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Biomedical subjects

A F Kossoy

Publications and source records attributed to A F Kossoy.

6 recordsLinked to original sources
PubMed1989

Are theophylline "levels" a reliable indicator of compliance?

Clinicians frequently rely on serum theophylline concentrations (STCs) as an indicator of compliance for asthma medications. Most patients with good compliance do not have excessive fluctuations during routine STC monitoring. However, our experience is that in certain patients, persistently low or erratic STCs may be a sign of abnormal theophylline disposition. With careful analysis of theophylline absorption (STC every 2 hours for 24 hours after oral theophylline doses) and elimination (serial STC for 12 hours after an intravenous dose of aminophylline), we identified several patients with previously unrecognized anomalies of theophylline pharmacokinetics. These include (1) a 16-year-old girl with consistent temporal fluctuation in STCs during administration of a sustained-release formulation every 8 hours because of delayed absorption and enhanced elimination of theophylline at night, (2) a 13-year-old girl with markedly delayed absorption of a once-daily preparation administered in the evening, (3) a 5-year-old boy with erratic absorption of a liquid theophylline preparation with significantly increased STCs during the night, and (4) a 49-year-old man with 60% bioavailability of aminophylline tablets. Based on these observations, we suggest that clinicians carefully consider the possibility of abnormalities in theophylline disposition before assuming unexpected deviations in STCs are solely the result of noncompliance.

Administration, Oral↗
PubMed1986

Renal tubular acidosis in infancy: a clinical approach to diagnosis and treatment.

Renal tubular acidosis is defined as the failure of the kidneys to respond appropriately to systemic acidosis. The usual criterion for diagnosis involves titration curves to establish renal bicarbonate threshold. This evaluation is time consuming, expensive, and probably avoidable in selected patients. We report four cases in which a presumptive diagnosis was based solely on clinical data. The criteria for diagnosis without bicarbonate titration curves include clinical and biochemical characteristics and therapeutic response. With use of such criteria, bicarbonate titration curves will be needed only for equivocal cases.

Acidosis, Renal Tubular↗
PubMed1985

Therapeutic indications in carbamazepine overdose.

After ingesting carbamazepine, our four patients had elevated serum drug levels but minimal symptoms and were treated conservatively with excellent results. While serum levels may provide the diagnosis, they do not indicate therapy, which depends upon clinical manifestations.

Adult↗
PubMed1985

Potentially toxic theophylline ingestions: are heroic measures indicated?

We have treated six patients with theophylline overdoses, all of whom had high blood theophylline levels but lacked symptoms of serious toxicity. All improved with conservative therapy. While other reports of theophylline overdose describe aggressive therapy in patients with high blood levels and serious toxic signs, we believe blood levels cannot be used to predict serious toxic reactions. The symptoms that precede toxic convulsions--excitation, irritability, twitching, and alertness--are more valuable than blood medication levels as indicators of the need for aggressive therapy.

Charcoal↗