When drugs disappear from the patient: elimination of intravenous medication by hemodiafiltration.
Twenty-three hours after heart transplantation, life-threatening acute right heart failure was diagnosed in a patient requiring continuous venovenous hemodiafiltration (CVVHDF). Increasing doses of catecholamines, sedatives, and muscle relaxants administered through a central venous catheter were ineffective. However, a bolus of epinephrine injected through an alternative catheter provoked a hypertensive crisis. Thus, interference with the central venous infusion by the dialysis catheter was suspected. The catheters were changed, and hemodynamics stabilized at lower catecholamine doses. When the effects of IV drugs are inadequate in patients receiving CVVHDF, interference with adjacent catheters resulting in elimination of the drug by CVVHDF should be suspected.
Departments of Intensive Care Medicine, Bern University Hospital and University of Bern, Inselspital, Bern, Switzerland.
Kay H
KH
Stricker
Jukka
J
Takala
Roger
R
Hullin
Christoph C
CC
Ganter
D000208:Acute Disease; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D000328:Adult; D002405:Catheterization, Central Venous; D004837:Epinephrine / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology; D016027:Heart Transplantation / Q000009:adverse effects*; D006439:Hemodynamics / Q000187:drug effects; D006440:Hemofiltration / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000503:physiopathology; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000493:pharmacokinetics; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics
D000316:Adrenergic alpha-Agonists; D006993:Hypnotics and Sedatives; D009465:Neuromuscular Agents; D004837:Epinephrine