CytoSorbents Corporation (CTSO)

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Case of the week 32/2016
Use of CytoSorb to prevent acute renal failure during drug intoxication-associated rhabdomyolysis

Dr. med. Murad Alkhani, Dr. Michael Rennicke, Dr. Klotilda Jahaj, Dr. Anna Semyonova, Dr. Irina Veil, Dr. Karem Suleiman, Dr. Changguang Shan, Prof. Dr. Rüdiger Becker | Internal Intensive Care Unit of the Medical Clinic I, Hospital Wolfsburg
This case study reports on a 55-year-old female patient, found disoriented and poorly responsive at home who was subsequently brought to hospital by emergency ambulance.
Case presentation

In the emergency room it was found that the patient had ingested 8 g of ibuprofen and 25 g of metamizol (~ 50 tablets) as well as potassium bromatum (amount unknown) in a suicidal intent in chronic depression
On admission the patient had plasma levels of creatine kinase (CK) of 32,383 U/L, myoglobin> 3,000 µg/L, CRP 48 mg/L and exhibited a drastically increased CK level > 127,100 U / L (out of range) the next day, indicative for a drug-induced rhabdomyolysis
Patient was at any time hemodynamically and respiratory stable, renal function tests remained consistently within the normal range
Fluid Administration as well as of 8.4% sodium bicarbonate solution (~ 500 ml/day) to prevent myoglobin precipitation in the renal tubuli level
Due to massive elevation of serum CK and myoglobin very quick decision to use CytoSorb in combination with renal replacement therapy with the rationale for the treatment of rhabdomyolysis-associated complications even before acute renal failure could establish
Treatment

Three consecutive CytoSorb treatments for a total treatment time of 72 hours (24 hours each)
CytoSorb was used in conjunction with a Octo Nova CRRT machine (Diamed; used hemofilter APS-18H from Asahi Kasei Medical Co., Ltd)
Anticoagulation: heparin (PTT guided administration)
CytoSorb adsorber position: pre-hemofilter
Measurements

Rhabdomyolitic parameters (CK, myoglobin)
Inflammatory parameters (CRP)
Results

After the last treatment CK plasma concentrations were at 51.111 U/L, myoglobin 1.045 µg/L, both continuing to decline
While receiving treatment, there were no signs of acute renal failure at any time, the patient always showed good excretion and normal creatinine levels
Patienten Follow-Up

In the further course creatine kinase (4. 695 U/L) and myoglobin levels (936 µg/l) continued to decrease
Patient could be discharged in completely stable condition within a few days directly from intensive care to her home environment
CONCLUSIONS

The CytoSorb therapy proved as highly efficient in terms of the elimination of CK and myoglobin in this patient
According to the medical team, such patients with such a pronounced rhabdomyolysis are usually transferred to a university hospital, however due to the rapid response to CytoSorb therapy this was not necessary in the present case
An acute renal failure could be prevented by the early combined use of CytoSorb and renal replacement therapy
Safe, simple and extremely practical application of CytoSorb especially with the Octo Nova machine
http://cytosorb-therapy.com/the-studies/case-of-the-week/