Pharmacologic treatment of hyperthyroidism during lactation

QUESTION I have a patient who has hyperthyroidism due to Graves disease. She was taking methimazole but discontinued when she found out she was pregnant. She is currently close to delivery and might require antithyroid therapy in the postpartum period. Can methimazole cross into human milk, and is breastfeeding safe for her infant?ANSWER The exposure of infants to methimazole or propylthiouracil through breast milk is minimal and not clinically significant. Women with hyperthyroidism using methimazole or propylthiouracil should not be discouraged from breastfeeding, as the benefits of breastfeeding largely outweigh the theoretical minimal risks.     

Elevated serum creatine kinase. Following febrile seizures

Serum creatine kinase (CK) was determined in 52 children admitted following an episode of febrile convulsions. Enzyme levels correlated with the estimated duration of the seizure. Twenty-four hour values were significantly higher than those observed 1 hour after the convulsive episode. Serum CK levels are frequently used for diagnostic purposes, so the questionable validity of this test when drawn after a convulsive episode must be considered.     

The effect of serum prolactin levels on ovarian steroidogenesis

In order to assess the effect of hyperprolactinemia on ovarian steroidogenetic potential, a group of anovulatory hyperprolactinemic patients and a control group of anovulatory normoprolactinemic women were submitted to exogenous gonadotropin (hMG) stimulation under identical experimental conditions. Serum 17 beta-estradiol (E2) concentrations were determined before and after hMG stimulation. The mean basal serum E2 levels in the hyperprolactinemic group (22.7 +/- 3.3 pg/mL, mean +/- 1 SE) were significantly lower than in the normoprolactinemic control group (48.7 +/- 8.4 pg/mL, P less than .01). A significant negative correlation (r = -.6157, P less than .01) between basal serum E2 levels and basal serum prolactin (hPRL) concentrations was found. Following hMG stimulation, the serum E2 increment (delta E2) from basal E2 levels in the control group (491 +/- 91 pg/mL) was significantly higher than the increment in the hyperprolactinemic group (182 +/- 48 pg/mL, P less than .01), and a significant negative correlation was observed between basal serum hPRL levels and the logarithm of delta E2 (r = -.4744, P less than .05). Our results suggest that chronic hyperprolactinemia induces ovarian refractoriness to exogenous gonadotropin stimulation and substantially reduces its steroidogenetic potential.     

Acute rheumatic fever in the young: changing prevalence and pattern

Acute rheumatic fever (ARF) is rare in young people. A group of 28 patients is described who were hospitalized during the years 1960–1984. Patients were divided into two groups: children who were admitted between 1960 and 1966 and those admitted between 1966 and 1984. The annual incidence of ARF declined from 1.17 to 0.44 cases per 10,000 population at risk. The incidence of arthritis declined in parallel to the decrease in number of children presenting with ARF, whereas the incidence of carditis remained the same.Abbreviations ARF acute rheumatic fever - RF rheumatic fever     

Trends of medication errors in hospitalized children

Medication errors are a major cause of morbidity and mortality among hospitalized children. Due to the small volumes of stock solution involved, even a large error may look as an unsuspiciously small dose. Strategies were implemented to reduce medication errors in a large tertiary pediatric hospital in Toronto. Starting in 1993, several initiatives were taken, including a new hospital computer system for medication ordering, a review process to remove hazardous drugs from wards where they are not needed immediately, and in the training of pediatric residents. The rates of reported medication errors were compared before and after these initiatives were taken. Compared to baseline, there was a steady and a statistically significant decrease in medication errors through the decade. Total errors (actual and potential) decreased for nurses and physicians by half and for pharmacists by 75%. Actual incidents decreased by half. Moderate and severe errors decreased by more than 70%. It was concluded that a combination of several initiatives to decrease system and human errors has resulted in more than a 50% reduction of medication errors reaching the pediatric patient.