ME Rules Death Of Brooklyn 6-Month-Old ‘Accident’ Resulting From Antibiotic Overdose
A Brooklyn family is dealing with absolute devastation after their only child died following
a fatal mistake. Th eir baby boy was taken to the hospital with just a fever and was given what turned out to be a deadly dose
of medication.
Earlier Wednesday afternoon, the New York City Medical Examiner ruled the death of 6-month-old Amaan Ahmmad an
accident. Th e ME said the death was the result of complications following administration of an adult dose of the antibiotic
azithromycin, which is commercially known as Zithromax.
Instead of looking forward to a lifetime of birthdays, the family is now making funeral arrangements for their child. Ummay
Sultana and Amain Ahmmad said their son became ill last Friday, so they took him to Brookdale, where he was born.
“He catch cold and we took him to the emergency,” Sultana said.
Hospital records showed baby Amaan was brought to the ER “alert and responsive” and with the exception of a fever, which
was reportedly around 100, the nursing staff did not list any other visible symptoms.
But an examination led to a diagnosis of clinical pneumonia. Amaan was transferred to the pediatric unit and given a dose of
the azithromycin through an IV drip in his right arm.
According to the nursing notes, at least 36 minutes passed before the hospital staff realized something was wrong.
CBS 2’s Jay Dow spoke with the parents Wednesday and asked the boy’s father who he blames for his son’s death.
“Hospital management, doctor, nurse—of emergency,” he replied.
“I’m like ‘look, look my baby’s dying! My baby’s dying!’ and then nurse came over and said ‘no, you’re baby’s pretty good. He’s
sleeping,’” Sultana told CBS 2’s Sean Hennessey.
A copy of the hospital’s discharge summary states the child was given “Azithromycin (500mg), in error” — which led to
“cardiac shock.”
Family pediatrician Dr. Suzanne Loiselle said that dosage is more typical for an adult and not a 17-pound baby like Amaan.
“Nobody can feel worse for the family than the doctors and nurses that were involved in this child’s care,” Loiselle said. “About
80 milligrams would be appropriate for a child roughly in his weight class.”
Less than 24 hours after the overdose, Ummay and Amain were told their son was brain dead. Amaan was taken off a respirator
on Monday.
“Th ey told us there is no hope because his head is totally collapsed,” his father told Hennessey.
Brookdale Hospital would not answer questions from 1010 WINS or CBS 2, saying only: “We are investigating the circum
stances of this tragic incident and express our condolences to the Ahmmad family.”
“I never think like that he pass away forever,” Sultana said. “I thought he’s gonna come back.”
T
h e two fi rst-time parents said they are both devastated and outraged over a fatal medical mistake that cut short their baby’s
life just as it was getting started.
—Printed with permission of CBS Local
“A Case of Medication Error” by Brahmadeo Dewprashad
Page 1
Pre-Case Questions (40 points)
NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE
1. Sultana indicated that the baby “catch cold and we took him to the emergency.” She was referring to what is
known as the “common cold.” What causes the “common cold”? What are its symptoms? How is it usually
treated? Is the underlying cause of the illness treated or are only its symptoms treated? (3 points)
Reference: http://www.niaid.nih.gov/topics/commoncold/pages/default.aspx
2. Th e “common cold” and infl uenza (fl u) are diff erent. What causes infl uenza? What are its symptoms and how is
it generally treated? (3 points)
Reference: http://www.niaid.nih.gov/topics/Flu/understandingFlu/Pages/overview.aspx
3. What is pneumonia? What causes it? What is its relationship to infl uenza and the common cold? (3 points)
Reference: http://www.niaid.nih.gov/topics/pneumonia/Pages/Default.aspx
4. Pneumonia is usually treated with antibiotics. What is an antibiotic? (3 points)
Reference: http://www.nlm.nih.gov/medlineplus/antibiotics.html
5. Explain how azithromycin works to treat pneumonia without harming us. In other words, explain the mode of
action of azithromycin and the reason for its selective toxicity. (3 points)
Reference: http://chemistry.elmhurst.edu/vchembook/654antibiotic.html
6. Explain what is meant by the therapeutic index (TI) of a medication. (3 points)
Reference: http://www.britannica.com/EBchecked/topic/591179/therapeutic-index
7. (5 points)
(a) Defi ne a “conversion factor” and provide an example of it.
(b) Using a suitable example, explain how the conversion factor you provided can be used in a calculation.
8. Some conversions require the use of more than one conversion factor. Using a suitable example, explain how
two conversion factors can be used in a calculation. (4 points
Sample Solution
This is a tragic case highlighting the devastating consequences of medication errors. Let's address the pre-case questions based on the provided information and the referenced websites.
1. Sultana indicated that the baby “catch cold and we took him to the emergency.” She was referring to what is known as the “common cold.” What causes the “common cold”? What are its symptoms? How is it usually treated? Is the underlying cause of the illness treated or are only its symptoms treated? (3 points)
- Cause: The "common cold" is most often caused by viruses, with rhinoviruses being the most common culprits. Other viruses, such as respiratory syncytial virus (RSV), parainfluenza viruses, and human coronaviruses, can also cause colds.
- Symptoms: Common symptoms include a runny nose, nasal congestion, sore throat, cough, sneezing, headache, and sometimes a mild fever.
Full Answer Section
- Treatment: Treatment for the common cold typically focuses on relieving symptoms. This includes rest, drinking plenty of fluids, using over-the-counter pain relievers for fever and aches, decongestants for nasal congestion, and cough suppressants for cough.
- Underlying Cause vs. Symptoms: The underlying cause of the common cold (a viral infection) is generally not directly treated with readily available medications. Antibiotics, which target bacteria, are ineffective against viruses. Treatment aims to alleviate the symptoms while the body's immune system fights off the viral infection.
2. The “common cold” and influenza (flu) are different. What causes influenza? What are its symptoms and how is it generally treated? (3 points)
- Cause: Influenza, or the flu, is caused by influenza viruses. There are different types (A, B, C, and D), with influenza A and B being the primary causes of seasonal epidemics in humans.
- Symptoms: Flu symptoms can include fever (often higher than with a cold), cough (usually dry), sore throat, muscle aches, fatigue (often severe), headache, and sometimes runny or stuffy nose, and vomiting and diarrhea (more common in children than adults).
- Treatment: Treatment for the flu can involve antiviral medications (like oseltamivir, zanamivir, peramivir, and baloxavir) that can reduce the severity and duration of the illness, especially if started early. Supportive care, similar to cold treatment (rest, fluids, pain relievers), is also important for managing symptoms. In some cases, complications of the flu, such as pneumonia, may require antibiotic treatment if a secondary bacterial infection develops.
3. What is pneumonia? What causes it? What is its relationship to influenza and the common cold? (3 points)
- What is Pneumonia: Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and trouble breathing.
- Causes: Pneumonia has several causes, including:
- Bacteria: Streptococcus pneumoniae is the most common bacterial cause.
- Viruses: Viruses that cause the common cold and flu (like influenza virus, RSV, rhinovirus) can also lead to viral pneumonia.
- Fungi: Less common, but can cause pneumonia in individuals with weakened immune systems.
- Mycoplasma: A type of organism that is not quite a bacteria or a virus.
- Relationship to Flu and Common Cold: Both influenza and the common cold can sometimes lead to pneumonia. The initial viral infection can weaken the respiratory system, making it more susceptible to a secondary bacterial infection that can cause pneumonia. In other cases, certain viruses themselves can directly cause viral pneumonia. The case description mentions baby Amaan being diagnosed with "clinical pneumonia" after initially presenting with a fever, a symptom that can be associated with both a cold and the flu.
4. Pneumonia is usually treated with antibiotics. What is an antibiotic? (3 points)
- An antibiotic is a type of medication that is used to treat infections caused by bacteria. Antibiotics work by killing bacteria or by preventing them from growing and multiplying. They target specific processes essential for bacterial survival, such as cell wall synthesis, protein synthesis, or DNA replication. Antibiotics are ineffective against viral infections like the common cold or the flu.
5. Explain how azithromycin works to treat pneumonia without harming us. In other words, explain the mode of action of azithromycin and the reason for its selective toxicity. (3 points)
- Mode of Action of Azithromycin: Azithromycin is a macrolide antibiotic. It works by inhibiting bacterial protein synthesis. Specifically, it binds to the 50S ribosomal subunit of the bacterial ribosome, which is essential for the process of translation (the reading of mRNA to assemble proteins). This binding prevents the translocation of aminoacyl-tRNA, thus halting the elongation of the peptide chain and stopping bacterial growth (bacteriostatic effect at lower concentrations) or killing the bacteria (bactericidal effect at higher concentrations against susceptible organisms).
- Reason for Selective Toxicity: Azithromycin exhibits selective toxicity because it primarily targets the bacterial ribosome, which is structurally different from the ribosomes found in human cells (which are 80S, with 40S and 60S subunits). While there can be some minor interactions with mitochondrial ribosomes in human cells (which are more similar to bacterial ribosomes), the drug's primary action is on the bacterial 70S ribosome, leading to a greater effect on bacterial protein synthesis with less disruption of human cellular processes at therapeutic doses. However, at very high doses, even selective antibiotics can have toxic effects on the host.
6. Explain what is meant by the therapeutic index (TI) of a medication. (3 points)
- The therapeutic index (TI) of a medication is a quantitative measure of its relative safety. It represents the ratio between the dose of a drug that is toxic to 50% of the population (TD50, the median toxic dose) and the dose of the drug that is effective in 50% of the population (ED50, the median effective dose).
- Formula: TI = TD50 / ED50
- A higher therapeutic index indicates a larger margin of safety. This means that there is a greater difference between the dose required for a therapeutic effect and the dose that is likely to cause toxic effects. Medications with a low therapeutic index require careful monitoring of drug levels in the patient to ensure that the dose remains within the therapeutic range and does not reach toxic levels.
7. (5 points) (a) Define a “conversion factor” and provide an example of it.
- A conversion factor is a ratio that expresses how many units of one measurement are equal to a specific number of units of another measurement. It is used to convert a quantity expressed in one unit to an equivalent quantity in a different unit.
- Example: 1 kilogram (kg) = 1000 grams (g). The conversion factors that can be derived from this equality are:
- (1000 g) / (1 kg)
- (1 kg) / (1000 g)
(b) Using a suitable example, explain how the conversion factor you provided can be used in a calculation.
- Example Calculation: Let's say you have a mass of 2.5 kilograms and you want to convert it to grams. You would use the conversion factor where grams are in the numerator (the unit you want to convert to):
- Mass in grams = 2.5 kg × (1000 g / 1 kg)
- Mass in grams = 2.5 × 1000 g
- Mass in grams = 2500 g
- In this calculation, the "kg" units cancel out, leaving the answer in the desired unit of grams.
8. Some conversions require the use of more than one conversion factor. Using a suitable example, explain how two conversion factors can be used in a calculation. (4 points)
- Example: Let's say you want to convert a distance of 3 miles into feet. You know the following conversions:
- 1 mile = 5280 feet
- In this case, only one conversion factor is needed. However, let's take a slightly more complex example: converting a speed of 60 miles per hour (mph) to feet per second (ft/s). You would need two conversion factors:
- 1 mile = 5280 feet
- 1 hour = 3600 seconds
- Calculation:
- Speed in ft/s = 60 miles/hour × (5280 feet / 1 mile) × (1 hour / 3600 seconds)
- Speed in ft/s = (60 × 5280) / 3600 ft/s
- Speed in ft/s = 316800 / 3600 ft/s
- Speed in ft/s = 88 ft/s
- In this calculation, the "miles" units cancel out using the first conversion factor, and then the "hours" units cancel out using the second conversion factor, leaving the final answer in the desired units of feet per second. This demonstrates how multiple conversion factors can be chained together to perform more complex unit conversions.