Acute renal failure secondary to milrinone in a patient with cardiac amyloidosis.
Milrinone is a phosphodiesterase type III inhibitor with positive inotropic and vasodilatory effects. A common side effect of milrinone is hypotension from the peripheral vasodilation. Although mild elevations in serum creatinine have been described previously in the setting of milrinone-induced hypotension, acute oligoanuric renal failure requiring renal replacement therapy has not yet been described. This case report is the first to document such a result and to report the successful use of peritoneal dialysis in this setting. Previous case reports documented vasopressin as an effective alternative to catecholamines in the treatment of milrinone-induced hypotension. This report documents the use of four vasopressor agents (including vasopressin) in this patient, with only vasopressin resulting in improvement in systemic vascular resistance and blood pressure. Vasopressin may be the most effective vasopressor agent in the treatment of milrinone-induced hypotension.
Saab
Georges
G
Renal Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
Mindel
Graeme
G
Ewald
Gregory
G
Vijayan
Anitha
A
D058186:Acute Kidney Injury / Q000209:etiology* / Q000628:therapy; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000686:Amyloidosis / Q000188:drug therapy*; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D004280:Dobutamine / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006331:Heart Diseases / Q000188:drug therapy*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D009638:Norepinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D010530:Peritoneal Dialysis / Q000379:methods; D010656:Phenylephrine / Q000008:administration & dosage / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D014667:Vasopressins / Q000008:administration & dosage / Q000627:therapeutic use
D000318:Adrenergic beta-Agonists; D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D014667:Vasopressins; D010656:Phenylephrine; D004280:Dobutamine; D020105:Milrinone; D009638:Norepinephrine