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Altered gentamicin distribution in ascitic patients
Abstract:
Gentamicin pharmacokinetics were studied in eight patients with ascites. Gentamicin serum levels were measured by radioimmunoassay immediately before, 15 minutes after, and at one and two estimated half-lives after intermittent i.v. infusions of gentamicin. Volumes of distributions (Vd) calculated for the eight patients were significantly larger than mean values reported for the drug in normal patients (p less than 0.025). Vd ranged from 20.2 to 53 liters and correlated poorly with lean and total body weights. In patients with ascites or abnormal extracellular fluid volumes, gentamicin dosage should be based on frequent measurements of serum gentamicin levels and on clinical response.
Insights
Gentamicin pharmacokinetics in ascites patients show significantly larger volumes of distribution (Vd). Dosage adjustments based on serum levels and clinical response are crucial for effective gentamicin therapy in these individuals.
Area of Science:
- Pharmacokinetics
- Nephrology
- Internal Medicine
Background:
- Ascites, characterized by abnormal extracellular fluid accumulation, can alter drug distribution.
- Understanding gentamicin pharmacokinetics is vital for optimizing treatment in patients with fluid imbalances.
Purpose of the Study:
- To investigate gentamicin pharmacokinetics in patients with ascites.
- To determine the impact of ascites on gentamicin volume of distribution (Vd).
Main Methods:
- Eight patients with ascites were included in the study.
- Gentamicin serum levels were measured using radioimmunoassay at various time points post-intravenous infusion.
- Volume of distribution (Vd) was calculated for each patient.
Main Results:
- The calculated Vd for gentamicin in patients with ascites was significantly larger compared to normal subjects (p < 0.025).
- Observed Vd values ranged from 20.2 to 53 liters.
- A poor correlation was found between Vd and patient body weights (lean and total).
Conclusions:
- Ascites significantly increases the volume of distribution for gentamicin.
- Gentamicin dosing in patients with ascites should be individualized, guided by serum drug level monitoring and clinical assessment.
- Adjusting dosage based on frequent serum gentamicin measurements is recommended for patients with abnormal fluid volumes.