Pharmacists’ engagement in the inventory management of regular medicines in intensive care units (ICUs) generates economic effects; however, the existing literature has not examined all the aspects in detail. Therefore, in this study, we investigated whether pharmacists could improve the management of regular medicines in the ICU, which will reduce the economic loss incurred due to misplacement or damage.

　We compared the number of medicines reported to be in surplus, lost, or damaged and the amount of loss incurred before and after pharmacists’ engagement. We defined “before” and “after” as of September 1, 2016, to August 31, 2018, and September 1, 2018, to August 31, 2020, respectively.

　Consequently, the pharmacists reported a decrease in the number of damaged or misplaced medicines from 329 to 229 (30.4%), and the amount of loss incurred from 192,910 yen to 110,090 yen (42.9%). The number of medications reported as surplus inventory or loss has decreased significantly, which is related to management status rather than human error. In this study, the observed pharmacists’ inventory management in the ICU improved the management of regular medicines and reduced the economic loss incurred due to their misplacement or damage.

A 23-year-old woman with a history of refractory hives, for which she had been taking diaphenylsulfone (DDS) for 1 month, was transferred to our hospital because of a traffic accident. She had no dyspnea on admission, but her SpO₂ was low (92% on 10 L/min of O₂ with a reservoir mask). She had mild pain in her right chest; therefore, we suspected severe chest injury. However, computed tomography (CT) findings were normal. Blood gas analysis revealed a difference between SpO₂ (92%) and SaO₂ (98.8%), with 11.2% methemoglobinemia. She was diagnosed with methemoglobinemia caused by DDS, and DDS was discontinued. On the 5th day of admission, her methemoglobin level decreased to 4.0%, her SpO₂ increased to 97% (room air), and the difference between SpO₂ and SaO₂ improved. She was discharged on the 8th day of admission. It is necessary to consider the difference between SpO₂ and SaO₂ when SpO₂ is different from the clinical findings. Moreover, we must be aware that DDS can induce methemoglobinemia.

A stuck aortic valve is a fatal disease. Since it causes acute heart failure and cardiogenic shock, it usually requires surgical intervention. A 78-year-old man with a history of aortic valve replacement presented to the emergency department with acute onset of shortness of breath and chest pain. He presented with pulmonary edema and complete left bundle branch block. Echocardiography showed aortic valve stenosis (MaxV=4.23 m/s). We diagnosed acute heart failure and performed coronary angiography and cinefluoroscopy. Although his coronary artery was normal, cinefluoroscopy showed impaired motion of one of the leaflets of the mechanical aortic valve. Because of low PT-INR, we guessed it was caused by thrombosis. As his condition was stable at rest, we chose fibrinolysis as the first line of treatment, and started urokinase (120,000 units over a 12 h period) +heparin (10,000units per day). On the 7th day of hospitalization, we repeated cinefluoroscopy and confirmed the total restoration of leaflet motion. In conclusion, if the patient’s condition is stable, as the case may be, it is worth trying fibrinolysis instead of surgical intervention.