Pharmacokinetics of ceftolozane/tazobactam continuous infusion on renal replacement therapy: a pediatric case report

Pharmacokinetic parameters can be significantly altered for both extracorporeal life support (ECLS) and continuous renal replacement therapy (CRRT). This case report describes the pharmacokinetics of continuous-infusion meropenem in a patient on ECLS with concurrent CRRT. A 2.8-kg, 10-day-old, full-term neonate born via spontaneous vaginal delivery presented with hypothermia, lethargy, and a ~500-g weight loss from birth. She progressed to respiratory failure on hospital day 2 (HD 2) and developed sepsis, disseminated intravascular coagulation, and liver failure as a result of disseminated adenoviral infection. By HD 6, acute kidney injury was evident, with progressive fluid overload >1500 mL (+) for the admission. On HD 6 venoarterial ECLS was instituted for lung protection and fluid removal. On HD 7 she was initiated on CRRT. On HD 12, a blood culture returned positive and subsequently grew Pseudomonas aeruginosa with a minimum inhibitory concentration (MIC) for meropenem of 0.25 mg/L. She was started on vancomycin, meropenem, and amikacin. A meropenem bolus of 40 mg/kg was given, followed by a continuous infusion of 10 mg/kg/hr (240 mg/kg/day). On HD 15 (ECLS day 9) a meropenem serum concentration of 21 mcg/mL was obtained, corresponding to a clearance of 7.9 mL/kg/min. Repeat cultures from HDs 13 to 15 (ECLS days 7–9) were sterile. This meropenem regimen was successful in providing a target attainment of 100% for serum concentrations above the MIC for ≥40% of the dosing interval and was associated with a sterilization of blood in this complex patient on concurrent ECLS and CRRT circuits.

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Population pharmacokinetics and probability of target attainment in patients with sepsis under renal replacement therapy receiving continuous infusion of meropenem: sustained low‐efficiency dialysis (SLED) and continuous veno‐venous haemodialysis (CVVHD)

British Journal of Clinical Pharmacology ◽

10.1111/bcp.14846 ◽

2021 ◽

Author(s):

Isabella Westermann ◽

Silke Gastine ◽

Carsten Müller ◽

Wiebke Rudolph ◽

Frank Peters ◽

...

Keyword(s):

Renal Replacement Therapy ◽

Continuous Infusion ◽

Replacement Therapy ◽

Population Pharmacokinetics ◽

Target Attainment ◽

Low Efficiency

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Sodium fluoracetate's poisoning: A case report

Revista Médica de Risaralda ◽

10.22517/25395203.24444 ◽

2020 ◽

Vol 26 (2) ◽

Author(s):

Diana Ávila Reyes ◽

Juan Camilo Galvis Mejía ◽

Jose Fernando Gómez González ◽

Mateo Aguirre Flórez

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Case Report ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Lethal Dose ◽

Clinical Manifestations ◽

Timely Manner ◽

Satisfactory Outcome ◽

Cardinal Symptom

Introduction: Sodium fluoroacetate, known as compound 1080, was discovered in Germany during the Second World War. It is usually used as a rodenticide, it is an odorless and tasteless substance, with a lethal dose in humans of 2 mg / kg that is why it was withdrawn from the market in some countries, including Colombia; however, it is obtained illegally. This substance has biochemical and physiological effects at the cellular level that alter the transport of citrate at the mitochondrial level, generating accumulation of lactic acid and alteration of the glucose use. The clinical manifestations are nonspecific since there is no any cardinal symptom. Therefore, its diagnosis is made due to high clinical suspicion associated with establishment of exposure to the compound in view of the difficulty to obtain paraclinical confirmation in a timely manner. Methods: We present a case report of intentional ingestion of sodium fluoroacetate in an adolescent that is associated with an infection added to the bloodstream by methicillin- sensitive Staphylococcus aureus (MSSA). The patient developed multiple complications that lead to support in the Intensive Care Unit (ICU) with a satisfactory outcome. In view of the lack of a specific antidote, she was treated with ethanol in order to increase the level of acetate; thus, offering an alternative substrate to the Krebs cycle. It is suggested that the ethanol offers benefits in the acute treatment of these patients. Results: The patient with sodium fluoroacetate poisoning and kidney failure received renal replacement therapy with a favorable evolution and survival at discharge from the intensive care unit of a third-level hospital in the city of Pereira, Risaralda, Colombia. Conclusions: Sodium fluoroacetate poisoning is relatively rare and can cause acute kidney injury and multi-organ failure with a high rate of complications and death. A case of self-inflicted poisoning that received a timely manner continuous renal replacement therapy with a favorable outcome in terms of ICU survival was presented.

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Successful Use of Extracorporeal Life Support and Continuous Renal Replacement Therapy in the Treatment of Cardiogenic Shock Induced by Tumor Lysis Syndrome in a Pediatric Patient With Lymphoma: A Case Report

Frontiers in Medicine ◽

10.3389/fmed.2021.762788 ◽

2022 ◽

Vol 8 ◽

Author(s):

Zhulin Wang ◽

Fang Zhang ◽

Long Xiang ◽

Yinyu Yang ◽

Wei Wang ◽

...

Keyword(s):

Case Report ◽

Renal Replacement Therapy ◽

Cardiopulmonary Resuscitation ◽

Cardiogenic Shock ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Tumor Lysis Syndrome ◽

Electrolyte Imbalance ◽

Tumor Lysis ◽

Critical Ultrasound

The use of extracorporeal membrane oxygenation (ECMO) in the treatment of cardiopulmonary failure in children with malignant tumors is controversial. There are few reports on the use of ECMO in the treatment of children with tumor lysis syndrome. This article reports a case of a 9-year-old girl who presented with hyperkalemia and cardiogenic shock. The discovery of an abdominal mass with critical ultrasound provided key evidence for the initial diagnosis of tumor lysis syndrome. Cardiopulmonary resuscitation was performed for 1 h. Veno-arterial ECMO was installed at the bedside to provide cardiopulmonary support for the patient and was combined with continuous renal replacement therapy (CRRT) to improve her internal environment. The patient was ultimately diagnosed with mature B-cell lymphoma with tumor lysis syndrome. A severe electrolyte disorder led to cardiogenic shock. After the electrolyte imbalance was corrected, the patient's heart function gradually improved, ECMO was successfully weaned, and chemotherapy was continued with the support of CRRT. One month after ECMO weaning, the organ function of the patient had recovered and there were no serious complications. In this case report, we paid attention to the rapid diagnosis of the etiology behind a patient's shock with critical ultrasound as well as the initiation and management of extracorporeal cardiopulmonary resuscitation (ECPR), which provided us with valuable experience using VA-ECMO on critically ill children with tumors. It is also important evidence for the use of ECMO in the treatment of children with cardiopulmonary arrest secondary to malignancy.

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Acute nephrotoxicity and neurotoxicity associated with concentrated star fruit juice consumption

BMJ Case Reports ◽

10.1136/bcr-2020-234460 ◽

2020 ◽

Vol 13 (12) ◽

pp. e234460

Author(s):

Isolda Prado de Negreiros Nogueira Maduro ◽

Alba Regina Jorge Brandão ◽

Karla Cristina Petruccelli Israel

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Case Report ◽

Renal Replacement Therapy ◽

Kidney Disease ◽

Replacement Therapy ◽

Fruit Juice ◽

Neurological Dysfunction ◽

Star Fruit

Star fruit toxicity has been hugely described in patients with chronic kidney disease, either on conservative or renal replacement therapy. This is a case report of a man, without prior kidney or neurological dysfunction, who appeared to develop nephrotoxicity and neurotoxicity less than 12 hours after drinking concentrated star fruit juice (approximately 20 units of the fruit). He received timely renal replacement therapy and renal function fully recovered after discharge.

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