Respiratoire insufficiëntie na aspiratie van een medicatieblister

Respiratory failure after aspiration of a medication blister package INTRODUCTION To promote coaching of elderly patients in correct use of medication, we present the case of an old man who choked on a medication blister package. In Dutch nursing homes some of the elderly are responsible themselves for the management of their medication. The elderly often suffer from decreased cognition and handicaps which may complicate the correct use of medication. DESCRIPTION A 84-year-old man with a cardiac history and COPD was admitted with chief complaints of dyspnoea and cough productive of white sputum. After 5 days he developed respiratory failure with haemoptysis. Bronchoscopic examination revealed a foreign body in the right main bronchus which was successfully removed. It turned out to be a medication blister package. Two months earlier, the standard packaging of his medication (daily-dose packaging filled with loose tablets] by his pharmacy had been temporarily interrupted during admission to another hospital. After discharge, he choked on a blister package awaiting delivery of the next daily-dose packaging. DISCUSSION At discharge, patients are informed about changes in their medication regimen. Verification of correct medication use in the home setting after discharge is not standard yet in the Netherlands. Problems with handling of packaging can only become manifest once the patient is at home. CONCLUSION Hospital discharge is a critical moment; the ability to adequately deal with medication packaging can be (temporarily) reduced. Coaching chronically ill older patients after discharge, to ensure correct medication use, may reduce the rates of subsequent rehospitalisation

Acquisition of wild-type HIV-1 infection in a patient on pre-exposure prophylaxis with high intracellular concentrations of tenofovir diphosphate: a case report.

Pre-exposure prophylaxis (PrEP) with emtricitabine and tenofovir disoproxil fumarate is highly effective against acquisition of HIV infection, and only two cases of infection with a multidrug-resistant virus have been reported under adequate long-term adherence, as evidenced by tenofovir diphosphate concentrations in dried blood spots. We report a case of wild-type HIV-1 infection despite consistent use of emtricitabine and tenofovir disoproxil fumarate