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Quinine clearance in continuous venovenous hemofiltration
J G Davies1, E F Greenwood, J C Kingswood
1Department of Pharmacy, University of Brighton, England.
The Annals of Pharmacotherapy
|May 1, 1996
Summary
Continuous venovenous hemofiltration (CVVH) does not significantly remove quinine in malaria patients with acute renal failure. Initial quinine dosing should not be reduced due to renal impairment, with adjustments based on clinical status and drug levels.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Background:
- Malaria treatment with quinine can lead to acute renal failure.
- Continuous venovenous hemofiltration (CVVH) is used for renal replacement therapy in critically ill patients.
Observation:
- A case study of a patient with Plasmodium falciparum malaria and acute renal failure treated with intravenous quinine.
- The patient required intensive care and CVVH.
- Quinine plasma concentrations were monitored to assess drug clearance.
Findings:
- Continuous venovenous hemofiltration (CVVH) demonstrated minimal extracorporeal clearance of quinine, accounting for less than 1.5% of total body clearance.
- Quinine is not significantly removed by the hemofiltration process.
Implications:
- Initial quinine dosage in patients with malaria and acute renal failure should not be reduced.
- Subsequent quinine dosage adjustments should be guided by clinical condition and plasma drug concentrations, not solely by renal impairment.
- This study provides crucial data for optimizing quinine therapy in critically ill malaria patients with renal dysfunction.