The use of CG and MDRD provided discordant estimations in over 60% of the elderly patients. While the importance of these equations cannot be questioned, caution should be exercised in situations where they have not been prospectively validated. Therefore, their interchangeable use cannot be advocated in the dosing of medications until further prospective validations are performed.
We describe here a case of olanzapine associated weight gain, hyperglycemia and neuroleptic malignant syndrome in a 64 year-old woman with a significant medical history. Eighteen weeks after initiating olanzapine, Mrs X lost glycemic control, exhibited signs and symptoms consistent with neuroleptic malignant syndrome and gained 8.9 kg. We suggest that utilization of olanzapine in the less medically stable geriatric patient be implemented with vigilant monitoring for such complications mentioned above.
Objectives:The primary objective of this study was to determine the incidence of prolonged corrected QT (QTc) intervals in a population of geriatric psychiatry inpatients. Our secondary objective was to examine the associations between prolonged QTc intervals and risk factors identified as determinants in prolonging the QTc interval.
Methods:We identified all geriatric patients (aged 60 years and older) who were admitted to the geriatric program of our facility between May 1, 2003, and December 31, 2003. Those patients with a heart rate QTc interval calculated on the electrocardiogram (ECG) were eligible for the study. We used Bazett's formula to calculate the QTc interval. We defined a priori that a prolonged QTc interval would be 450 ms and 460 ms for men and women, respectively. We collected data on demographic variables such as weight, sex, age, and Axis I and III diagnoses, as well as on recognized risk factors for prolonged QTc interval. We used Student's t tests to conduct parametric analysis on continuous variables, and chi-square to test categorical variables for independence.Results: During the study period, 88 patients were admitted to the geriatric division of Riverview Hospital. Of these patients, 34 men and 42 women had calculated QTc intervals on their ECG and therefore made up the study population. Our data show that 29.4% of men and 21.4% of women had prolonged QTc intervals. However, neither diagnostic nor medicinal risk factors were found to be associated with an increased incidence of prolonged QTc interval in this patient population.
Conclusion:The preliminary findings of this study suggest that in this patient population the QTc interval may not be influenced by recognized risk factors to the same extent as observed in the adult population. These results warrant confirmation by a larger, prospectively designed study. Clinical Implications · Known risk factors may not influence the QTc intervals of geriatric psychiatric patients to the same extent as they influence the QTc intervals of the adult population. · Sex differences in QTc interval are less apparent in the geriatric population, possibly owing to declining hormonal influences. · Cardiac risk factors tended to influence the QTc interval.Limitations · This was a cross-sectional study and the results need to be verified with a prospectively designed study. · The relatively small sample size may have prevented the identification of the influence of some risk factors on QTc. · The QTc interval itself is only a surrogate marker for the prediction of a serious cardiac event.
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