FRIDAY, Jan. 27 (HealthDay News) -- Following the U.S. Food Drug Administration's approval last year of an intravenous formulation of acetaminophen for fever and pain in a hospital setting, researchers warn that use of the preparation could lead to serious overdoses, particularly among the youngest patients.
The problem: There is confusion over measurement guidelines -- milligrams vs. milliliters, to be specific -- that can result in the accidental administration of doses that are up to 10 times more than the proper amount.
"This product would be given in a health care facility," said study co-author Dr. Richard Dart, from the Rocky Mountain Poison and Drug Center at Denver Health in Colorado. "And thus, the overdose ends up being from a miscalculation by a health care provider."
"In theory, the risk to the child is that they could develop serious liver injury," Dart added. "Liver injury is avoided if the overdose is detected and the antidote [acetylcysteine] is administered within several hours. [But] the challenge in the case of an intravenous overdose is that the medication error needs to be detected by the health care provider because it doesn't produce identifiable symptoms," apart from nausea and vomiting.
Dart and his colleague, Dr. Barry Rumack, discuss their concerns in the February issue of Pediatrics.
The authors noted that dosages of IV-administered acetaminophen are calculated in milligrams, mixed at a ratio of 10 milligrams of the drug for every one milliliter of a non-drug solution. Problems arise if and when that drug ratio is improperly executed.
Since it came on the global market a decade ago, the IV option has been very popular, with roughly 500 million doses having already been distributed to patients of all ages worldwide.
The FDA approval, however, restricted the drug's use to American patients above the age of 2. But, given the inherent difficulty in administering oral versions of the drug to pediatric patients, the authors cautioned that so-called "off label" use of the drug among very young Americans is pretty much inevitable.
Despite the fact that overdosing (pediatric or otherwise) has not yet been widely reported in the United States, the authors pointed to dozens of pediatric overdose cases in Britain and elsewhere across Europe (most involving children under the age of 1).
Dart and Rumack advised that hospitals using IV acetaminophen work with pharmacy and nursing staff to raise awareness of the overdose dangers. They also suggest that clinicians watch for accidental poisonings and report overdoses.
"This type of error is unfortunately common in medicine, and affects many drugs," said Dart, who also works in the department of emergency medicine at the University of Colorado School of Medicine. "I think the wisest way of avoiding the problem is to make sure that all orders written in a hospital are reviewed by a pharmacist before they are implemented. This markedly reduces the opportunity for error."
Frank Federico, a pharmacist and executive director of the Institute for Healthcare Improvement in Cambridge, Mass., believes "there are ways to ensure or at least improve the safety of drug administration in a hospital setting for pediatrics."
"For example, when you have a drug like this one that is ordered in milligrams but administered in milliliters you need a good safeguard and system that ensures that the conversion is simple and easy to do," he said. "And so you have computers do the math for you, rather than a person. You eliminate human error and you use clearly printed labels."
Federico, who once served as director of pharmacy at Children's Hospital Boston, suggested that it is possible to put in place a labeling protocol that is straightforward and allows for multiple checks.
"Our labels listed the concentration of the product, with the most basic ratio in there," he noted. "It was clear. And that way not only was the technician who was preparing the product clear on how much liquid was necessary, but so were the pharmacists who would check and the nurses who would check."
Parents should also not be afraid to ask hospital staff to double check the dosing. "Asking is always appropriate," he added.
More information
For more on medication errors, visit the U.S. Food and Drug Administration.
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Money is often tight these days and you make an effort to save it, but much of that effort might be wasted on strategies that hurt more than they help. Paul Michael of the personal finance blog Wise Bread shares his insights on which savings tactics you should avoid to prevent yourself from accidentally spending more. 
It's something I did in college when money was tight. "Ahh, who needs to pay money to a dentist to have him tell me I should floss more?" Well, after leaving the dentist alone for a few years, I paid the price. Avoiding the regular cleanings and check-ups left me facing a hefty bill later on when I needed a bunch of costly fillings. I was lucky that I didn't need root canals or replacement teeth. Now I have a dental plan that covers free check-ups twice a year, but even if you don't, get to the dentist and doctor for health checks. It's a lot better to pay a co-pay now than pay for major surgery later on. And worse still, it could even cost you your life, especially as so many conditions can be treated if they're caught early enough.
You are probably asked this all the time - "Would you like to sign up for our credit card today and save 30% instantly on your purchase?" It's a good deal, IF you actually pay off the credit card in full when you get the first statement. Sadly, when that first statement arrives, many people find it way to easy to avoid the pay-off amount and instead pay the much smaller minimum payment. Before long, you're paying the minimum every month, adding more to the store card, and you're suddenly a credit card revolver who is paying hefty interest charges. That initial 30% you saved can cost you so much more if you're not careful. Pay it late, just once, and you can add late fees and interest rate hikes to your burden.
Many people use software like TurboTax and TaxCut, and they do save a bunch on an accountant. These software programs are OK for very basic tax preparation. But if you have anything slightly more complex, it's well worth your time to hire a tax professional to file your return. These people are trained in the minutia of the lengthy tax codes, and they can find deductions are tax exemptions that you have no idea about. And while the software may be able to take these into consideration, you need to know what you can actually legally deduct before entering it. I have a tax accountant, she charges around $250 to prepare my taxes, and she has saved my thousands over the years. She asks questions that the software doesn't, and she knows how to get me the biggest possible refund. I would never trust tax software over her for my situation, despite the massive initial saving. And remember, tax preparation fees are also tax deductible the following year!
It's essential these days to have an emergency fund. The finance experts say you need six months to one year of expenses (although how anyone does that in this dire economy, with pay raises not meeting inflation and massive unemployment, is something of a miracle). But experts also agree that you need to look after your financial future, as you cannot rely on any kind of state pension. If you're squirreling away money now into an emergency fund or savings account, but you're not putting money into a 401(k), IRA, or other long-term savings plan, you're not prepared for something you know is coming - old age. And with compound interest being what it is, every day you put it off is thousands of dollars wasted. If your employer has a 401(k) match, that's also additional money you are throwing away. Be smart, think long term. Once you have that in place, by all means build your emergency fund.
I've said it before, I'll say it again - buy cheap, buy twice. Now, being a Wise Bread blogger does not mean I don't like quality items; I just don't like to pay retail for them. Almost everything I buy is well below the RRP or MSRP, but it's usually a well-made product with a good rating. That goes for clothes, shoes, electronics, tools - you name it. However, if you buy a screwdriver set for $1 at a dollar store, or get your shoes for a few bucks at a flea market stall, the chances are you'll be buying them again real soon. Cheaply made, poor-quality items may save you a few bucks in the short term, but you'll only have to pay more later to replace them. And if you replace them with more cheap junk, you'll be repeating the cycle. You get what you pay for. The only time I would say that this is not true is buying generic brands in the grocery stores. In that case, you're usually buying the same product that's in the name-brand tin or packet but for half the price.
You may be a world-class speedy shopper or errand runner, but you just aren't that lucky. Sooner or later, and probably sooner, if you try and dodge the parking meters, you will get a ticket. These days, a parking ticket can run you anywhere from $10 to $50, depending on which city you live in. Is it worth gambling that 25 cents for a ticket?
BOGO (Buy-One-Get-One), when it's genuine, is hard to resist. But even then, whether it's BOGO free or BOGO half price, you have to stop and ask yourself "would I really have bought this much of this item at this price anyway?" For instance, if you go to a store looking for jam, and you see BOGO free on jam, that's probably a great time to stock up. But if you're looking for a new pair of sneakers and see BOGO half off, stop and think. You went out looking to spend $60 on sneakers. Now you're spending about $100 after taxes. Did you even want two pairs? Will you wear them both? Do you even like the second pair you're buying? Sure, it can be a great deal, but if you really only want, and need, one pair, you should only buy one pair.
At the time of writing this article, the average cost of a gallon of regular gasoline is $3.28. And the average vehicle MPG is around 23. That gives you around 7 miles for every dollar you spend on gas. Do the math. For example, if you want to put 10 gallons of gas in your car, and drive four miles out of your way to buy gas that is five cents cheaper per gallon, you have spent 57 cents to save 50 cents. And you've wasted your time, put more wear on your tires, and used up oil life as well. True, it's not a lot, but in the grand scheme of things, it's just not worth it. I've also talked to people who traveled 30-40 miles, one way, to buy something used from Craigslist. So right there, you're adding up to $10 to the cost of the item you're buying.
Most of us use a car to get to work. It's something that we need to make money. It's also something that needs regular maintenance, just like your own body. But many of us like to save that money and do only the basics. We'll take it in for an oil change, run it through the car wash, and that's about it. Of course, then the time comes to get your next oil change, and the mechanic has to inform you that your tires are worn on one side because you didn't rotate them. Or you discover that little knocking sound you ignored needs a major repair. When it comes to cars, the old adage "a stitch in time saves nine" couldn't be more true. Take care of your car, and it will take care of you.
I'm guilty of this one from time-to-time because bargains are so hard to pass up. When you see a whole bunch of bananas on sale for less than half the price, you grab them. But then you watch them turn black because you bought too many. I have lost count of the food items I have bought over my lifetime that I never got a chance to use. Ironically, when I was a poor student, it didn't happen. I would shop from day to day, buying fresh produce and cooking it that night. It would last two or three meals and then I'd start again. The fridge was bare. These days, I have so much stuff in the fridge I don't know what's in there, and I think that's a big problem. We load up on cheap bulk items and then have no way of using it all. So, while buying in bulk is good for lots of things, be careful when buying perishables. It's not a bargain if you throw it away.
