Critical Care and Shock

Accuracy of calculated creatinine among amputees: case presentation and literature review


Dosing vancomycin for patients who do not follow population pharmacokinetics can be challenging. Standard predictive clinical equations do not account for extreme patient characteristics. In particular, serum creatinine is significantly reduced while creatinine clearance is overestimated in patients with amputations. The “missing” body part must be accounted for when executing a dosing regimen for these challenging patients. In addition, health care professionals must judiciously review the patient holistically, practice evidence-based medicine, and consider the overestimation of renal function, when calculating doses for this and other agents. While current literature does not provide a clear consensus for this population, there are several factors to take into consideration when determining the optimal dose in patients presenting to the hospital requiring medications dosed by changes in renal function. We recently had one such case.