Abstract: Background: The aim of this study was to evaluate the influence of an infusion of NaCl 0.9% 500 ml during preparatory plasmapheresis or apheresis on the immunoglobulin G (IgG) content in separated plasma.
Subjects and Methods: 32 donors of plasma were studied in a crossover design after informed consent on a day without NaCl 0.9% 500 ml during apheresis and on another day with infusion of NaCl 0.9% 500 ml during apheresis. Infusion of NaCl 0.9% 500 ml was gradually given in divided doses after each cycle through the harness set of the Haemonetics® plasma collecting system 2 (PCS2). Concentrations of IgG in serum and in plasma were measured by an immunturbidimetric assay. Percentages of IgG concentrations in plasma were calculated by dividing the mean serum IgG concentrations (x100).
Results: Without infusion of NaCl 0.9% 500 ml the mean percentage of IgG in separated plasma was 85.5 ± 2.3%, and it was 80.5 ± 3.4% when NaCl 0.9% 500 ml was given. The difference between the two samples was statistically highly significant (p<0.001).
Conclusion: We conclude that the gradual infusion of NaCl 0.9% 500 ml during apheresis causes a statistically highly significant difference of IgG content in separated plasma.
Abstract: The aim of this study was to investigate the disposition of propafenone and its Phase I and II metabolites in relation to kidney function under steady-state conditions. The mechanism of the renal handling of propafenone glucuronides (filtration, secretion) was also examined. Racemic (R/S) propafenone was administered to 7 young volunteers, to 5 older patients with a normal glomerular filtration rate and to 4 patients with chronic renal failure. No difference was found in the plasma concentrations of propafenone and 5-hydroxypropafenone between the three groups. The propafenone glucuronide (PPFG) concentration was elevated in the older compared to the younger subjects (S-PPFG: 544 vs. 222 nmol.ml-1.mol-1; R-PPFG: 576 vs. 304 nmol.ml-1.mol-1). Although Glomerular filtration rate did not differ, the renal clearance of propafenone glucuronides was reduced in the former group, which could be attributed to their impaired renal secretion. A dramatic increase in propafenone glucuronide concentration was observed in the patients with renal failure (S-PPFG: 2783 nmol.ml-1.mol-1; R-PPFG: 7340 nmol.ml-1.mol-1). In summary, the disposition of propafenone and of its active metabolite 5-hydroxypropafenone was not affected by kidney dysfunction, indicating that no dose adjustment is necessary in patients with renal failure. The accumulation of drug glucuronides in older patients with apparently normal kidney function should be taken into account as a possible factor modifying drug therapy.
Abstract: A case of lorcainide poisoning with fatal outcome is reported. A young girl of 15 ingested, without high lethality of intent, 2500 mg lorcainide, an antiarrhythmic agent. Bradycardia, shock, coma, and cerebral convulsions rapidly occurred. Despite immediate resuscitative measures with high doses of catecholamines and hypertonic sodium bicarbonate the patient died three hours later. The course of lorcainide poisoning was similar to that of other class Ic antiarrhythmic agents.
Abstract: We report a retrospective evaluation of plasma concentrations of flecainide obtained from five dialysis patients during chronic oral treatment. A more than sevenfold variation in the dose/concentration relationship was observed. Plasma concentrations of flecainide above 1,200 ng/ml appeared to be associated with serious side effects and in one case with sudden death. Therefore, flecainide should be used with extreme caution in patients with impaired renal function. Frequent therapeutic drug monitoring should be mandatory.
Abstract: The elimination of cefmenoxime after single and repeated i.v. dosing was studied in 12 patients with severe renal failure and sepsis during continuous haemofiltration. More than 30% of the drug was found in the filtrate. The sieving coefficient (S) was 0.54. Vss% was unchanged 0.31 l.kg-1 in comparison with patients with normal renal function, whereas the mean t1/2ss was prolonged to about 16 h, and total clearance was reduced 20.8 ml.min-1.1.73 m-2. Once daily administration of 1 g cefmenoxime is suggested as the appropriate dose under such circumstances.
Abstract: This article describes concepts of drug treatment for patients with severe renal failure (creatinine clearance less than 10 ml/min), especially in intensive care. These subjects often develop multiorgan failure and require special considerations: 1. Not only should the maintenance dose of digoxin be reduced to 0.05-0.1 mg/day, but the loading or digitalizing dose should also be diminished to 0.4-0.6 mg. 2. Penicillins, cephalosporins, quinolones, and other antibiotics with a high therapeutic ratio can be given as recommended by the manufacturer or reference lists according to renal insufficiency. 3. For drugs with a low therapeutic index, such as aminoglycosides, vancomycin, flucytosine, some antiarrhythmic agents, cardiac glycosides, and theophylline, therapeutic drug monitoring is mandatory. 4. Steroids, insulin, atropine, catecholamines, anticoagulants, thrombolytic agents, antihypertensive drugs, and organic nitrates can be given according to their effect. However, nitroprusside should be discontinued after 2 days because its metabolites may be toxic. 5. The dose of H2-receptor antagonists used for the control of gastric acidity and the treatment of peptic ulcers should be reduced to 20-50% of the normal. The administration of aluminum, magnesium, and bismuth compounds should be avoided. 6. Loop diuretics (e.g., furosemide) can be effective at increased doses in patients with chronic renal failure and fluid overload, particularly when used in combination with a thiazide in refractory edema. Thiazides alone are useless, and potassium-sparing diuretics are contraindicated. 7. Colloid-containing solutions should be infused cautiously at a maximal rate of 2 x 500 ml/week only when the plasma volume is contracted.(ABSTRACT TRUNCATED AT 250 WORDS)
Abstract: Permanent vascular access for long-term hemodialysis should be prepared when serum creatinine exceeds 8.5 ± 2 mg%. As primary operation we make an artery-side to venous-end fistula at the wrist or side-to-side fistula near the elbow. From all complications - thrombosis, stenosis, bleeding, infection, aneurysm, steal-syndrome, nerve lesion, or cardiac decompensation - today most important appear stenoses which can be corrected by PTA or various operative measures. When veins are exhausted we use PTFE grafts as secondary vascular access, recommend CAPD as alternative to hemodialysis, or implant an atrial catheter.
Notes: Konner K, Evers J:
Erst- und Folgeeingriffe bei Dauerdialysepatienten mit AV-Fisteln nach Brescia-Cimino
Hämodialyse Shuntchirurgie ed. von Sommogy S, Kistler D, Blackwell Berlin, 147-153, 1993
Konner K, Adam M, Evers J, Finke K,
Erythropoietin and fistula thrombosis
angio archiv 22, 1991, 58 - 62
Konner K., Evers J., Renner E. :
Erythropoietin (rH-EPO) therapy and vascular access thrombosis. A clinical experience In: Progress in Access Surgery ed. by ..., Maastricht, 72-76, 1990, www.gefaesschirurgie-wien.at/downloads/shunttage95.doc - Ähnliche Seiten
Konner K, Karnahl HM, Evers J, Meider G:
Die transvenöse Serien-Xero-Arteriographie … zur Darstellung von AV-Fisteln bei Dauerdialysepatienten
Acces Surgery, 227-233, MTP Press (1982)
Konner K, Evers J, Meider G:
Die arterio-venöse Fistel zur chronioschen Hämodialyse nach Brescia-cimino.
Angio 3:121-127, 1981. ...ves.sagepub.com/cgi/content/refs/34/4/291 - Ähnliche Seiten
Abstract: The pharmacokinetics of isosorbide dinitrate (ISDN) and its two active metabolites isosorbide-2-nitrate (IS-2-N) and isosorbide-5-nitrate (IS-5-N) were studied in 20 patients with normal and impaired renal function after repeated oral doses of standard 20 mg tablets ISDN t.i.d. Blood samples were taken in the steady-state on days 2 and 14, and the plasma concentrations were measured by electron capture capillary gas chromatography. We found a wide variation of pharmacokinetic parameters (AUCss0-8 and t1/2) of ISDN, IS-2-N, and IS-5-N in our patients. No correlation was detected between AUCss0-8 or t1/2 and the degree of renal insufficiency. No drug accumulation was observed after 14 days of administration.
Abstract: We monitored the plasma levels of mexiletine in 20 dialysis patients with severe cardiac arrhythmias after repeated oral administration and the elimination by various dialysis procedures. The levels of mexiletine in plasma and dialysate were assayed by high-pressure liquid chromatography. After repeated administration of mexiletine 400-600 mg/day trough levels were in the range from 500-2,000 ng/ml. Treatment controlled by Holter monitoring was effective in 13/20 patients. Doses of 600 mg/day and more often were not tolerated by patients with dialysis after some weeks. There was no important removal of mexiletine from plasma during hemodialysis, hemofiltration, peritoneal dialysis, or plasmapheresis. In conclusion, we recommend a slightly reduced dosage of 400-600 mg mexiletine/day (usually 600-800 mg) for patients with end-stage renal insufficiency, irrespective of dialysis.
Abstract: The pharmacokinetics of isosorbide-5-nitrate (IS-5-N) was studied in ten patients on haemodialysis (HD) after a single oral dose of 20 mg IS-5-N, and in six patients on continuous ambulatory peritoneal dialysis (CAPD) after repeated oral doses of 3 X 20 mg IS-5-N. There was significant removal of IS-5-N from blood during HD; Cmax decreased by about 20%, AUC(0-8 h) by 30% and t1/2 by about 20% from 4.3 to 3.4 h, and plasma clearance was increased by 81 ml/min. No important loss of IS-5-N was observed in patients on CAPD.
Abstract: The pharmacokinetics of the antianginal drug isosorbide-5-nitrate (IS-5-N) was studied in 20 patients with varying degrees of chronic renal failure after repeated oral doses of standard 20 mg tablets t.d.s. Blood samples were taken in the steady state on the 2nd and 28th days, and the plasma level was assayed by HPLC. There was no statistically significant difference in Cssmax, t1/2 and AUCss0-8 between the 2nd and 28th days, nor was a difference found between patients with mild and severe renal failure.
Abstract: Kinetics of brotizolam (0.25 mg) were studied in patients with different degrees of renal failure after single and repeated oral ingestion. Serum levels were analysed by radio-immunoassay. Patients were divided into three groups according to their renal function, i.e. creatinine clearance values of 45-80, 15-45, or less than 15 ml/min. The mean elimination half-life was 6.9-8.15 h, with a considerable variation of the peak concentration and elimination half-life in slight to moderate renal failure. There was no delay in elimination in severe renal failure and there was no drug accumulation. No dose adjustment is necessary for brotizolam in renal failure.
Abstract: A 36 year old female patient hat taken 100 tablets Novo-Dolestan (or 30 g diethylpentenamid (DAPA) and 2.5 g diphenhydramin-hydrochloride). After 1 h she was found in coma and she was taken to the next hospital. The blood level of DAPA 2 hours after ingestion was 18 mg/100 ml. After primary therapy she was transmitted to our hospital for hemodialysis treatment. We performed a hemodialysis in combination with a charcoal hemoperfusion. After 2 hours she improved and wakened up on the next day. From 20 mg DAPA in 2 g charcoal we calculated that at least 6 g DAPA or >20% of the ingested dose was removed by hemoperfusion.
We concluded that hemoperfusion should be performed in addition to hemodialysis in severe intoxication with DAPA.
