Clinical Pharmacokinetics Consult Service

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Instructions

• When you have finished a section of the SOAP note click "Check Answers."
• If the grade box change from "Ungraded" to "CORRECT" you may proceed to the next section.
• If any grade box changes to "ERROR" then an entry must be corrected before proceeding. After making all necessary changes, click "Check Answers" as before.
• When the grade boxes for all sections display "CORRECT" you may print the plan for this consult by clicking the button at the bottom of the page.

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Problem: Bacteremia (Staphylococcus aureus)
 

Subjective BF presented to his primary care physician two days ago complaining of vague symptoms including fever, muscle aches and tiredness. He was admitted to the hospital yesterday by his primary care physician after blood samples tested positive for Staphylococcus aureus. ID service was consulted and vancomycin therapy meets approval criteria. ID recommends Cpk = 35-40 mg/L and Ctr = 10-15 mg/L
Objective   Gen: BF is a 40 year-old white male looking his stated age and in no acute distress.   Vitals: BP 138/87, Pulse 62, Respiratory Rate 16, Temp 102.5°F (oral) Height 6', Weight 176 lbs   Labs: Leukocyte count (WBC) = 15.5 x 106/mcl (3.5-5 x 106/mcl), Serum Creatinine = 1.2 mg/dL (0.5-1.7 mg/dL), Urea nitrogen (BUN) = 10 mg/dL (8-25 mg/dL)   Renal Fxn (lab calculator): ABW = kg   IBW = kg   ABW % of IBW = %   CrCl = mL/min with Cockcroft & Gault using IBW Vancomycin Therapy: Tx Day #1: vancomycin was started 1200 mg or mg/kg Q12H and give over 1 hour. Two doses were given (0800 and 2000).   Tx Day #2: vancomycin concs drawn around 3rd dose: Trough = 8.7 mg/L drawn at 0730 Dose = 1200 mg IV, infused from 0800-0900 Peak = 22 mg/L, drawn at 1100

 

Assessment & Goals
Use the lab Pharmacokinetic Dosing Calculator Ensure vancomycin is the drug selected and change the Calculation to REVISION Enter all required information (carefully) and use the calculator to determine the following information.
PART 1 - PK Parameters Revised Vd = L   Revised kel = hr-1   Revised t1/2 = hours	Part 1
PART 2 - Assessment of Concentrations Previous doses administered on time & represent steady-state.   Ct drawn appropriately.   Cpk drawn 1 hour late. If drawn correctly at 1000 then Cpk (corrected) = mg/L   Cpk (corrected) = Cpk / e(-kel * t')   where t' = time difference between Cpk and corrected Cpk   Calculate a new dose based on a 12 hour dosing interval and selected target trough of 12.5 mg/L (the middle of what was recommended by the ID service).   New dose = mg   Round dose to 1800 mg and press "Calculate Peak and Trough"   Based on new dose of 1800 mg q12 hours, using bolus model:   New Estimated Peak = mg/L   New Estimated Trough = mg/L	Part 2

 

Plan

All grade boxes must read "CORRECT." If so, you may press this button to print your Pharmacokinetic Consult Note.