title: Clinical response to unintentionally rapid infusion of drotrecogin alfa (activated).
abstract: OBJECTIVE
  The case of a patient with severe sepsis who received a bolus dose of 184 microg/kg of drotrecogin alfa (activated) over one hour is reported.
  
  
  CONCLUSIONS
  An 84-year-old woman who had undergone right total knee replacement was admitted to the hospital from a rehabilitation facility with an initial diagnosis of mental status changes and a suspected urinary tract infection. Examination of the patient's incision from her recent knee surgery revealed a discharge, and a culture was obtained. The patient was diagnosed with sepsis, intubated, and transferred to the intensive care unit. Multiple antibiotics were administered, but the patient's condition continued to deteriorate. In addition, the patient developed acute renal failure, required a ventilator, had cyanotic limbs, and had partially compensated metabolic acidosis. On hospital day 7, drotrecogin alfa (activated) was initiated. She inadvertently received an infusion of 184 microg/kg of drotrecogin alfa over 1 hour. Nine hours later, she received drotrecogin alfa 24 microg/kg/hr for 95 hours. The patient's clinical status was improved after the initial infusion. Peripheral limb cyanosis was markedly decreased, with pink, warm extremities. In addition, the patient's clinical laboratory test values improved after administration of drotrecogin alfa. However, the patient was unable to recover fully from the acute kidney failure and was discharged to hospice care.
  
  
  CONCLUSIONS
  A drotrecogin alfa dose of 184 microg/kg i.v. was erroneously administered over 1 hour to a patient with sepsis. Nine hours later, a drotrecogin alfa infusion of 24 microg/kg/hr was started and continued for 95 hours. The patient improved clinically and had no apparent adverse events.
authors.affiliation: Pharmacy Department, Indian River Medical Center (IRMC), Vero Beach, FL, USA.
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Urban
authors.forename: George A
authors.initials: GA
authors.lastname: Mitchell
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Wellborn-Kim
authors.forename: William F
authors.initials: WF
authors.lastname: Terneus
authors.forename: Charles M
authors.initials: CM
authors.lastname: Callahan
authors.forename: Joseph
authors.initials: J
authors.lastname: Mendes
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Webber
mesh_terms: D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003422:Critical Care; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008508:Medication Errors; D011486:Protein C / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018805:Sepsis / Q000188:drug therapy* / Q000503:physiopathology; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000890:Anti-Infective Agents; D011486:Protein C; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated