Creaming and plasma clearance rate of intravenous fat emulsion in critically ill patients

BackgroundInter-individual variation in pharmacokinetics in children is an area where there has been little research. We wished to determine the extent of inter-individual variation in the clearance of theophylline in paediatric patients of different ages.MethodsA systematic literature review was performed using the following databases; Embase (1974 to January 2013), Medline (1946 to January 2013), CINAHL (1937 to January 2013), International Pharmaceutical Abstracts (1970 to January 2013) and the Cochrane Library. From the papers, the range in plasma clearance and the coefficient of variation (CV) in plasma clearance were determined.ResultsA total of 56 articles reporting on 1,315 patients met our inclusion criteria. Twenty six studies gave individual data. The majority of the studies were in critically ill patients. Inter-individual variation was a major problem in all age groups. The CV was 9–93% in preterm neonates, 20–97% in term neonates, 18–52% in infants, 2–72% in children and 4.5–43% in adolescents. The mean clearance was higher in children (0.85 to 2 ml/min/kg) than in neonates (0.24 to 0.6 ml/min/kg).ConclusionsLarge inter-individual variation was seen, especially in critically ill patients. Inter-individual variation was higher in neonates than children and adolescents.

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Plasma clearance of iodine contrast media as a measure of glomerular filtration rate in critically ill patients

Critical Care Medicine ◽

10.1097/00003246-200108000-00008 ◽

2001 ◽

Vol 29 (8) ◽

pp. 1544-1550 ◽

Cited By ~ 60

Author(s):

Christiane M. Erley ◽

Birgit D. Bader ◽

Elke D. Berger ◽

Anika Vochazer ◽

Jork J. Jorzik ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Contrast Media ◽

Glomerular Filtration ◽

Critically Ill ◽

Critically Ill Patients ◽

Filtration Rate ◽

Plasma Clearance

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Cardiogenic Shock in a Hemodialyzed Patient on Flecainide: Treatment with Intravenous Fat Emulsion, Extracorporeal Cardiac Life Support, and CytoSorb® Hemoadsorption

Case Reports in Cardiology ◽

10.1155/2019/1905871 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Nicolas De Schryver ◽

Philippe Hantson ◽

Vincent Haufroid ◽

Mélanie Dechamps

Keyword(s):

Cardiogenic Shock ◽

Plasma Clearance ◽

Life Support ◽

Spontaneous Circulation ◽

Fat Emulsion ◽

Continuous Hemofiltration ◽

Intravenous Fat Emulsion ◽

Stage Renal Disease ◽

End Stage ◽

The Impact

A 67-year-old woman with a history of end-stage renal disease on hemodialysis received a therapeutic dose (150 mg daily) of flecainide for three weeks. She was admitted to the Emergency Department for malaise and dizziness, and the electrocardiogram revealed ventricular tachycardia treated by amiodarone. Hemodynamic condition remained stable, and the toxicity of flecainide was initially not suspected until she developed within 8 hours a cardiogenic shock requiring vasopressors. The patient then received sodium bicarbonate (300 mmol) and dobutamine but experienced cardiac arrest two hours later. The administration of intravenous fat emulsion (IFE) was associated with return of spontaneous circulation, but there was a relapse of cardiovascular shock at the end of IFE infusion. The patient was placed on extracorporeal cardiac life support (ECLS), continuous hemofiltration, and hemoadsorption using the CytoSorb® cartridge. Serial determinations of serum flecainide concentration were obtained during the course of hemoadsorption, with a terminal half-life of 3.7 h during the first four hours and a global plasma clearance of 40.3 ml/min over the first 22 hours. The weaning of ECLS was possible on day 7. Intravenous fat emulsion infusion was followed by a significant increase in serum flecainide concentration. In addition, while conventional techniques of extrarenal epuration usually appear as poorly effective for flecainide removal, a mean plasma clearance of 40.3 ml/min was observed using the hemoadsorption technique based on CytoSorb® cartridge. However, the impact on the clinical course was probably extremely modest in comparison with ECLS.

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Evaluation of glomerular filtration rate using iohexol plasma clearance in critically ill patients with augmented renal creatinine clearance

European Journal of Anaesthesiology ◽

10.1097/eja.0000000000001501 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Magalie Collet ◽

Dany Hijazi ◽

Pauline Sevrain ◽

Romain Barthélémy ◽

Marc-Antoine Labeyrie ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Creatinine Clearance ◽

Glomerular Filtration ◽

Critically Ill ◽

Critically Ill Patients ◽

Filtration Rate ◽

Plasma Clearance ◽

Iohexol Plasma Clearance

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Fat clearance rate and pulmonary gaz exchange after intravenous fat emulsion

Clinical Nutrition ◽

10.1016/0261-5614(90)90232-h ◽

1990 ◽

Vol 9 ◽

pp. 30

Author(s):

C. Guillaume ◽

J.M. Vedrinne ◽

C. Vedrinne ◽

R. Cartier ◽

M.C. Penes ◽

...

Keyword(s):

Clearance Rate ◽

Fat Emulsion ◽

Intravenous Fat Emulsion

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Inter-individual variation in midazolam clearance in children

Archives of Disease in Childhood ◽

10.1136/archdischild-2013-305720 ◽

2014 ◽

Vol 100 (1) ◽

pp. 95-100 ◽

Cited By ~ 11

Author(s):

Mohammed I Altamimi ◽

Helen Sammons ◽

Imti Choonara

Keyword(s):

Critically Ill ◽

Individual Variation ◽

Critically Ill Patients ◽

Plasma Clearance ◽

Full Range ◽

Age Groups ◽

Cochrane Library ◽

Preterm Neonates ◽

Term Neonates ◽

Critically Ill Neonates

ObjectivesTo determine the extent of inter-individual variation in clearance of midazolam in children and establish which factors are responsible for this variation.MethodsA systematic literature review was performed to identify papers describing the clearance of midazolam in children. The following databases were searched: Medline, Embase, International Pharmaceutical Abstracts, CINAHL and Cochrane Library. From the papers, the range in plasma clearance and the coefficient of variation (CV) in plasma clearance were determined.Results25 articles were identified. Only 13 studies gave the full range of clearance values for individual patients. The CV was greater in critically ill patients (18%–170%) than non-critically ill patients (13%–54%). Inter-individual variation was a major problem in all age groups of critically ill patients. The CV was 72%–106% in preterm neonates, 18%–73% in term neonates, 31%–130% in infants, 21%–170% in children and 47%–150% in adolescents. The mean clearance was higher in children (1.1–16.7 mL/min/kg) than in neonates (0.78–2.5 mL/min/kg).ConclusionsLarge inter-individual variation was seen in midazolam clearance values in critically ill neonates, infants, children and adolescents.

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