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The kinetics of metamizol and its metabolites in critical-care patients with acute renal dysfunction

✍ Scribed by G. Heinemeyer; H. -J. Gramm; I. Roots; R. Dennhardt; W. Simgen

Publisher
Springer
Year
1993
Tongue
English
Weight
555 KB
Volume
45
Category
Article
ISSN
0031-6970

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✦ Synopsis

We have studied the clearance of monomethylaminoantipyrine (MMAAP), the pharmacologically active form of metamizol, in 46 patients in surgical intensive care with different degrees of renal dysfunction. In 23 patients without any renal impairment, mean clearance was 2.8 ml.min-1 x kg-1. Twenty-one patients with acute renal impairment had a significantly reduced clearance of MMAAP (0.83 ml.min-1 x kg-1). There was also reduced clearance in four patients with septic shock (1.0 ml.min-1 x kg-1). Kinetics of the metabolites of MMAAP (N-formylaminoantipyrine (FAAP), aminoantipyrine (AAP), and its secondary product N-acetylaminoantipyrine (AcAAP)) were calculated. FAAP and AcAAP showed delayed invasion, which can be explained by reduced hepatic metabolic activity. The product of N-demethylation, AAP, was not significantly altered. The delayed elimination of monomethylaminoantipyrine can be explained by reduced hepatic function in parallel with acute renal failure due to disturbed cardiovascular function caused by septic shock. This may also lead to disturbed hepatic macro- and microperfusion associated with altered oxygen supply and oxygen consumption.

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Renal insufficiency and anemia are independent risk factors for death among patients with acute myocardial infarction1,21As published material, the contents of this manuscript may not be cited, quoted, reproduced or published without the consent of the authors.2The analyses upon which this publication is based were performed under Contract Number 500-96-P704, entitled “Operation Utilization and Quality Control Peer Review Organization (PRO) for the State of Georgia” and sponsored by the Centers for Medicare and Medicaid Services (CMS), Department of Health and Human Services. The conclusions and opinions expressed, and methods used herein are those of the authors. They do not necessarily reflect CMS policy. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by CMS, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this Contractor. Ideas and contributions to the authors concerning experience in engaging with issues presented are welcomed.
✍ Langston, Robert D.; Presley, Rodney; Flanders, W. Dana; Mcclellan, William M. 📂 Article 📅 2003 🏛 Nature Publishing Group 🌐 English ⚖ 373 KB