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Letters
May 6, 2009

Dexamethasone and Postoperative Bleeding After Tonsillectomy in Children—Reply

JAMA. 2009;301(17):1764-1766. doi:10.1001/jama.2009.576

In Reply: Drs Beutner and Koll ask for more details concerning the dexamethasone formulation that we used in our randomized trial. Our dexamethasone sodium phosphate solution also contained propylene glycol, edetic acid disodium salt, sodium chloride, and water. Of those, only edetic acid disodium salt (used as an antioxidant for many intravenous drug formulations) may theoretically have an effect on coagulation when used in very high doses.1 However, considering the minimal concentration of this substance when used as an additive, an increased bleeding risk is highly unlikely. A fatal case due to the chelating properties of edetic acid disodium salt with subsequent hypocalcemia has been described.2

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