Volume 186 - Issue 3
An unusual cause of severe metabolic acidosis
Authors: John V Peter, Natasha Rogers and Sandra L Peake
Med J Aust 2007; 186 (3): 158-159. || doi: 10.5694/j.1326-5377.2007.tb00847.x
Published online: 5 February 2007
Published online: 5 February 2007
In reply: Boyd and Hedger have raised concerns regarding the initiation and choice of antibiotics in our recent case report.1 Several aspects of this correspondence need to be addressed. The primary focus of the article was to highlight an important and probably underrecognised cause of unexplained metabolic acidosis, and discussion regarding antibiotic choice was not within the scope of the article.
Further, the patient’s management before admission to the intensive care unit was by a different treating team. Subsequent case-note review did not reveal reasons for initiation or choice of antibiotics other than described in our article, although it was evident that gentamicin doses were adjusted based on drug levels. We agree that a less nephrotoxic agent could have been chosen and that the profligate use of antibiotics in the absence of strong evidence of infection could have been avoided.
The excessive use of antibiotics in the current medical milieu may stem from a physician’s lack of confidence, or even legal ramifications of “watching and waiting” in the setting of “fevers, chills, rigors, raised inflammatory markers and neutrophilia”, as encountered in our patient.
References
- Peter JV, Rogers N, Murty S, et al. An unusual cause of severe metabolic acidosis. Med J Aust 2006; 185: 223-225. 0_FACBAIIF
Hospital-Admitted Injection-Related Infections Among Incarcerated People Who Inject Drugs in Australia: A Retrospective Cohort Study
Andrew Palmer, Matthew Carter, Jeremy Yeo, Cecilia Shim, Jason Connor, Jeremy Hayllar, Gerald Holtmann, Naomi Moy, Elliott G. Playford, Naomi Runnegar, Paul J. Clark
The Live Attenuated Influenza Vaccine in Australia: An Additional Tool for Influenza Prevention
Cyra Patel, Alexis Pillsbury, Tran Nguyen, Xia Wang, Helen E. Quinn, Clayton K. Chiu, Allen C. Cheng, Katie L. Flanagan, Zhicheng Wang
Reflex Testing for Hepatitis D Infection: A Unique Opportunity to Reduce Hepatitis D-Related Chronic Liver Disease Deaths in Australia
Jessica Howell, Lauren Andersson, Miriam T. Levy, James O'Beirne, Leon Adams, Katharine Irvine, Avik Majumdar, Golo Ahlenstiel, Kathy Jackson, Krispin Hajkowicz, Joseph Doyle, Jane Davies, Sarah Cherian, Wayne Dimech, Alexander J. Thompson
Localised Herpes Simplex Following Midline Laparotomy
Jessica S. Bulluss, Paul Chee, Matthew J. Verheyden
West Nile virus Kunjin subtype in rural NSW
Emily Gibson, Megan Whitley, Peter Murray, Linda Hueston, Jane Bennett, Raguharan Kathiresu, David N Durrheim
Differentiated and simplified oral HIV pre‐exposure prophylaxis (PrEP) models hold the key to virtually eliminating HIV transmission in Australia by 2030
Tyson Arapali, Sarah Warzywoda, Anthony K J Smith, Curtis Chan, Timothy R Broady, Erin Sullivan, Catherine MacPhail, Mohamed A Hammoud, Alexander Dowell‐Day, Benjamin R Bavinton