肝硬化和非肝硬化枸橼酸药代动力学.pdf

Citrate pharmacokinetics and metabolism in cirrhotic and noncirrhotic critically ill patients Ludwig Kramer; Edith Bauer; Christian Joukhadar; Wolfram Strobl; Alexandra Gendo; Christian Madl; Alfred Gangl Objectives: To investigate pharmacokinetics and metabolism bonate concentrations increasing more slowly in cirrhotic pa- of sodium citrate in critically ill patients. To determine the risk of tients. No citrate-related side effects were noted. Citrate clear- citrate accumulation in the setting of liver dysfunction (cirrhosis, ance could not be predicted by standard liver function tests and hepatorenal syndrome). was not appreciably influenced by renal function and Acute Design: Prospective cohort study. Physiology and Chronic Health Evaluation II scores. Setting: Intensive Care Unit, Department of Medicine IV, Uni- Conclusions: This first systematic study on citrate pharmaco- versity Hospital Vienna. kinetics and metabolism in critically ill patients confirms a major Patients: Consecutive critically ill cirrhotic (n 16) and non- role of hepatic citrate metabolism by demonstrating reduced cirrhotic patients (n 16). citrate clearance in cirrhotic patients. Pharmacokinetic data could Interventions: Infusion of sodium citrate (0.5 mmol·kg1·hr1) provide a basis for the clinical use of citrate anticoagulation in and calcium chloride (0.17 mmol·kg1·hr1) for 2 hrs. Analysis of critically ill patients. Provided dose adaptation and monitoring of serial arterial blood samples. ionized calcium, citrate