Over the Counter Complexities

Abstract

See ''Severe Hypocalcemia and Acute Respiratory Failure in a 3-Month-old Boy With Constipation'' by Lucrezia et al on page e23 T he letter by Lucrezia et al. (1) highlights the dangers of overthe-counter medications and the assumptions that we make as clinicians, assuming that parents and caregivers have the necessary skills needed to dose medications. Some of the most common medicines prescribed by gastroenterologists are now over the counter including proton pump inhibitors, H2 antagonists, milk of magnesia, polyethylene glycol 3350, senna, bisacodyl, and enemas. At a time when care teams are busier than ever and electronic medical record communication between providers and families is at an all-time high, providing specific and standardized written instructions in the patients' native language becomes critically important as this case illustrates. The case also highlights the importance of taking a thorough, open-ended medication history including questions, such as 'describe to me how and when you take the medicine' and 'what are the barriers that you have to giving medications?' among many others. Finally, the case beautifully highlights the idea that all medications including those over-thecounter medications have risk, when given appropriately or, in this case, inappropriately and that risk-benefit counselling and documentation of these discussions is important. The authors are commended for bringing this learning case to the readers as clinicians of all levels can use this important reminder on the difficulties of practicing in the over-the-counter culture.