Saturday December 23, 2006
Iodide in Thyroid Storm

Q; How long should you wait to administer iodide after giving antithyroid medication in the management of thyroid storm ?

A; Atleast one hour.

Oral or rectal iodide compounds block release of thyroid hormones after starting antithyroid drug therapy. But if given early in management (before antithyroid medication become effective) it can get utilize in the synthesis of new thyroid hormone.

Read nicely written review on Thyroid Storm (and Myxedema coma) by Nikolaos Stathatos, MD, and Leonard Wartofsky, MD from Washington Hospital Center in Washington, D.C. - ref.: emedmag.com, 02/15/2003 issue.

Friday December 22, 2006
Ibutalide (Corvert)

Use of Ibutalide has practically became non-existent due to fear of provoking torsades de pointes. It is true that 4% of patients may develop torsades de pointes but still it is a very useful drug to convert atrial flutter or fibrillation of recent onset. It has a very high rate of chemical cardioversion.

Consider a situation where you have "only chemical code" patient who has gone into acute atrial fibrillation with severe hemodynamic instabilty. Amiodarone may not be a perfect choice as a chance of cardioversion with amiodarone is only 5% and overall it is a good drug for rate control instead of cardioversion. Moreover, bolus of amiodarone may dips down blood pressure further. Point is - intensivists need to be aware of this drug as a backup when all other options are exhausted.

The usual dose of ibutilide is 1 mg followed by another dose if the first one is not effective.