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GENERAL ARTICLE

When Drugs Disappear from the Patient: Elimination of Intravenous Medication by Hemodiafiltration

Kay H. Stricker, MD^*, Jukka Takala, MD, PhD^*, Roger Hullin, MD, PhD, and Christoph C. Ganter, MD^*

From the Departments of *Intensive Care Medicine, Anesthesiology and Pain Therapy, and Cardiology, Bern University Hospital and University of Bern, Inselspital, Bern, Switzerland.

Address correspondence to Christoph C. Ganter, MD, Intensive Care Unit, Department of Internal Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. Address e-mail to chganter{at}bluewin.ch.

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.