Osborne R J, Joel S P, Slevin M L
Br Med J (Clin Res Ed). 1986 Jun 14;292(6535):1548-9. doi: 10.1136/bmj.292.6535.1548.
Patients with impaired renal function may experience severe and prolonged respiratory depression when treated with morphine. This has been attributed to accumulation of the drug during renal failure. Three patients are described who had classical signs of intoxication with morphine in the absence of measurable quantities of morphine in the plasma. The observed clinical effect is attributed to accumulation of the pharmacologically active metabolite morphine-6-glucuronide, which is usually renally excreted. It is concluded that morphine does not accumulate in patients with renal failure but that accumulation of metabolites does occur. The previously reported observations of morphine accumulation during renal failure probably result from the use of radioimmunoassays that cannot distinguish between morphine and morphine-6-glucuronide. Thus the apparent morphine concentration measured with these assays in fact reflects the total quantity of morphine and morphine-6-glucuronide present.
肾功能受损的患者在使用吗啡治疗时可能会出现严重且持久的呼吸抑制。这被归因于肾衰竭期间药物的蓄积。本文描述了三名患者，他们具有吗啡中毒的典型体征，但血浆中未检测到可测量的吗啡量。观察到的临床效应归因于通常经肾脏排泄的具有药理活性的代谢产物吗啡 - 6 - 葡萄糖醛酸苷的蓄积。得出的结论是，吗啡在肾衰竭患者中不会蓄积，但代谢产物确实会发生蓄积。先前报道的关于肾衰竭期间吗啡蓄积的观察结果可能是由于使用了无法区分吗啡和吗啡 - 6 - 葡萄糖醛酸苷的放射免疫测定法。因此，用这些测定法测得的表观吗啡浓度实际上反映了存在的吗啡和吗啡 - 6 - 葡萄糖醛酸苷的总量。
