Population Pharmacokinetics of Intravenous Salbutamol in Children with Refractory Status Asthmaticus

Background: Intravenous salbutamol is used to treat children with refractory status asthmaticus, however insufficient pharmacokinetic data are available to guide initial and subsequent dosing recommendations for its intravenous use. The pharmacologic activity of salbutamol resides predominantly in the (R)-enantiomer, with little or no activity and even concerns of adverse reactions attributed to the (S)-enantiomer. Objective: Our aim was to develop a population pharmacokinetic model to characterize the pharmacokinetic profile for intravenous salbutamol in children with status asthmaticus admitted to the pediatric intensive care unit (PICU), and to use this model to study the effect of different dosing schemes with and without a loading dose. Methods: From 19 children (median age 4.9 years [range 9 months–15.3 years], median weight 18 kg [range 7.8–70 kg]) treated with continuous intravenous salbutamol at the PICU, plasma samples for R- and S-salbutamol concentrations (111 samples), as well as asthma scores, were collected prospectively at the same time points. Possible adverse reactions and patients’ clinical data (age, sex, weight, drug doses, liver and kidney function) were recorded. With these data, a population pharmacokinetic

Early recognition and access to terminal complement blockers in patients with atypical HUS significantly improves their outcome : a case report

A 7-year-old boy presented with fever, pruritus and petechiae. Laboratory analysis revealed haemolytic anaemia with presence of schistocytes, thrombocytopenia and acute kidney injury, diagnostic for a thrombotic microangiopathy (TMA). Given the severe clinical presentation, the lack of evidence for verotoxin positive TMA and a normal ADAMTS13, treatment with eculizumab was started. This resulted in a complete resolution of the TMA course with recovery of the kidney injury. Workup revealed high titre of anti-factor H antibodies, diagnostic for an atypical haemolytic uremic syndrome (aHUS). Early recognition and treatment of TMA is essential to optimize the outcome of these patients

Population Pharmacokinetics of Intravenous Salbutamol in Children with Refractory Status Asthmaticus

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