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.
Abstract
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.
Footnotes
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Accepted for publication July 9, 2009.
Jukka Takala is Section Editor of Critical Care and Trauma for the Journal. The manuscript was handled by Steve Shafer, Editor-in-Chief, and Dr. Takala was not involved in any way with the editorial process or decision.
The authors sought, and received, written permission from the patient to report the case.
Reprints will not be available from the author.