Myoglobin clearance by super high-flux hemofiltration in a case of severe rhabdomyolysis: a case report.

Abstract

OBJECTIVE:

To test the ability of a novel super high-flux (SHF) membrane with a larger pore size to clear myoglobin from serum.

SETTING:

The intensive care unit of a university teaching hospital.

SUBJECT:

A patient with serotonin syndrome complicated by severe rhabodomyolysis and oliguric acute renal failure.

METHOD:

Initially continuous veno-venous hemofiltration was performed at 2 l/hour ultrafiltration (UF) with a standard polysulphone 1.4 m2 membrane (cutoff point, 20 kDa), followed by continuous veno-venous hemofiltration with a SHF membrane (cutoff point, 100 kDa) at 2 l/hour UF, then at 3 l/hour UF and then at 4 l/hour UF, in an attempt to clear myoglobin.

RESULTS:

The myoglobin concentration in the ultrafiltrate at 2 l/hour exchange was at least five times greater with the SHF membrane than with the conventional membrane (>100,000 microg/l versus 23,003 microg/l). The sieving coefficients with the SHF membrane at 3 l/hour UF and 4 l/hour UF were 72.2% and 68.8%, respectively. The amount of myoglobin removed with the conventional membrane was 1.1 g/day compared with 4.4-5.1 g/day for the SHF membrane. The SHF membrane achieved a clearance of up to 56.4 l/day, and achieved a reduction in serum myoglobin concentration from >100,000 microg/l to 16,542 microg/l in 48 hours.

CONCLUSIONS:

SHF hemofiltration achieved a much greater clearance of myoglobin than conventional hemofiltration, and it may provide a potential modality for the treatment of myoglobinuric acute renal failure.

• Authors: Toshio Naka, Daryl Jones, Ian Baldwin, Nigel Fealy, Samantha Bates, Hermann Goehl, Stanislao Morgera, Hans H Neumayer, Rinaldo Bellomo
• Journal: Critical care (London, England) (Crit Care) Vol. 9 Issue 2 Pg. R90-5 (Apr 2005) ISSN: 1466-609X [Electronic] England
• PMID: 15774055 (Publication Type: Case Reports, Comparative Study, Journal Article)

Chemical References

• Myoglobin

Topics

• Acute Kidney Injury (complications)
• Female
• Glasgow Coma Scale
• Hemofiltration (instrumentation, methods)
• Hospitals, Teaching
• Humans
• Intensive Care Units
• Middle Aged
• Myoglobin (blood)
• Myoglobinuria (therapy)
• Oliguria (complications)
• Rhabdomyolysis (therapy)
• Serotonin Syndrome (complications, diagnosis, therapy)
• Time Factors