Acetaminophen clearance during ex vivo continuous renal replacement therapies
- 61 Downloads
Intravenous acetaminophen is an adjuvant to opioid use in critically ill and surgical patients requiring continuous renal replacement therapy (CRRT). The objective of this study was to determine the ex vivo transmembrane clearance of intravenous acetaminophen during continuous hemofiltration and hemodialysis. Transmembrane clearance was assessed using a validated ex vivo bovine blood model for CRRT using an F8 or HF1400 hemodiafilter. Ultrafiltrate and dialysate flow rates were 1, 2, and 3 L/h. Urea and acetaminophen clearances were calculated and compared. Acetaminophen was readily cleared by continuous hemofiltration with both hemodiafilters. Acetaminophen clearance rates were 92–98% of ultrafiltrate production rates. Similarly, dialytic acetaminophen clearances approximated dialysate flow rates for both hemodiafilters. Acetaminophen is readily cleared by CRRT. Patients receiving CRRT and acetaminophen may require increased doses for adequate pain control.
KeywordsIntravenous acetaminophen Critical care Continuous renal replacement therapy Dialysisex vivo clearance
- 1.Abelha FJ, Botelho M, Fernandes V, Barros H. Determinants of postoperative acute kidney injury. Crit Care. doi: 10.1186/cc7894.
- 4.Lewis SJ, Mueller BA. Antibiotic dosing in patients with acute kidney injury: “enough but not too much”. J Intens Care Med. doi: 10.1177/0885066614555490 .
- 5.Sinatra RS, Jahr JS, Reynolds LW, Viscusi ER, Groudine SB, Payen-Champenois C. Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery. Anesthesiology. 2005;102(4):822–31.CrossRefPubMedGoogle Scholar
- 6.American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012; 116(2):248–73.CrossRefGoogle Scholar
- 8.Ofirmev. [package insert]. San Diego, CA: Cadence Pharmaceuticals, Inc; 2010.Google Scholar