Michael W. McKenzie

Thiazide diuretics and bone mineral content in postmenopausal women.

This retrospective study of 54 postmenopausal women taking thiazide diuretics found that bone mineral measurements and bone fracture prevalence did not differ significantly from those of matched control subjects. Matching on the variables of type of menopause (surgical/nonsurgical), years postmenopausal, duration of estrogen therapy (if any), daily intake of dietary and supplemental calcium and vitamin D, and Quetelet index was done without knowledge of the bone mineral measurements. Bone mass was recorded as the bone mineral content and bone density of the distal and midshaft radius. Only fractures associated with osteoporosis (hip, rib, vertebrae, and wrist) were recorded. This study suggests that thiazide diuretics do not provide protection against osteoporosis.

Adverse drug reactions leading to hospitalization in children

During a three-year period of prospective epidemiologic surveillance for adverse drug reactions in a pediatric population, 72 (2.0%) of 3,556 medical admissions were the result of adverse drug reactions. Antineoplastic drugs were most frequently cited as causing a reaction leading to admission. Approximately 40% of the reactions were severe, and four reactions contributed to death.

Treatment of Hypercalcemia

The indications, effectiveness, and adverse effects of the numerous treatment modalities for hypercalcemia are presented. Results of a retrospective chart review of 72 admissions (53 patients) for hypercalcemia-related diseases are presented to emphasize the therapeutic principles that should be applied in the management of these patients. Hydration, forced diuresis, oral phosphates, and glucocorticosteroid drugs are common therapeutic approaches. Combination therapy with glucocorticosteroid drugs, oral phosphates, and forced diuresis is utilized to take advantage of multiple mechanisms of action. Outpatient therapy for hypercalcemia consists primarily of glucocorticosteroid agents and oral phosphates. Most patients are treated if the serum calcium level is ≥ 12 mg/dL. An algorithm is presented to assist the clinician in selecting the most efficacious treatment plan.