枸橼酸药物动力学和代谢在肝硬化和noncirrhotic危重病人。

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克雷默L,鲍尔E, Joukhadar C, Strobl W, Gendo, Madl C, Gangl

枸橼酸药物动力学和代谢在肝硬化和noncirrhotic危重病人。

暴击治疗地中海。2003年10月,31 (10):2450 - 5。

PubMed ID

14530750 (在PubMed

]

文摘

目的:探讨药物动力学和新陈代谢的柠檬酸钠危重病人。确定柠檬酸积累的风险肝功能异常的设置(肝硬化,肝肾综合症)。设计:前瞻性队列研究。设置:重症监护室,医学系的第四,维也纳大学医院。病人:连续病危肝硬化(n = 16)和noncirrhotic病人(n = 16)。干预措施:注入柠檬酸钠(0.5 mmol.kg - 1. -人力资源- 1)和氯化钙(0.17 mmol.kg - 1. -人力资源- 1)2小时。分析连续动脉血液样本。测量和主要结果:全身的柠檬酸是正常间隙noncirrhotic危重病人显著降低肝硬化患者(710和340毫升/分钟,p = .008)。柠檬酸浓度和浓度峰值随时间增加了65%和114%的肝硬化患者(p <措施),分别;量的分布是相同的。 Net metabolic changes were quantitatively similar, with pH and plasma bicarbonate concentrations increasing more slowly in cirrhotic patients. No citrate-related side effects were noted. Citrate clearance could not be predicted by standard liver function tests and was not appreciably influenced by renal function and Acute Physiology and Chronic Health Evaluation II scores. CONCLUSIONS: This first systematic study on citrate pharmacokinetics and metabolism in critically ill patients confirms a major role of hepatic citrate metabolism by demonstrating reduced citrate clearance in cirrhotic patients. Pharmacokinetic data could provide a basis for the clinical use of citrate anticoagulation in critically ill patients. Provided dose adaptation and monitoring of ionized calcium, citrate anticoagulation seems feasible even in patients with decompensated cirrhosis. Metabolic consequences of citrate infusion were not different between groups in this study but may be more pronounced in prolonged infusion.

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药物

柠檬酸钠