Treatment of vancomycin overdose using high-efficiency dialysis membranes

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).