Subject(s)
Humans , Multiple Organ Failure/therapy , Respiratory Distress Syndrome, Newborn/therapy , Systemic Inflammatory Response Syndrome/therapy , Adjuvants, Immunologic/pharmacology , Body Water/physiology , Capillary Permeability , Colloids/pharmacology , Hemofiltration , Nutritional Requirements , Respiration, Artificial , Cardiopulmonary Resuscitation , Systemic Inflammatory Response Syndrome/drug therapy , Water-Electrolyte BalanceABSTRACT
We studied the pharmacokinetics and clearence of a 200 mg ciprofloxacin and a 500 mg amikacin intravenous dose during 5 continuous hemodialysis procedures in 5 patients with acute oliguric renal failure. Hourly blood and ultrafiltrate drug concentrations were measured during 8 hours. Dialysate flux (Qd) was 16.6 ml/min during the first hours and 33.2 ml/min thereafter. For each Qd, total ciprofloxacin clearence was 1.13ñ0.99 and 2.8ñ1.71 ml/min (p<0.001), diffusive clearence was 0.96ñ0.87 and 2.47ñ1.56 ml/min (p<0.005) and convective clearence was 0.16ñ0.17 and 0.33ñ0.2 ml/min (p<0.05). Likewise, total amikacin clearence was 3.47ñ1.31 and 4.18ñ0.53 ml/min (p<0.001), diffusive clearence was 2.97ñ1.24 and 3.86ñ0.52 ml/min and convective clearence was 0.50ñ0.47 and 0.32ñ0.29 ml/min (p=NS). Protein binding was 84 percent for ciprofloxacin and 77 percent for amikacin. It is concluded that during continuous hemodialysis with cuprofan membrane, the main transport mechanism of ciprofloxacin and amikacin is diffusive. Very low amounts of ciprofloxacin are depurated by the dialyser. Likewise, the shortening of amikacin half life suggest the presence of other elimination pathway and the need to use suplementary doses every 24 hours