Shortage of mannitol for injection


The American Society of Health-System Pharmacists reports a shortage of mannitol for injection. Whenever a doc decides it is best for you to pee a lot in a hurry, this might be how he chooses to accomplish that. If your kidneys have stopped functioning in the short term for whatever reason, this injection might get them going. Rarely, it might be used to actually measure kidney function as the glomerular filtration rate, (GFR) but usually this is a calculation from other measurements in a lab report. If you’ve been treated for lead poisoning with dimercaprol/disodium EDTA  and want to get the bound toxic metal out of the body as fast as possible, this might be a good choice.

There are also a couple of instances when mannitol is pretty much a last resort. Sometimes the brain swells and the pressure inside your head builds up to the point that your life is endangered. As long as there is no actual bleeding in the brain that must be stopped by other measures, injecting mannitol can remove enough water from the brain and its surroundings to give you temporary relief. In the second instance, when the usual eyedrops haven’t worked to relieve pressure in your eyes and your vision is in danger of being destroyed, a mannitol injection might help.

Shortage of atracurium for injection

The American Society of Health-System Pharmacists reports a shortage of atracurium for injection. The reason for this shortage is that Ben Venue has given up on being able to profitably produce drugs that will pass FDA inspection at its Bedford, Ohio, location – the rust belt indeed. There are two other suppliers, but they aren’t able to meet demand. This drug or another in it’s class is used to relax the muscles so the gag reflex won’t interfere with the placement of a breathing tube down the airway prior to anesthesia and surgery. At that point a machine is breathing for the patient and his/her own muscles aren’t functioning at all. This also keeps the patient’s muscles from jumping or twitching when touched or cut.

However many states are still using a three drug combination to kill people by lethal injection"Old Main" NM State Penitentiary also use this drug or another of the same class as the second drug injected. The first drug causes the prisoner to lose consciousness, the second drug stops breathing, the third drug stops the heart. Drug shortages have forced both changes in the three drug combination and changes to the use of a single drug. Hence yesterday’s execution in Arizona in which the prisoner was alive for a little under two hours after the injection was started.

Shortage of calcium gluconate for injection

The American Society of Health-System Pharmacists reports a shortage of calcium gluconate for injection. There are several ways the human body can be deprived of the calcium it needs to function normally. The hormone that maintains the balance between the amount of calcium throughout the body and that used for bones may be deficient, for example. Teenage growth spurts or the rapid size increase of a fetus during the last trimester of pregnancy can all cause transient calcium shortages that can be corrected in the short term by injection and by educating the patient for the long term.

black widow

I was unaware that the muscle cramps resulting from the injection of black widow spider venom can be relieved by a calcium injection.

This shortage illustrates a new possibility granted the FDA by Congress. Until 2012 the FDA could only reject products for injection if they contained glass or metal particles. Now they have the option of allowing them to stay on the market and requiring that they be filtered before use.

In this particular instance, all lots of calcium gluconate for injection made by Luitpold Pharmaceuticals for distribution by American Regent have had vials containing glass particles. The vials with visible particles must be discarded and the others can be filtered as per this notice. The downside of this new flexible response to drug shortages is that this is not a new problem for Luitpold (2011 voluntary recall notice). Glass particles from the vials and metal particles from the manufacturing equipment are indeed one of the most common systemic problems in the drug industry. Generally speaking, they reflect the unwillingness of a manufacturer to invest in new production line equipment, something which is beyond the control of the FDA by law.





Shortage of tetracycline capsules

The American Society of Health-System Pharmacists reports a shortage of tetracycline capsules. This antibiotic has been on the market for a very long time for use both in humans and livestock. Consequently, many bacteria are able to continue growing in its presence, that is, they are antibiotic-resistant.


An antibiotic sensitivity test is therefore recommended. On the right is an example of the Kirby-Bauer disk diffusion method. Disks impregnated with various antibiotic concentrations are placed on o plate of solid growth media with the bacteria isolated from a person. The inner ring in which no bacterial growth occurs must be 19 mm in diameter.

Remembrance of Religious Violence

Three threads lead me to once more congratulate America’s founders for their knowledge of history and their foresight when they disestablished a state-sponsored religious institution. May we continue to reap the benefits of their wisdom.

I recently finished Adrian McKinty’s Troubles trilogy, which features a police officer attempting to fulfill his role in society during The Troubles. Although the books are set in the Thatcher period, there is a recollection of Sunday, January 30, 1972, also known as Bloody Sunday. On that date thirteen unarmed people participating in a peaceful civil rights march in Derry, Ireland, were killed by British paratroopers. In the course of a few months, IRA paramilitaries controlled large portions of Derry, where English law had become unenforceable.

what would Jesus do

The second thread was the appearance in my Facebook timeline of this graphic and its variations aimed specifically at bankers, starting before the Holy Week just past and increasing in frequency. The Temple was a powerful economic institution. Shekels were the only currency allowed for payment of the temple tax, hence the money changers. Animals suitable for sacrifice could only be purchased in a courtyard. The disruption of this system is a large part of what led to Jesus’ crucifixion.

Third was the remembrance during Holy Week of the violence done to Jesus. If you are part of one of the religious traditions that includes The Stations of the Cross, you might be more aware of this than most. Still, many people have been exposed to the story of betrayal, arrest, torture, and execution by crucifixion. Hardly any wonder that resurrection is the preferred focus for many.

I am glad this kind of violence is only a minor feature of life in the US. That said, where are the more civil expressions of outrage that lead to changes supported by the majority of Americans? Sixbears has a relevant quote, which makes more sense if you read his entire post.

“We can make pretend that politicians matter, that law enforcement has our respect, that the IRS should be feared, and so on. They are all a bit . . . challenged (bat shit crazy). We know how the power game is really played, so pretending to live in a functional democracy is just playing a polite game.”

Perhaps the time for politeness and gamesmanship will pass.