Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium.
Department of Pediatric Metabolic Disease, Ghent University Hospital, 9000 Ghent, Belgium.
Toxins (Basel). 2021 Jul 13;13(7):484. doi: 10.3390/toxins13070484.
Acute neonatal hyperammonemia is associated with poor neurological outcomes and high mortality. We developed, based on kinetic modeling, a user-friendly and widely applicable algorithm to tailor the treatment of acute neonatal hyperammonemia. A single compartmental model was calibrated assuming a distribution volume equal to the patient's total body water (V), as calculated using Wells' formula, and dialyzer clearance as derived from the measured ammonia time-concentration curves during 11 dialysis sessions in four patients (3.2 ± 0.4 kg). Based on these kinetic simulations, dialysis protocols could be derived for clinical use with different body weights, start concentrations, dialysis machines/dialyzers and dialysis settings (e.g., blood flow Q). By a single measurement of ammonia concentration at the dialyzer inlet and outlet, dialyzer clearance (K) can be calculated as K = Q∙[(C - C)/C]. The time (T) needed to decrease the ammonia concentration from a predialysis start concentration C to a desired target concentration C is then equal to T = (-V/K)∙LN(C/C). By implementing these formulae in a simple spreadsheet, medical staff can draw an institution-specific flowchart for patient-tailored treatment of hyperammonemia.
急性新生儿高氨血症与不良神经预后和高死亡率相关。我们基于动力学模型开发了一种用户友好且广泛适用的算法，以定制急性新生儿高氨血症的治疗方案。采用单室模型进行校准，假设分布容积等于患者的总体水量（V），根据 Wells 公式计算，透析器清除率根据四名患者的 11 次透析期间测量的氨时间-浓度曲线得出（3.2 ± 0.4 kg）。基于这些动力学模拟，可以为不同体重、起始浓度、透析机/透析器和透析设置（例如血流 Q）推导用于临床使用的透析方案。通过在透析器入口和出口处单次测量氨浓度，可以计算出透析器清除率（K），即 K = Q∙[(C - C)/C]。从预透析起始浓度 C 降低到所需目标浓度 C 所需的时间（T）等于 T = (-V/K)∙LN(C/C)。通过在简单的电子表格中实施这些公式，医务人员可以为每位患者制定特定机构的流程图，以进行高氨血症的个体化治疗。
