QuestionSBA
QuestionChoice
There is no need to repeat the blood test as the serum gentamicin level was taken accurately within 6 - 14 hours, allowing interpretation of the timing of the next dose
34441
b
Repeat the blood test at 0400 today
QuestionChoice
There is no need to repeat the blood test as the serum gentamicin level was taken accurately within 6 - 14 hours, allowing interpretation of the timing of the next dose
34442
c
Repeat the blood test at 1600 tomorrow
QuestionChoice
Gentamicin nomogram is used to determine when the next dose of gentamicin is due. In this situation, the trough level (taken 6-14 hours after the initiation of gentamicin) is 6mg/mL. Referring to the Hartford nomogram, the next dose should be given in the next 24 hours from the 1st dose, hence, 375mg IV at 1600 tomorrow
34440
a
Gentamicin 375mg IV 1600 tomorrow
QuestionChoice
As his trough level falls within the 24 hour frequency, the next dose should be given 24 hours from the first dose which was at 1600 and not from the time the sample was taken
34444
e
Gentamicin 375mg IV 2300 tomorrow
QuestionChoice
According to the nomogram, his trough level falls under the every 24 hour frequency, hence, the next dose should be given at 1600 tomorrow and not the day after
34443
d
Gentamicin 375mg IV 2300 the day after
QuestionComment
why do you not need to measure a pre-dose level as well as a trough level, to see if the next dose should be reduced/increased?
40023
QuestionComment
with gentamicin the dose stays the same and the interval between administration changes depending on the concentration plotted on that graph, assuming normal renal function
42260
User
subscriber
ButtMuncher
User
subscriber
Vaccine Ketone
QuestionComment
Where can you find the gentamicin normogram
43071
User
subscriber
JAK snow
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2831
Gentamicin monitoring
Topic
9
Internal Medicine
6899
Case Presentation:




A 55-year-old lady presents to the emergency department with rigor and pyrexia complaining of 3 day history of dysuria and urinary frequency. A urine dipstick was performed, which showed positive leucocyte esterase and nitrates. Microscopy, culture and sensitivity confirmed urosepsis, with sensitivity showing susceptibility to gentamicin. She is started on gentamicin 5mg/kg IV OD. Her first dose of gentamicin was administered at 1600 today. Weight 75kg.


 **Investigations**
Serum gentamicin at 2300 6mg/L


||||
|---------------------------|:-------:|--------------------|
|Urea|6.5 mmol/L|2.5 - 7.8|
|Creatinine|100 µmol/L|60 - 120|
|eGFR|>90 mL/min/1.73m<sup>2</sup>|> 60|


Question:
Select the most appropriate decision option based on these data and using the[Hartford Nomogram](http://www.leedsformulary.nhs.uk/docs/RxGentamicinHartford.pdf)
a