Plasma aluminum levels during sucralfate prophylaxis for stress ulcerationin critically ill patients on continuous venovenous hemofiltration: A randomized, controlled trial
H. Mulla et al., Plasma aluminum levels during sucralfate prophylaxis for stress ulcerationin critically ill patients on continuous venovenous hemofiltration: A randomized, controlled trial, CRIT CARE M, 29(2), 2001, pp. 267-271
Objective: To investigate plasma aluminum levels in critically ill patients
requiring continuous venovenous hemofiltration (CVVH), while receiving suc
ralfate for stress ulcer prophylaxis.
Design: Randomized, controlled study.
Setting: Cardiothoracic intensive care unit.
Patients: Twenty postoperative cardiac surgical patients
Interventions: Twenty patients requiring CVVH support for acute renal failu
re were randomized into two groups for concurrent stress ulcer prophylaxis.
Group 1 (n = 10) received nasogastric sucralfate, and group 2 patients rec
eived intravenous ranitidine. Plasma aluminum samples were analyzed at base
line and on days 1, 4, 8, and 14.
Measurements and Main Results: In both the sucralfate and ranitidine groups
, clinical characteristics, number of days the patients were on CVVH suppor
t (median, 5.5 [range, 2-32] days, and median, 3 [range, 2-18] days, respec
tively) and duration of prophylaxis (median, 12 [range, 4-42] days, and med
ian, 16 [range, 3-62] days, respectively) were similar. There were no signi
ficant differences in the baseline aluminum concentrations (median, 0.37 [r
ange, 0.15-1.63] mu mol/L, vs. median, 0.32 [range, 0.11-1.0] mol/L; p = .7
9). On initiation of therapy, aluminum levels in the sucralfate group incre
ased dramatically on day 1 (median, 0.87 [range, 0.26-4.4] mu mol/L) and pe
aked on day 4 (median, 2.84 [range, 1.52-4.44] mu mol/L) with seven of the
ten patients exhibiting levels of >2 mu mol/L. In the ranitidine group, the
re were no significant elevations in aluminum levels above baseline. Analys
is of the two groups at the four time points revealed that aluminum levels
in the sucralfate group were up to 14 times higher, with the confidence int
ervals suggesting that the true value may be 2-27 times higher (p < .0001).
On cessation of CVVH, a rapid decline in aluminum levels was observed. No
clinical manifestations of these potentially toxic levels were observed.
Conclusions: The use of sucralfate for stress ulcer prophylaxis in patients
requiring CVVH results in toxic elevations in plasma aluminum levels. Alte
rnative agents should be considered for prophylaxis in these patients.