Department of Pharmacy, University of California (UC) San Diego Health System, San Diego, California.
Department of Emergency Medicine, UC San Diego School of Medicine, San Diego, California; Division of Ultrasound, UC San Diego Health, San Diego, California.
J Emerg Med. 2021 Jan;60(1):54-57.e1. doi: 10.1016/j.jemermed.2020.09.010. Epub 2020 Nov 5.
Transjugular intrahepatic portosystemic shunt (TIPS) alters portal blood flow and may impact drug metabolism and bioavailability. However, little evidence has been published to provide guidance on medication alterations after TIPS procedures.
We report a patient who developed phenytoin toxicity requiring a prolonged readmission after a TIPS procedure. It is likely that the TIPS procedure altered phenytoin metabolism and led to toxicity in this patient. Phenytoin is an antiepileptic drug that is primarily eliminated by hepatic metabolism. It is possible that phenytoin toxicity may occur after TIPS, and that decreased dose requirements may be a durable effect of the procedure. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: TIPS is now the most common portal hypertension decompressive procedure performed by interventional radiologists and has become the primary portosystemic shunt (surgical or percutaneous) performed in the United States. Patients with a history of TIPS procedures commonly present to tertiary- and quaternary-care emergency departments with complex clinical presentations. Greater familiarity with the potential effects of TIPS on drug metabolism may help emergency physicians prevent adverse drug effects and optimize clinical outcomes.
经颈静脉肝内门体分流术（TIPS）改变门静脉血流，可能影响药物代谢和生物利用度。然而，很少有证据表明 TIPS 手术后药物需要调整。
我们报告了 1 例 TIPS 术后发生苯妥英钠中毒需要长期住院的患者。TIPS 手术可能改变了苯妥英钠的代谢，导致患者中毒。苯妥英钠是一种主要通过肝脏代谢消除的抗癫痫药物。TIPS 术后可能会发生苯妥英钠中毒，并且剂量需求减少可能是该手术的持久效果。
为什么急诊医生应该了解这一点？TIPS 现在是介入放射科医生进行的最常见的门脉高压减压手术，并且已成为美国主要的门体分流术（手术或经皮）。有 TIPS 手术史的患者常因复杂的临床表现就诊于三级和四级保健急诊。更熟悉 TIPS 对药物代谢的潜在影响可能有助于急诊医生预防药物不良反应并优化临床结果。
