Continuous venovenous hemofiltration

CWH, continuous venovenous hemofiltration CWHD, continuous venovenous hemodialysis CVVHDF, continuous venovenous hemodiafil-tration. 

The results of hemodialysis in biguanide-induced lactic acidosis are variable. Metformin and buformin are dialy-sable, but phenformin is poorly eliminated. Successful continuous venovenous hemofiltration has been reported (81). 

Hemodialysis (383,552,553), sometimes with additional continuous venovenous hemofiltration dialysis (554,555), continues to be described as a successful intervention for lithium poisoning. Peritoneal dialysis is a far less efficient way to clear lithium from the body. One patient treated in this way had permanent neurological abnormalities and another died a third toxic patient who also had diabetic ketoacidosis died after treatment with hydration and insulin (556). On the other hand, a 51-year-old woman who took 50 slow-release lithium carbonate tablets (450 mg) had a serum lithium concentration of 10.6 mmol/1 13 hours later, but no evidence of neurotoxicity or nephrotoxicity. She was treated conservatively with intravenous fluids and recovered fully (557). Acute lithium overdose is often better tolerated than chronic intoxication. 

Two teenagers with neurological toxicity (serum concentrations 5.4 mmol/1 and 4.81 mmol/1) were treated successfully with hemodialysis followed by continuous venovenous hemofiltration, which prevented a post-dialysis rebound in serum lithium concentrations (554). 

Successful continuous venovenous hemofiltration has been reported (58). 

The pharmacokinetics of intravenous ciprofloxacin have been studied in intensive care unit patients during continuous venovenous hemofiltration (n — 5) or hemo-diafiltration (n — 5) (67). Ciprofloxacin clearance was not altered. A dosage of 400 mg/day was sufficient to maintain effective drug plasma concentrations in patients undergoing continuous renal replacement therapy. 

An agitated, confused, disoriented 52-year-old woman who took an overdose of lithium recovered fully after high-volume continuous venovenous hemofiltration (452). 

One study in 114 patients showed that in patients with severe chronic renal impairment (serum creatinine >2 mg/dL [>176.8 pmol/L]), continuous venovenous hemofiltration (1,000 mL/hr without weight loss) was more effective than intravenous volume expansion in reducing the risk for CIN (normal sahne 1 mL/kg per hr). Hemofiltration and intravenous volume expansion were both started 4-8 hours before percutaneous coronary intervention (PCI) and continued for 18-24 hours... 

Bugge JF. Pharmacokinetics and drug dosing adjustments during continuous venovenous hemofiltration or hemodiafiltration in critically ill patients. Acta Anaesthesiologica Scandinavica 2001 45 929-934. 

BSA bovine serum albumin CVVH continuous venovenous hemofiltration... 

Macias WL. Mueller BA, Scarim SK, et al. Continuous venovenous hemofiltration An alternative to continuous arteriovenous hemofiltration and hemodiafiltration in acute renal failure. Am J Kidney Dis 1991 18 451-458. 

Tegeder I, Bremer F, Oelkers R, et al. Pharmacokinetics of imipenem-cilastatin in critically ill patients undergoing continuous venovenous hemofiltration. Antimicrob Agents Chemother 1997 41 2640-2645. 

Matzke GR, Frye RF, Joy MS, Palevsky PM. Determinants of ceftazidime clearance by continuous venovenous hemofiltration and continuous venovenous hemodialysis. Antimicrob Agents Chemother 2000 44 1639— 1644. 

Hammer, G.B., et al.l996. Continuous venovenous hemofiltration with dialysis in combination with total hepatectomy and portacaval shunting. Bridge to liver transplantation. Transplantation, 62(1) pp. 130-132... 

A 49-year-old woman with diabetes and hypertension took a deliberate overdose of 60 tablets containing metformin 500 mg and about 25 tablets of hydrochlorothiazide/lisinopril 12.5/ 20 mg. She was seen and treated within 1 hour. Her pH was 7.18, bicarbonate 6 mmol/1, lactate 9.6 mmol/1, glucose 32 mmol/1, and creatinine 106 (imol/1. Treatment included isotonic saline, sodium bicarbonate, and insulin but 5 hours later her pH was 6.79 and bicarbonate 8.4 mmol/1. Continuous venovenous hemofiltration was begun. Hypotension was treated with noradrenaline, phenylephrine, and then... 

Wester JPJ, Van Der Spoel JI, Dijksman LM, Zandstra DF. Citrate anticoagulation for continuous venovenous hemofiltration. Crit Care Med 2009 37(2) ... 

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