INTRODUCTION Clinical review, therapeutic drug monitoring (TDM) and adverse drug reaction (ADR) management contribute to the quality use of medicines by ensuring safe and appropriate dosage and administration of medicines, improving response to therapy and minimising medicinesrelated problems. Clinical review, TDM and ADR management commence when a patient presents or is admitted to a health service organisation and continue as routine activities throughout the episode of care in conjunction with assessment of current medication management and other clinical pharmacy activities.

Journal of Pharmacy Practice and ResearchVolume 43, Issue 2 p. 91-93 EditorialFree Access Clinical Pharmacy COSP – Standards of Practice for Clinical Pharmacy Services George Taylor PhC, MPharm, DipHospPharm, FSHP, George Taylor PhC, MPharm, DipHospPharm, FSHP Chairman, Clinical Lecturer G.Taylor@utas.edu.au SHPA COSP in Clinical Pharmacy, School of Pharmacy, Faculty of Health Science, University of Tasmania, Hobart, Tas., 7001Search for more papers by this author George Taylor PhC, MPharm, DipHospPharm, FSHP, George Taylor PhC, MPharm, DipHospPharm, FSHP Chairman, Clinical Lecturer G.Taylor@utas.edu.au SHPA COSP in Clinical Pharmacy, School of Pharmacy, Faculty of Health Science, University of Tasmania, Hobart, Tas., 7001Search for more papers by this author First published: 13 April 2015 https://doi.org/10.1002/j.2055-2335.2013.tb00226.xCitations: 14AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume43, Issue2June 2013Pages 91-93 ReferencesRelatedInformation

Objective: To describe magnesium flux and serum concentrations in ICU patients receiving continuous venovenous haemodiafiltration (CVVHDF).Design: Samples were collected from 22 CVVHDF circuits using citrate anticoagulation solutions (Prismocitrate 10/2 and Prism0cal) and from 26 circuits using Hemosol BO and heparin anticoagulation. CVVHDF prescription, magnesium supplementation and anticoagulation choice was by the treating intensivist. We analysed 334 sample sets consisting of arterial, prefilter and postfilter blood and effluent. Magnesium loss was calculated from an equation for conservation of mass, and arterial magnesium concentration was described by an equation for exponential decay.Results: Using flow rates typical of adults receiving CVVHDF, we determined a median half-life for arterial magnesium concentration to decay to a new steady state of 4.73 hours (interquartile range [IQR], 3.73-7.32 hours). Median arterial magnesium concentration was 0.88 mmol/L (IQR, 0.83-0.97 mmol/L) in the heparin group and 0.79 mmol/L (IQR, 0.69-0.91 mmol/L) in the citrate group. Arterial magnesium concentrations fell below the reference range regularly in the citrate group and, when low, there was magnesium flux from dialysate to patient. Magnesium loss was greater in patients receiving citrate.Conclusions: Exponential decline in magnesium concentrations was sufficiently rapid that subtherapeutic serum magnesium concentrations may occur well before detection when once-daily sampling was used. Measurements should be interpreted with regard to timing of magnesium infusions. We suggest that continuous renal replacement therapy fluids with higher magnesium concentrations be introduced in the critical care setting.