Removal of methadone by extended dialysis using a high cut-off dialyzer: implications for the treatment of overdose and for pain management in patients undergoing light chain removal
| Autor: | Julius J. Schmidt, Viktor Arelin, Jan T. Kielstein, Gabriele Eden, Nathalie Kayser, Hendrik Suhling, W. Nikolaus Kühn-Velten |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Analgesic 030226 pharmacology & pharmacy Dialysis tubing 03 medical and health sciences 0302 clinical medicine Renal Dialysis medicine Humans Pain Management In patient Dialysis Volume of distribution business.industry Acute kidney injury General Medicine Acute Kidney Injury medicine.disease Surgery Analgesics Opioid Nephrology Anesthesia Hemodialysis Drug Overdose business Methadone 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Clinical Nephrology. 85:353-357 |
| ISSN: | 0301-0430 |
| DOI: | 10.5414/cn108724 |
| Popis: | The synthetic opioid methadone hydrochloride has a low molecular weight of 346 D, a high volume of distribution (4 - 7 L/kg), and is lipophilic. It is used as an analgesic and for the maintenance treatment of opiate dependence. In drug addicts, methadone is frequently involved in mixed intoxications that can lead to death. Here we present the case of a drug addict in whom a high cut-off dialysis membrane together with extended dialysis was used in the setting of suspected overdose and acute kidney injury. Although the observed dialyzer plasma clearance (31.5 mL/min) and reduction ratio (38%) were higher than previously reported for standard hemodialysis, the total amount of methadone in the spent dialysate after 1 extended dialysis session was quite low. Hence, even extended dialysis with a high cut-off membrane does not seem to offer a clinically relevant benefit in the setting of overdose for enhanced methadone removal. On the other hand, in patients undergoing high cut-off dialysis for the removal of light chains, methadone could still be used as an analgesic without an additional dose after high cut-off hemodialysis. |
| Databáze: | OpenAIRE |
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