Acetaminophen clearance during ex vivo continuous renal replacement therapies

Abstract

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.

A Clinician’s Guide to Dosing Analgesics, Anticonvulsants, and Psychotropic Medications in Continuous Renal Replacement Therapy

“…acetaminophen 115,130,149 Removed by CVVH (Scoville 2018) Removed by CVVHD (Scoville 2018) No data. tramadol 116 No data in CRRT clonidine 117 No data in CRRT; Dose for GFR 10-50 (expert opinion).…”

“…Common pharmacokinetic characteristics of medications are summarized in Table 2 . 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125…”

“…q. 8 h Additional Sedatives and Psychotropic Medications d Propofol 107 178 97 2 4 Context-sensitive half-life, lipophilic, monitor RASS Urine 88%, feces <2% 5–75 μg/kg/min continuous infusion Dexmedetomidine 108 200 94 1.7 c 2 Context-sensitive half-life, lipophilic, monitor RASS Urine 95%, feces 4% 0.2–1.5 μg/kg continuous infusion Ketamine 109 238 27 2.4 0.25 Context-sensitive half-life, lipophilic, monitor RASS Urine 91%, feces 3% Sedation: 0.5–2 mg/kg bolus, 0.2–2.5 mg/kg per hour continuous infusion Acetaminophen 110 , 111 151 10 1 2 Hydrophilic, monitor NRS/CPOT Urine <5% 325–1000 mg i.v./p.o./p.f.t. q.…”