date, some do not; some have used it for considerable periods and no longer need it; some find other controls effective. Methylphenidate is only one of the measures available for improving a situation that is very difficult for the family, the neighbourhood and especially the ADHD child. This medication allows many of our children to interact with their peers and siblings in a manner not possible before. Family life invariably improves: for a few hours in a day we can relate to our ADHD children as we do our other children experiencing the ups and downs of childhood. Another benefit is seen in the classroom. Although our children do not suddenly become model students they have the ability to concentrate for longer (or at all), listen more attentively and interact instead of underreacting or overreacting. A significant number have other learning disabilities, and yet we see them persevere in spite of their frustrations. It is a boost to their selfesteem. As I write this letter my child is in the adjoining rooom playing cars with a friend. The scenario is probably unremarkable to most people but invaluable to the parents of some ADHD children. I believe that this simple example is a tribute, in good part, to methylphenidate. Although there is potential for abuse of this drug (as with many drugs) we are happy with the statement from the Canadian Paediatric Society. I realize that we are a biased sample, but we feel that a substantial number of our ADHD children have been helped to achieve the sense of satisfaction that we take for granted in our other children. Those of us who chose this medication had to do a lot of soul-searching, reading and talking to the parents of other children who have used it. All of us tried the other avenues 998
CAN MED ASSOC J 1990; 143 ( 10)
first. We did not make uninformed decisions. Despite Kline's experience with his young patients there is definitely another side to the issue - a positive one. Suzanne M. Broste Chairperson Saskatchewan Foundation for Attention Deficit-Hyperactivity Disorder Saskatoon, Sask.
Luckily most pharmacists can unscramble almost any of my directions. However, it makes me wonder how many other physicians' prescription instructions get interpreted in ways other than what was meant. Grazina M. Girdauskas, MD Dermatologist 419-2425 Bloor St. W Toronto, Ont.
Decoding prescriptions F rom time to time we are warned to write legibly on our prescriptions. I won't claim any prizes for handwriting, but over the years I have learned to keep carbon copies of my prescriptions so that discrepancies by the pharmacist or a patient's claim that I did not prescribe something is easily checked by looking at my chart. However, I have run into a new glitch, and it would be interesting to know whether anybody else is having similar problems. When I prescribe any of the vitamin A acid preparations for acne I tell the patient not to apply the preparation immediately after washing but to wait at least half an hour. On the prescription I used to say "Apply one half hour after wash". Occasionally the pharmacist interpreted these directions to mean that the vitamin A acid had to be applied and washed off in one half hour. At that time I decided to change my directions to "Apply one half hour after washing". That appears to be a simple direction even to my frequently muddled way of thinking. However, a couple of patients have just told me that they find it inconvenient to apply the medicine and then have to check the clock to see when the half hour is up, so that they can wash it off. Again the pharmacist had written some variation of "Apply and wash off in one half hour".
Hypernatremia associated with N-acetylcysteine therapy for meconium ileus in a premature infant n their case report (Can Med Assoc J 1990; 143: 202-203) Dr. Jacob C. Langer, Dr. Boscoe M. Paes and Shari Gray failed to supply information that may be critical to understanding the pathophysiology involved. It is not clear if the N-acetylcysteine solution is absorbed from the ileal loop, and, if not, what the volume of the return is. In the latter case is the N-acetylcysteine itself absorbed? What are the concentrations of N-acetylcysteine and the osmolalities of the various formulations described? The authors assume that the hypernatremia is due to absorbed sodium. If this were the case the infant should have had either marked extracellular fluid volume overload or marked sodium diuresis. Were these observed, and what were the urine osmolality and the urine sodium concentration? There exists another possible contributor to the hypernatremia. Any nonabsorbed solute (N-acetylcysteine itself?) in the gut will draw water into the lumen and thus lead to a water deficit and hypernatremia. This possibility could be assessed by comparing the osmolality and sodium and
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CAN MED ASSOC J 1990; 143 ( 10)
first. We did not make uninformed decisions. Despite Kline's experience with his young patients there is definitely another side to the issue - a positive one. Suzanne M. Broste Chairperson Saskatchewan Foundation for Attention Deficit-Hyperactivity Disorder Saskatoon, Sask.
Luckily most pharmacists can unscramble almost any of my directions. However, it makes me wonder how many other physicians' prescription instructions get interpreted in ways other than what was meant. Grazina M. Girdauskas, MD Dermatologist 419-2425 Bloor St. W Toronto, Ont.
Decoding prescriptions F rom time to time we are warned to write legibly on our prescriptions. I won't claim any prizes for handwriting, but over the years I have learned to keep carbon copies of my prescriptions so that discrepancies by the pharmacist or a patient's claim that I did not prescribe something is easily checked by looking at my chart. However, I have run into a new glitch, and it would be interesting to know whether anybody else is having similar problems. When I prescribe any of the vitamin A acid preparations for acne I tell the patient not to apply the preparation immediately after washing but to wait at least half an hour. On the prescription I used to say "Apply one half hour after wash". Occasionally the pharmacist interpreted these directions to mean that the vitamin A acid had to be applied and washed off in one half hour. At that time I decided to change my directions to "Apply one half hour after washing". That appears to be a simple direction even to my frequently muddled way of thinking. However, a couple of patients have just told me that they find it inconvenient to apply the medicine and then have to check the clock to see when the half hour is up, so that they can wash it off. Again the pharmacist had written some variation of "Apply and wash off in one half hour".
Hypernatremia associated with N-acetylcysteine therapy for meconium ileus in a premature infant n their case report (Can Med Assoc J 1990; 143: 202-203) Dr. Jacob C. Langer, Dr. Boscoe M. Paes and Shari Gray failed to supply information that may be critical to understanding the pathophysiology involved. It is not clear if the N-acetylcysteine solution is absorbed from the ileal loop, and, if not, what the volume of the return is. In the latter case is the N-acetylcysteine itself absorbed? What are the concentrations of N-acetylcysteine and the osmolalities of the various formulations described? The authors assume that the hypernatremia is due to absorbed sodium. If this were the case the infant should have had either marked extracellular fluid volume overload or marked sodium diuresis. Were these observed, and what were the urine osmolality and the urine sodium concentration? There exists another possible contributor to the hypernatremia. Any nonabsorbed solute (N-acetylcysteine itself?) in the gut will draw water into the lumen and thus lead to a water deficit and hypernatremia. This possibility could be assessed by comparing the osmolality and sodium and
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