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Successful treatment of normeperidine neurotoxicity by hemodialysis.

Abstract
Normeperidine, a major metabolite of meperidine, is half as potent as meperidine as an analgesic but two to three times more potent as a convulsant. Renal failure significantly increases the plasma half-life of normeperidine. The intensity of the central nervous system excitation is highly correlated with the plasma concentration of normeperidine. Moreover, normeperidine toxicity is not reversed by naloxone, which may exacerbate it. We report a patient with end-stage renal disease undergoing maintenance continuous cycler peritoneal dialysis who had been receiving meperidine for pain control. The patient subsequently developed myoclonic contractions and a grand mal seizure. The patient was successfully treated with hemodialysis (using an F8 dialyzer) for presumed normeperidine-induced seizure. During hemodialysis, normeperidine average blood clearance was 73 mL/min, average plasma clearance was 50 mL/min, and average percentage of plasma extraction was 24%. There also was a 26% reduction in plasma concentration of normeperidine over 3 hours of hemodialysis. In conclusion, our findings suggest that hemodialysis may be used effectively for treating patients with suspected normeperidine-induced neurotoxicity.
AuthorsH Hassan, B Bastani, M Gellens
JournalAmerican journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 35 Issue 1 Pg. 146-9 (Jan 2000) ISSN: 1523-6838 [Electronic] United States
PMID10620557 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Analgesics, Opioid
  • Meperidine
  • normeperidine
Topics
  • Aged
  • Analgesics, Opioid (administration & dosage, adverse effects, blood)
  • Epilepsies, Myoclonic (blood, chemically induced, therapy)
  • Epilepsy, Tonic-Clonic (blood, chemically induced, therapy)
  • Female
  • Half-Life
  • Humans
  • Kidney Failure, Chronic (blood)
  • Meperidine (administration & dosage, adverse effects, analogs & derivatives, blood)
  • Metabolic Clearance Rate (physiology)
  • Peritoneal Dialysis, Continuous Ambulatory
  • Renal Dialysis

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