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The Pharmacologic Approach to the Critically Ill Patient

Theodore C. Smith, MD
Arch Intern Med. 1985;145(6):993. doi:10.1001/archinte.1985.00360060049003.
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Believing most pharmacologic specialty texts are not clearly superior to equivalent portions of the standard texts, I was surprised to find this one useful. The editors assembled 54 other authorities to write a reference source "for pharmacokinetic information and research data in addition to the more mundane prescribing information." It defines the "critically ill" as those in intensive care units and emergency rooms and those receiving resuscitation. On balance, the work is timely, valuable, and instructive, which makes the not-so-few lapses all the more disappointing by comparison.

It might be considered three texts in one. First, the section entitled "Clinical Pharmacology" reviews pharmacokinetics and pathophysiologic alterations caused by hepatic, renal, and pulmonary disease, as well as alterations in infants and children, including drug interactions. One might hope the next edition would add the effects of aging and cardiovascular disease. Twenty-four percent to 37% of the 863 citations are current, a


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