In hospitalized patients

The patient is monitored carefully vital signs are taken frequentiy, and die patient is placed on a cardiac monitor while the drug is being titrated to a therapeutic dose The dosage may be increased more rapidly in hospitalized patients under close supervision. 

Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients a meta-analysis of prospective studies. JAMA. 1998 Apr 15 279(15) 1200-5. 

Rosenheck R, Cramer J, Xu W, et al (1997). A comparison of clozapine and haloperidol in hospitalized patients with refractory schizophrenia. N Engl J Med b b7> 809-15. 

Neufeld, 0. Smith, J. R. and Goldman, S. L. Arterial Oxygen Tension in Relation to Age in Hospital Patients. 

In hospitals today a wide variety of complex equipment is used in the course of patient treatment. Humidifiers, incubators, ventilators, resuscitators and other apparatus require proper maintenance and decontamination after use. Chemical disinfectants used for this purpose have in the past through misuse become contaminated with opportunist pathogens, such as Ps. aeruginosa, and ironically have contributed to, rather than reduced, the spread of cross-infection in hospital patients. Disinfectants should only be used for their intended purpose and directions for use must be followed at all times. 

Acute renal failure (ARF) is a potentially life-threatening clinical syndrome that occurs primarily in hospitalized patients and frequently complicates the course of the critically ill. It is characterized by a rapid decrease in glomerular filtration rate (GFR) and the resultant accumulation of nitrogenous waste products (e.g., creatinine and urea nitrogen), with or without a decrease in urine output. A recent consensus statement... 

Hyponatremia is a very common finding in hospitalized patients and is defined as a serum sodium level below 136 mEq/L (136 mmol/L). 

Hyponatremia is very common in hospitalized patients and is defined as a serum sodium concentration below 136 mEq/L (136 mmol/L). Clinical signs and symptoms appear at concentrations below 120 mEq/L (120 mmol/L) and typically consist of agitation, fatigue, headache, muscle cramps, and nausea. With profound hyponatremia (less than 110 mEq/L [110 mmol/L]), confusion, seizures, and coma maybe seen. Because therapy is also influenced by volume status, hyponatremia is further defined as (1) hypertonic hyponatremia (2) hypotonic hyponatremia with an increased ECF volume (3) hypotonic hyponatremia with a normal ECF volume and (4) hypotonic hyponatremia with a decreased ECF volume.16... 

Most initial antimicrobial therapy is empirical because cultures usually have not had sufficient time to identify a pathogen. Empirical therapy should be based on patient- and antimicrobial-specific factors such as the anatomic location of the infection, the likely pathogens associated with the presentation, the potential for adverse effects in a given patient, and the antimicrobial spectrum of activity. Prompt initiation of appropriate therapy is paramount in hospitalized patients who are critically ill. Patients who receive initial antimicrobial therapy that provides coverage against the causative pathogen survive at twice the rate of patients who do not receive adequate therapy initially.8... 

Maintaining adequate nutritional status, especially during periods of illness and metabolic stress, is an important part of patient care. Malnutrition in hospitalized patients is associated with significant complications, including increased infection risk, poor wound healing, prolonged hospital stay, and increased mortality, especially in surgical and critically ill patients.1 Specialized nutrition support refers to the administration of nutrients via the oral, enteral, or parenteral route for therapeutic purposes.1 Parenteral nutrition (PN), also... 

TABLE 97-8. Suggested Frequency of Monitoring Parameters in Hospitalized Patients Receiving Parenteral Nutrition... 

The amount of EN actually administered is often less than the amount ordered owing to interruptions in therapy for performance of procedures and other daily activities, especially in hospitalized patients. It is imperative to monitor volume of feedings actually received and to make adjustments in rates or amounts of EN as necessary. 

In recent years, parenteral dosage forms, especially IV forms, have enjoyed increased use. The reasons for this growth are many and varied, but they can be summed up as (a) new and better parenteral administration techniques, (b) an increasing number of drugs that can be administered only by a parenteral route, (c) the need for simultaneous administration of multiple drugs in hospitalized patients receiving IV therapy, (d) new forms of nutritional therapy, such as intravenous lipids, amino acids, and trace metals, and (e) the extension of parenteral therapy into the home. 

Gupta TP, Ehrinpreis MN Candida-associated diarrhea in hospitalized patients. Gastroenterology 1990 98 780-785. 

Low-molecular-weight heparin or low-dose subcutaneous unfractionated heparin (5,000 units twice daily) is recommended for prevention of deep venous thrombosis in hospitalized patients with decreased mobility due to stroke and should be used in all but the most minor strokes. 

Candida species (particularly Candida albicans) are a common cause of sepsis in hospitalized patients. 

Cyclic PN (e.g., 12 to 18 hours/day) is useful in hospitalized patients who have limited venous access and require other medications necessitating interruption of PN infusion, to prevent or treat hepatotoxicities associated with continuous PN therapy, and to allow home patients to resume normal lifestyles. Patients with severe glucose intolerance or unstable fluid balance may not tolerate cyclic PN. 

Lazarou, J., et al., "Incidence of Adverse Drug Reactions in Hospitalized Patients, A Meta-Analysis Of Prospective Studies," JAMA, 279,1200-1205 (1998). 

Horne R and Weinman J (1999) Patients beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 47(6) 555-567 Kannisto V, Lauritsen J, Thatcher AR et al. (1994) Reductions in mortality at advanced age several decades of evidence from 27 countries. Population and development review 20(4) 793-810 Lazarou J, Pomeranz BH, Corey PN (1998) Incidence of adverse drug reactions in hospitalized patients a meta- analysis of prospective studies. JAMA 279(15) 1200-1205 LeSage J (1991) Polypharmacy in geriatric patients. Nurs Clin North Am 26(2) 273-290 Pitkala KH, Strandberg TE, Tilvis RS (2001) Is it possible to reduce polypharmacy in the elderly ... 

A nutritional deficit often exists in hospitalized patients. There are many conditions and diseases for which nutritional support is recommended by enteral or parenteral routes of administration. Provision of nutrients by vein, in amounts sufficient to maintain or achieve anabolism, is referred to as total parenteral nutrition (TPN). 

Classen D.C., Pestotnik, S.L., Evans, R.S., Lloyd, J.F., Burke, J.P. (1997) Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. The Journal of the American Medical Association, 277 (4), 301-306. 

Bates, D.W., Miller, E.B., Cullen, D.J., Burdiek, L., Williams, L., and Laird, N., Patient risk faetors for adverse drug events in hospitalized patients, zlrcA Intern. Med., 159 2553-2560 (1999). 

Classen, D C., Pestotnik, S.L., Evans, S., et ah. Adverse drug events in hospitalized patients,... 

Ischemic acute renal failure (ARF), characterized by a sharp decline of glomerular filtration rate, is a very common complication in hospitalized patients and particularly in patients with multiorgan failure. Although it develops most frequently in multimorbid patients, its occurrence per se increases the risk of death by 10- to 15-fold (Ghertow et al, 1998). This unacceptable situation in both diseases warrants the urgent development of new treatment modalities. 

The health of the small intestine can also be compromised by poor nutrition or starvation, which can regularly occur in hospital. Patients are normally starved overnight, prior to operation, and starvation may continue well after completion of the surgery because of the nature of the operation or because of the anorexia that can result from surgery or anaesthesia. This will deny adequate nutrition to epithelial cells in the intestine, which can resnlt in slow recovery after surgery and, in addition, may compromise the immune system. Provision of food by the enteral ronte, as soon as possible after injury, surgery, sepsis or bums, is therefore highly desirable (Chapter 18). 

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