respiratory depression during emergency department procedural sedation with ketamine plus propofol versus propofol alone. Secondary outcomes are provider satisfaction, sedation quality, and total propofol dose. In this randomized, double-blind, placebo-controlled trial, healthy children and adults undergoing procedural sedation were pretreated with intravenous fentanyl and then randomized to receive either intravenous ketamine 0.5 mg/kg or placebo. In both groups, this procedure was immediately followed by intravenous propofol 1 mg/kg, with repeated doses of 0.5 mg/kg as needed to achieve and maintain sedation. Respiratory depression was defined according to any of 5 predefined markers. Provider satisfaction was scored on a 5-point scale, sedation quality with the Colorado Behavioral Numerical Pain Scale, and propofol dose according to the total number of milligrams of propofol administered. The incidence of respiratory depression was similar between the ketamine/propofol (21/97; 22%) and propofol-alone (27/96; 28%) groups, difference 6% (95% confidence interval -6% to 18%). With ketamine/propofol compared with propofol alone, treating physicians and nurses were more satisfied, less propofol was administered, and there was a trend toward better sedation quality. Compared with procedural sedation with propofol alone, the combination of ketamine and propofol did not reduce the incidence of respiratory depression but resulted in greater provider satisfaction, less propofol administration, and perhaps better sedation quality.

Study to support the standardization of the prescribing, dispensing and labeling of etoposide formulations in Australia

Etoposide is used in a wide variety of solid and hematological tumors. It is available in Australia in two intravenous formulations; etoposide base and the etoposide phosphate salt with 113.6 mg of etoposide phosphate being equivalent to 100 mg of the etoposide base. Variances between the etoposide dose prescribed and that actually given have been reported recently in Australia with patients receiving either too much or too little of the intended dose of etoposide. We carried out a review of national practices of prescribing, dispensing and labeling of etoposide and etoposide phosphate. Cancer care clinicians and pharmacists, identified through their membership of the Clinical Oncological Society of Australia (COSA), were asked to complete an online survey or participate in a telephone interview, about their etoposide prescribing and dispensing practices. Nineteen pharmacists and 11 prescribers provided responses suitable for analysis. The most common reason for using the etoposide phosphate formulation was its shorter infusion time. The most common reason provided for preferring the base formulation over the phosphate formulation was that the original clinical trial data supported its use. There were a variety of methods identified that a prescriber might use to indicate the formulation of etoposide required and a variety of methods used for the labeling of etoposide formulations. Prescribing, ordering and dispensing practices for etoposide base and etoposide phosphate are inconsistent across Australia, which could lead to dosing errors. We recommend that a national standard is adopted with etoposide phosphate preparations prescribed and labeled as "Etoposide (as the PHOSPHATE) x mg. Where x is the number of milligrams of etoposide base required." This would move towards minimizing the risk of dosage errors occurring with these formulations.

Opinion #2: Melvin C. Gitlin, MD, and Marcos FeBornstein, MD

The first question pertains to whether it is ethical to use blind dosing. Most drug treatments are “blind”; we normally do not spend much time or energy discussing the milligrams of, for example, antihypertensives or antibiotics. We simply tell the patient how to take the medication and, for the most part, encounter no resistance. In fact, when patients are asked which medications they take, they rarely know the dose in milligrams. So the question is more specific to pain treatment. Why should milligrams of analgesics be an issue in the first place? Because it is made an issue in this case, it is a question worth examining. According to the case report, “it is used here [the blind dosing] to avoid the tug of war that so often ensues about the ‘number of milligrams’ of any opioid that is being used.” However, the case report makes no mention of any tug of war. Assuming a tug of war has not actually happened, the clinician may be assuming a priori that this is going to occur and is acting preventively. If this is the case, the clinician is acting on an assumption, not on facts. Second, we do not know the basis of this assumption, whether it is based on prejudice, given the patient's history of heroin use, or some other data. If the rationale to use blind dosing is that such a tug of war “so often ensues,” it is being justified on a basis that does not pertain to the patient in particular but is a generalization. The treatment is no longer individualized but is based on some other general frame …

Prescribing patterns and purchasing costs of long-acting opioids over nine years at an academic oncology hospital

The prescribing patterns and purchasing costs of long-acting opioids over nine years at an academic oncology hospital were studied. Data were collected for doses of transdermal fentanyl, methadone (all routes of administration), and oral sustained-release morphine and oxycodone dispensed for individual inpatient use for the month of October for each year between 1996 and 2004. The dates included in the retrieval were selected to document long-acting opioid use before and after the establishment of the palliative care and rehabilitation medicine department. For each opioid the number of milligrams dispensed daily per patient was determined and converted into a morphine-equivalent daily dose (MEDD). The average wholesale price per dosing unit of each drug during each period studied was obtained from internal databases. Costs were calculated by multiplying the number of units dispensed by the average wholesale price per unit and then normalized to 1996 U.S. dollars. The mean aggregate cost for a single MEDD in a month was determined by multiplying the mean cost per MEDD for each agent by that agent's percent contribution to the total MEDDs dispensed in that month. Long-acting opioid and methadone usage increased from 1996 to 2004. Between 1996 and 2004, the mean cost of a single MEDD dropped from $0.0738 to $0.0330. During the study period, the median daily cost to treat one patient dropped from $5.96 to $2.80. Long-acting opioid use increased and cost per MEDD decreased at an academic oncology hospital between 1996 and 2004. The decreased cost of purchasing opioids was attributed to the increased proportional use of methadone.

Will the Number of Milligrams of an Opioid Dose Ever Re-Achieve the Truly Meaningless Status It Deserves?

Will the Number of Milligrams of an Opioid Dose Ever Re-Achieve the Truly Meaningless Status It Deserves?

Will the Number of Milligrams of an Opioid Dose Ever Re-Achieve the Truly Meaningless Status It Deserves?

There is a notion that tolerance is an inevitable complication when patients are maintained on opioid analgesic regimens for an extended period of time. Whether this is true or not, it is important to remember that, in spite of growing regulatory scrutiny and spreading fear around these medications, defining “ceiling doses” of opioids has more to do with clinician comfort and much less to do with reality and patient requirements. This commentary posits that clinicians must return to the principles of balancing efficacy with toxicity as the dose-limiting factor once again, contextualized by outcomes in the areas of function and compliant drug-taking.

What Smokers Believe about Light and Ultralight Cigarettes

Objectives. To assess the knowledge of smokers and ex-smokers about light cigarettes and nicotine yields and their perception of the risk of lung cancer, and to identify the characteristics of smokers of light cigarettes. Methods. Mail survey in a population sample of 494 smokers and exsmokers in Geneva, Switzerland, in 1999. Results. Participants were on average 40 years old, and 49% were men. They estimated that one would have to smoke two light cigarettes or four ultralight cigarettes in order to inhale the same amount of nicotine as that in one regular cigarette. Most participants (60%) answered that the risk of lung cancer was the same, but 27% answered that this risk was lower in smokers of light cigarettes than in smokers of regular cigarettes. The most frequent answer (41% of answers) to an open-ended question on the meaning of the number of milligrams of nicotine printed on cigarette packs was that this number indicated the nicotine content in cigarettes, rather than a machine-determined yield in smoke. In a multivariate model, smoking mild, light, or ultralight (vs regular) cigarettes was associated with females, a lower Fagerström dependence score, an intention to quit smoking, and an intention to decrease cigarette consumption. Conclusions. Many smokers choose light cigarettes because they think that such cigarettes are safer or less addictive. The public should be further informed of the meaning and purpose of cigarette labels.

Postoperative Nausea and Vomiting: Prophylaxis Versus Treatment

Postoperative Nausea and Vomiting: Prophylaxis Versus Treatment

Clinical Significance of Lead Content in Dietary Calcium Supplements

Calcium supplements are sold in a wide variety of formulations and preparations, and product labels indicate the number of milligrams (mg) of calcium contained within each dosage unit. Until recently, consumers were often unaware that lead may be found in calcium supplements; however, this issue has received a great deal of recent media attention. Healthcare professionals are likely to receive many questions from the lay public regarding this issue. This article reviews current knowledge about the lead content of calcium supplements as a guide for clinicians. Key Words: calcium, calcium supplements, lead, dietary lead

Sex hormones during alcohol withdrawal: a longitudinal study of 29 male alcoholics during detoxification.

It is a well-known fact that alcohol affects sex hormone levels in males. Even in the absence of liver dysfunction, there is still a direct toxic effect of ethanol on testosterone synthesis resulting in acutely decreased values. This study is based on 29 male alcoholics without severe signs of liver disease treated on the alcohol detoxification ward at Huddinge hospital in Stockholm, Sweden during 1995. The aim was to study levels of sex hormones in male alcoholics during detoxification with benzodiazepines and after 3 weeks of sobriety. Blood samples were taken three times: one day after admission (day 2) when the patient was sober, at discharge (day 5) and after 3 weeks of sobriety (day 21). Levels of testosterone and sex hormone-binding globulin (SHBG) showed the same pattern during detoxification and follow-up. They were both low, but generally within normal limits, on days 2 and 5, but raised after 3 weeks of sobriety. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) were initially high, but were substantially depressed during detoxification. Levels of FSH recovered after 3 weeks, whereas LH remained at the same level. Most patients exhibited generally low levels of both FSH and LH, however. Levels of oestrone decreased steadily. There were no correlations between levels of sex hormones and the number of milligrams of oxazepam administered to the patients during detoxification either at admission, at discharge or at follow-up. In summary, the endocrinological response to alcohol intake is complex. This study suggests that the duration of endocrinological recovery after drinking is a quite long-lasting process, that different hormones need different times to recover and that the normal glandular-pituitary feed-back processes may be partly put out of order.

Iron Syrup Concentration Error

To the Editor.— There is an error in the new edition of The Harriet Lane Handbook concerning the concentration of iron in Fer-in-sol syrup.1 The text states that the number of milligrams of elemental iron is 18 milligrams per milliliter. According to the package insert, the concentration is actually 18 milligrams per 5 milliliters. Children being treated with this iron preparation potentially would be greatly underdosed if the printed information in the handbook is used by a physician in determining a treatment plan for iron deficiency anemia.

Amount and dietary sources of caffeine and saccharin intake by individuals ages 5 to 18 years

A nationwide, 7-day food consumption survey was utilized to assess average daily consumption of saccharin and caffeine by individuals 5 to 18 years old. The total sample's average daily saccharin and caffeine intakes were 4.1 and 37.4 mg, respectively. Only 14% of the individuals consumed saccharin while 98% consumed caffeine. On days when these dietary components were consumed, average saccharin intake was 87.4 mg and average caffeine intake was 47.9 mg. In general, intake levels of both dietary components increased with increasing age. However, on a body weight basis (mg/kg) caffeine intakes did not increase with increasing age. When expressed as milligrams of caffeine intake per kilogram body weight per day, children 5 to 6 years old had significantly higher intakes (1.1 mg/kg/day) than 7 to 8 year olds. No other age differences were noted. Artificially sweetened carbonated beverages contributed the greatest number of milligrams of saccharin to total intake while tea, followed by carbonated beverages, made the most significant impact on caffeine consumption. Considerable variation was found for both saccharin and caffeine consumption levels among the sample members as well as for each individual during the 7 days surveyed.