Zappulo Fulvia, Martano Laura, Ullo Ines, Catalano Veronica, Donini Sara, Scrivo Anna, Chiocchini Anna Laura Croci, La Manna Gaetano
Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Bologna, Italy.
Semin Dial. 2025 Mar-Apr;38(2):152-155. doi: 10.1111/sdi.13233. Epub 2024 Dec 16.
Extracorporeal therapies could be required for treatment of life-threatening severe acute intoxication. We present the case of an 82-year-old patient admitted to our Nephrology Unit because of metformin-associated lactic acidosis (MALA) and acute kidney injury (AKI stage III AKIN criteria). The patient also presented severe intoxication of digoxin and apixaban. The electrocardiogram presented a junctional escape rhythm with atrial fibrillation (AF) and lateral ST-segment depression that, despite fab-fragments' administration, has not regress. Due to patient's hemodynamic instability, an 8 h of sustained low-efficiency diafiltration (SLED) was prescribed. This treatment allowed to reduce serum concentration of apixaban and digoxin. Similarly, patient's hemodynamic and ECG trace improved with the resolution of junctional rhythm and persistence of AF. Even if continuous renal replacement therapy (CRRT) is the first choice in critical ill patients, SLED could represent a valid option for patients without indication to ICU.
对于危及生命的严重急性中毒，可能需要进行体外治疗。我们报告一例82岁患者，因二甲双胍相关性乳酸性酸中毒（MALA）和急性肾损伤（AKI III期，符合AKIN标准）入住我们的肾病科。该患者还出现了地高辛和阿哌沙班严重中毒。心电图显示交界性逸搏心律伴心房颤动（AF）和侧壁ST段压低，尽管给予了Fab片段治疗，但仍未恢复。由于患者血流动力学不稳定，处方了8小时的持续性低效透析滤过（SLED）。该治疗降低了阿哌沙班和地高辛的血清浓度。同样，随着交界性心律的消失和房颤的持续存在，患者的血流动力学和心电图表现有所改善。即使连续性肾脏替代治疗（CRRT）是危重症患者的首选，但对于无入住重症监护病房指征的患者，SLED可能是一种有效的选择。
