A Lite Look at Your Kidney Function (And Why It Matters!)

Written by Timothy McNamara, MD, MPH


Continued from page 1

For men, creatinine clearance = ((140- Age) * IBW) / (72 * SCr) For women, creatinine clearance = ((140- Age) * IBW * 0.85) / (72 * SCr) Where Age is in years, IBW is ideal body weight in kilograms, and SCr is serum creatinine in mg/dl.

(Forrepparttar algebraically-challenged and for anyone wanting help in calculatingrepparttar 114973 results of these complicated equations, please visit this creatinine clearance calculator: www.medicationadvisor.com/creatinine/creatinine.asp.)

Now once you run this a few times, you’ll find that creatinine clearance for young healthy people is about 100 ml/min (we’ll just leave offrepparttar 114974 “ml/min” part from now on).

And, dead people have a creatinine clearance of about 0, depending on how healthy they are.

Everyone else falls somewhere in between.

(Now someone inrepparttar 114975 back ofrepparttar 114976 room is saying, “I just ran this on myself and I have a creatinine clearance of 150”. Well aren’t you special? In fact, young good-looking people can have creatinine clearances of 130, 140, or more…but it doesn’t do a whole lot of good since 100 is perfectly acceptable. In fact, it’s just another case of overachiever overkill.)

Now, if someone has a creatinine clearance of 80, that means that they have about…..80% kidney function.

And, if someone has a creatinine clearance of 50, that means that they have about…..50% kidney function. (Are you following all of this?)

Many drugs that are eliminated byrepparttar 114977 kidney will require moderate dosage reductions once a patient’s renal function is inrepparttar 114978 40-60 range. Patients inrepparttar 114979 20-40 range will typically require very large reductions in dose.

And, patients who are inrepparttar 114980 “less than 20” range will often need HUGE dosage reductions for medications eliminated byrepparttar 114981 kidney (or better yet, they’ll need to take medications that are removed by some other organ altogether...if such an alternative is available).

One last tidbit to consider. Renal function declines as people age. No getting around that. But,repparttar 114982 rate of decline is different for different people. Byrepparttar 114983 time you’re 50 years old, there is a reasonable chance you’ll have moderate renal function (or worse)…byrepparttar 114984 time you’re 80, you’ll almost certainly have some important degree of renal impairment…and you probably won’t even know it or feel it.

Now that you know more renal physiology than you ever, EVER wanted to know…let’s get back torepparttar 114985 main thread of this article…medication safety.

If you (or a loved one) are at risk for having decreased kidney function (and I’ll tell you who such folks are in just a second), you need to step up torepparttar 114986 plate and get a handle on this issue (because there is a very good chance that your physician and pharmacist either didn’t have renal function data or didn’t consider it when coming up with a dosage for you).

Here arerepparttar 114987 steps I recommend for everyone taking prescription or over-the-counter medications:

1)For everyone: If you have access torepparttar 114988 results of a recent serum creatinine test (it is probably part of your annual physical and you may have gotten a copy), memorize it or write it down and then say to your physician or pharmacist when you get a medication, “Say, I think my serum creatinine is about X. So, does this medication need any dosage adjustment in order to be safe for me?

2)If you are in one ofrepparttar 114989 following categories, you should expect your physician and pharmacist to have considered your renal function before dosing a medication:

known kidney disease; age greater than 50; history or heart attack, angina, stroke, or other artery blockages; history of diabetes (any type); history of high blood pressure; prior exposure to chemotherapy drugs; prior prolonged exposure to IV antibiotics; frequent use of pain medications (especially non-steroidal anti-inflammatory drugs, but others as well).

So you might say to your physician or pharmacist, “Is this drug removed byrepparttar 114990 kidney, because I have condition X that could decrease kidney function and I just want to be safe.” Ifrepparttar 114991 drug is removed byrepparttar 114992 kidney, you might also askrepparttar 114993 physician or pharmacist to tell you what your serum creatinine is…and if he or she does not have this information, a big red flag should be going up in your head.

3)If you are not in one ofrepparttar 114994 categories in question 2 and you don’t have a serum creatinine available, don’t worry. You’re probably safe. But you may want to ask your physician if there is a serum creatinine in your chart and if so, what it is.

4)If you are on dialysis of any sort, serum creatinine is not all that useful for dosing medications. Just make sure your physician and pharmacist are aware that you are on dialysis and perhaps ask, “Now is thisrepparttar 114995 usual dose for someone on dialysis?”

These are some ofrepparttar 114996 steps I hope you will considerrepparttar 114997 next time you get a prescription or over-the-counter medication so you can be sure that that you (or your loved one) are gettingrepparttar 114998 right dose.

Timothy McNamara, MD, MPH is a nationally prominent expert in medication safety and healthcare technology. For additional practical steps you can take to improve medication safety and a personalized report of your medication profile, go to: http://www.medicationadvisor.com/art2.asp.


The Last Line of Defense Against Medication Errors

Written by Timothy McNamara, MD, MPH


Continued from page 1

In this series, we are going to take a close look atrepparttar processes that cause medication errors (some things that your physician and pharmacist may not even want you to know) and what steps you can specifically take to make sure that you and your love ones are protected from this hazard.

Ten years ago, your ability to get current, objective, reliable information on your medications in a quick and easy way was practically non-existent. It probably would have involved a trip torepparttar 114972 library and required considerable knowledge about pharmacology to getrepparttar 114973 answers.

Today, that’s notrepparttar 114974 case. There is a host of on-line tools, databases, and resources that allow you to learn information about medications that even your physician and pharmacist may not know.

We’re going to talk about them, show you were to go, tell yourepparttar 114975 key things you need to know about medications, expose some myths, and let you knowrepparttar 114976 questions you should be asking. It’s not as hard as it may seem.

In fact, you need to becomerepparttar 114977 final line of defense inrepparttar 114978 battle against medication errors.

Throughout, we are going to give you some key rules that should guide your defense.

So, Rule Number 1. Trust, but verify. Never assume thatrepparttar 114979 medication you have received isrepparttar 114980 right medication for you or that it is dosed correctly for you. Specifically, you should check:

•the name ofrepparttar 114981 patient onrepparttar 114982 bottle; •the name ofrepparttar 114983 doctor onrepparttar 114984 bottle; •the name ofrepparttar 114985 medication (and cross check it to be sure that it treats a disease or problem you actually have…there are lots of look-alike/sound-alike drug names out there); •the dose (from an independent source…to make sure that it is a plausible dose for you); •the “route” (to make sure, for example, that eye drops are being prescribed forrepparttar 114986 eye, and notrepparttar 114987 mouth, orrepparttar 114988 ear…amazingly injuries from drug misplacement occur allrepparttar 114989 time); •the expiration date.

We’ll talk about some specific resources that will help with each of these throughout this series.

The result, we hope, will berepparttar 114990 piece of mind to know that you and your family are getting your 7 rights:

•right drug; •right patient; •right dose; •right time; •right route; •right reason; •right documentation.

Right on!

© 2004 Timothy McNamara, MD, MPH

Timothy McNamara, MD, MPH is a nationally prominent expert in medication safety and healthcare technology. For additional practical steps you can take to improve medication safety and a personalized report of your medication profile, go to: http://www.medicationadvisor.com/art1.asp.


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