Two children underwent acute hemodialysis using high-efficiency dialysis me
mbranes for vancomycin intoxication (plasma levels 238 mu g/ml and 182 mu g
/ml). During a 3-h treatment, plasma vancomycin removal was on average 60%,
with a calculated vancomycin half-life (t(1/2)) Of 2 h. This is in contras
t to a recent report using charcoal hemoperfusion for vancomycin intoxicati
on (plasma level of 137 mu g/ml), which resulted in a 40% relative plasma c
learance and a calculated vancomycin t(1/2) of 12.5 h for a 4-h treatment.
The choice of optimal modality for clearing a toxin should take into accoun
t the availability of equipment, protein or lipid binding of the toxin, and
inherent risks of charcoal hemofiltration (large extracorporeal circuit, r
eversible hypocalcemia, heat loss, reversible coagulation defects) versus r
isks of high-efficiency hemodialysis (large extracorporeal circuit).