误服沙丁胺醇,血液透析治疗:病例报告和文献简评。

IF 0.7 Q4 UROLOGY & NEPHROLOGY
Case Reports in Nephrology and Dialysis Pub Date : 2024-06-18 eCollection Date: 2024-01-01 DOI:10.1159/000536523
Neva Bezeljak, Alexander Jerman, Damjan Grenc, Simona Krzisnik Zorman
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引用次数: 0

摘要

简介沙丁胺醇是β-2-肾上腺素能中度选择性激动剂。由于会激活 beta-1 和 beta-2 受体,因此会产生各种副作用。由于其分布容积较大,因此不能进行透析:病例介绍:这是一名沙丁胺醇中毒患者的病例,患者患有败血症、唐氏综合征和肝硬化,因医疗失误而导致沙丁胺醇中毒。最初的治疗取得了部分成功,并对抗生素进行了调整。呼吸衰竭恶化后,患者需要进行无创通气,并怀疑是之前未确诊的慢性阻塞性肺病。医生给他开了甲基强的松龙静脉注射处方,但他意外服用了 5 毫克沙丁胺醇(albuterol),结果立即导致严重的心律失常性心动过速,并伴有血流动力学衰竭。在心脏复律和输注兰地洛尔治疗未果后,开始了抢救性血液透析,以降低疑似高度升高的血清沙丁胺醇水平。30 分钟后,患者出现窦性心律,心功能正常。血液透析终止后,未发现反跳性心动过速,但由于严重脓毒性休克,低血压仍在持续,因此调整了血管活性药物。然而,血浆中沙丁胺醇的测量水平和文献数据并不支持血液透析是上述病情好转的原因这一观点:清除的药物总量非常少(占总剂量的 2.8%):我们的研究结果证实了沙丁胺醇的大量分布;测得的药物浓度在观察到的治疗浓度范围内;血液透析过程中测得的半衰期(3.1 小时)与治疗过程中观察到的半衰期相当。所观察到的与透析相关的良好临床益处可能是偶然的,突出了对积极临床结果和未经证实("挽救")疗法的潜在偏见。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Inadvertent Intoxication with Salbutamol, Treated with Hemodialysis: A Case Report and Brief Review of the Literature.

Introduction: Salbutamol is a moderately selective beta-2-adrenergic agonist. Various side effects can occur because of beta-1 and beta-2 receptor activation. Due to the large volume of distribution, it is not considered dialyzable.

Case presentation: A patient with salbutamol intoxication, which developed as a result of a medical error in a patient with sepsis, Down syndrome, and liver cirrhosis, is presented. Initial treatment was partially successful and antibiotic adjustments were made. After his respiratory failure worsened, the patient needed non-invasive ventilation, and previously undiagnosed chronic obstructive pulmonary disease was suspected. He was prescribed intravenous methylprednisolone but accidently received 5 mg of salbutamol (albuterol), which led to immediate severe arrhythmic tachycardia with hemodynamic collapse. After unsuccessful cardioversion and treatment with landiolol infusion, salvage hemodialysis was commenced to decrease suspectedly highly elevated serum salbutamol levels. After 30 min, sinus rhythm with normocardia was observed. After the hemodialysis termination, no rebound tachycardia was noted, but due to severe septic shock, the hypotension was ongoing and vasoactive medications were adjusted. However, the measured levels of plasma salbutamol and data from literature do not support the view that hemodialysis was the cause of the described improvement: the total amount of the drug cleared was very small (2.8% of total dose).

Conclusion: Our results confirm a large volume of salbutamol distribution; the measured levels are within observed therapeutic levels; and the measured half-life time during hemodialysis (3.1 h) is comparable to observed half-life times in therapeutic settings. The observed favorable clinical benefit associated with dialysis may be fortuitous, highlighting potential bias toward positive clinical outcomes and unproven ("salvage") therapies.

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来源期刊
CiteScore
1.20
自引率
0.00%
发文量
36
审稿时长
10 weeks
期刊介绍: This peer-reviewed online-only journal publishes original case reports covering the entire spectrum of nephrology and dialysis, including genetic susceptibility, clinical presentation, diagnosis, treatment or prevention, toxicities of therapy, critical care, supportive care, quality-of-life and survival issues. The journal will also accept case reports dealing with the use of novel technologies, both in the arena of diagnosis and treatment. Supplementary material is welcomed.
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