<abstract xmlns="http://www.w3.org/1999/xhtml"> Augmented renal clearance (ARC) is a recently reported condition in pathophysiology of critically ill patients in the intensive care unit. ARC refers to the enhanced renal elimination of circulating solutes. These patients are either young or previously healthy people who have undergone surgery or multiple trauma.This case report describes an adjustment of dosing regime of vancomycin to a young patient, who demonstrated ARC with severe polytrauma, overcome crush syndrome and sepsis. This 16-year old male patient was crushed by a tractor, which caused severe tissue damaged in the right lower limb. He gradually developed a serious crush syndrome. When kidneys resumed their function, creatinine clearance reached the value that indicated ARC (339.81 mL/min/1.73 m2). Vancomycin was included in the patient’s treatment regime by administering conventional dose of 1 g per 12 hours. The residual measured levels were very low. The dose of vancomycin had to be adjusted to double and then to triple the conventional dose. Without the therapeutic drug monitoring (TDM) and subsequent interpretation of the results by the clinical pharmacists, such high doses would not have been considered for administration.ARC responds strongly to sub-therapeutic serum vancomycin levels. Our case report confirms the significance of TDM and the consecutive interpretation of the results in critically ill patients.</abstract>

Augmented renal clearance (ARC) is a recently reported condition in pathophysiology of critically ill patients in the intensive care unit. ARC refers to the enhanced renal elimination of circulating solutes. These patients are either young or previously healthy people who have undergone surgery or multiple trauma.This case report describes an adjustment of dosing regime of vancomycin to a young patient, who demonstrated ARC with severe polytrauma, overcome crush syndrome and sepsis. This 16-year old male patient was crushed by a tractor, which caused severe tissue damaged in the right lower limb. He gradually developed a serious crush syndrome. When kidneys resumed their function, creatinine clearance reached the value that indicated ARC (339.81 mL/min/1.73 m2). Vancomycin was included in the patient’s treatment regime by administering conventional dose of 1 g per 12 hours. The residual measured levels were very low. The dose of vancomycin had to be adjusted to double and then to triple the conventional dose. Without the therapeutic drug monitoring (TDM) and subsequent interpretation of the results by the clinical pharmacists, such high doses would not have been considered for administration.ARC responds strongly to sub-therapeutic serum vancomycin levels. Our case report confirms the significance of TDM and the consecutive interpretation of the results in critically ill patients.

An adjustment of vancomycin dosing regimen for a young patient with augmented renal clearance: A case report / Úprava dávkového režimu vankomycínu pre mladého pacienta so zvýšeným renálnym klírensom: Kazuistika

Teaching Hospital Nitra, Department of Internal medicine, Nitra, Slovak Republic

Comenius University in Bratislava, Faculty of Pharmacy, Department of Pharmacology and Toxicology, Bratislava, Slovak Republic

Teaching Hospital Nitra, Department of Anesthesiology and Intensive medicine, Nitra, Slovak Republic

European Pharmaceutical Journal

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Augmented renal clearance (ARC) is a recently reported condition in pathophysiology of critically ill patients in the intensive care unit. ARC refers to the...

An adjustment of vancomycin dosing regimen for a young patient with augmented renal clearance: A case report / Úprava dávkového režimu vankomycínu pre mladého pacienta so zvýšeným renálnym klírensom: Kazuistika

Published Online: Dec 31, 2015

Page range: 1 - 4

Received: Sep 16, 2015

Accepted: Oct 15, 2015

DOI: https://doi.org/10.1515/afpuc-2015-0025

Keywords
Vancomycin, Augmented renal clearance (ARC), Therapeutic drug monitoring (TDM)

© by Maria Goboova

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

An adjustment of vancomycin dosing regimen for a young patient with augmented renal clearance: A case report / Úprava dávkového režimu vankomycínu pre mladého pacienta so zvýšeným renálnym klírensom: Kazuistika

Published Online: Dec 31, 2015

Page range: 1 - 4

Received: Sep 16, 2015

Accepted: Oct 15, 2015

DOI: https://doi.org/10.1515/afpuc-2015-0025

KeywordsVancomycin, Augmented renal clearance (ARC), Therapeutic drug monitoring (TDM)

© by Maria Goboova

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Keywords
Vancomycin, Augmented renal clearance (ARC), Therapeutic drug monitoring (TDM)