Abstract: PUB095
Early Intervention of Continuous Hemodialysis Filtration Is Effective to Improve Acute Kidney Injuries and Mortality in Patient with Propofol-Related Infusion Syndrome
Session Information
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Iwasaki, Masako, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
- Suzuki, Hitoshi, Juntendo University Urayasu Hospital, Urayasu, Japan
- Wakayama, Aiko, Juntendo University Faculty of Medicine, Tokyo, Japan
- Akira, Maiko, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
- Suzuki, Yusuke, Juntendo University Faculty of Medicine, Tokyo, Japan
Introduction
Propofol related infusion syndrome (PRIS) is a fatal syndrome that often develops under the long-term propofol infusion at high doses. The main features of the PRIS consist of cardiac failure, rhabdomyolysis, acute kidney injury, and severe metabolic acidosis. High dose propofol, but also supportive treatments with catecholamines and corticosteroids, act as triggering factors. Propofol is usually administered at 0.3~4.0 mg/kg/hr or less to the sedation of adult patients, and is not administered beyond 7 days to prevent PRIS. We report here a case of PRIS developed rhabdomyolysis, acute kidney injury, and severe metabolic acidosis under the dose of propofol within the safety dose.
Case Description
A 41-year-old woman was operated cervicothoracic posterior longitudinal ligament ossification. After the operation, maximum 3.5 mg/kg/hr of propofol was used for sedation for treatment of severe pneumonia under the mechanical ventilator. Catecholamines was also used to support hemodynamics. However, unidentified hyperthermia and impaired blood pressure were prolonged, then administration of propofol was discontinued on POD6. Acute kidney injuries (sCr2.3mg/dl), metabolic acidosis and high serum CK (79300U/L) due to rhabdomyolysis were observed on POD8. Continuous hemodialysis filtration (CHDF) therapy was initiated, and hyperthermia, oxygenation, impaired hemodynamics and renal dysfunction were gradually improved. Finally, cardiac failure and renal function were totally recovered.
Discussion
Propofol impairs free fatty acid utilisation and mitochondrial activity. Imbalance between energy demand and utilisation is a key pathogenetic mechanism, which may lead to cardiac and peripheral muscle necrosis. CHDF may effective to maintain renal function and acid-base equilibrium through removal of metabolites induced by mitochondrial damage, such as lactate and creatine kinase. PRIS particularly when combined with catecholamines can be lethal and we suggest early intervention of CHDF is effective to improve renal injuries and mortality.