Plasma aluminum levels during sucralfate prophylaxis for stress ulceration in critically ill patients on continuous venovenous hemofiltration

A randomized, controlled trial

Hussain Mulla, Giles J. Peek, David Upton, Edward Lin, Mahmoud Loubani

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objective: To investigate plasma aluminum levels in critically ill patients requiring continuous venovenous hemofiltration (CVVH), while receiving sucralfate 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 failure were randomized into two groups for concurrent stress ulcer prophylaxis. Group 1 (n = 10) received nasogastric sucralfate, and group 2 patients received intravenous ranitidine. Plasma aluminum samples were analyzed at baseline 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 support (median, 5.5 [range, 2-32] days, and median, 3 [range, 2-18] days, respectively) and duration of prophylaxis (median, 12 [range, 4-42] days, and median, 16 [range, 3-62] days, respectively) were similar. There were no significant differences in the baseline aluminum concentrations (median, 0.37 [range, 0.15-1.63] μmol/L, vs. median, 0.32 [range, 0.11-1.0] μmol/L; p = .79). On initiation of therapy, aluminum levels in the sucralfate group increased dramatically on day 1 (median, 0.87 [range, 0.26-4.4] μmol/L) and peaked on day 4 (median, 2.84 [range, 1.52-4.44] μmol/L) with seven of the ten patients exhibiting levels of >2 μmol/L. In the ranitidine group, there were no significant elevations in aluminum levels above baseline. Analysis 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 intervals 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. Alternative agents should be considered for prophylaxis in these patients.

Original languageEnglish (US)
Pages (from-to)267-271
Number of pages5
JournalCritical Care Medicine
Volume29
Issue number2
StatePublished - 2001
Externally publishedYes

Fingerprint

Sucralfate
Hemofiltration
Aluminum
Critical Illness
Randomized Controlled Trials
Ranitidine
Ulcer
Poisons
Acute Kidney Injury
Intensive Care Units
Confidence Intervals

Keywords

  • Acute
  • Aluminum
  • Critical illness
  • Drug toxicity
  • Hemofiltration
  • Histamine H
  • Kidney failure
  • Mechanical ventilation
  • Plasma
  • Receptor antagonists
  • Renal replacement therapy
  • Stress ulcer prophylaxis
  • Sucralfate

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Plasma aluminum levels during sucralfate prophylaxis for stress ulceration in critically ill patients on continuous venovenous hemofiltration : A randomized, controlled trial. / Mulla, Hussain; Peek, Giles J.; Upton, David; Lin, Edward; Loubani, Mahmoud.

In: Critical Care Medicine, Vol. 29, No. 2, 2001, p. 267-271.

Research output: Contribution to journalArticle

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title = "Plasma aluminum levels during sucralfate prophylaxis for stress ulceration in critically ill patients on continuous venovenous hemofiltration: A randomized, controlled trial",
abstract = "Objective: To investigate plasma aluminum levels in critically ill patients requiring continuous venovenous hemofiltration (CVVH), while receiving sucralfate 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 failure were randomized into two groups for concurrent stress ulcer prophylaxis. Group 1 (n = 10) received nasogastric sucralfate, and group 2 patients received intravenous ranitidine. Plasma aluminum samples were analyzed at baseline 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 support (median, 5.5 [range, 2-32] days, and median, 3 [range, 2-18] days, respectively) and duration of prophylaxis (median, 12 [range, 4-42] days, and median, 16 [range, 3-62] days, respectively) were similar. There were no significant differences in the baseline aluminum concentrations (median, 0.37 [range, 0.15-1.63] μmol/L, vs. median, 0.32 [range, 0.11-1.0] μmol/L; p = .79). On initiation of therapy, aluminum levels in the sucralfate group increased dramatically on day 1 (median, 0.87 [range, 0.26-4.4] μmol/L) and peaked on day 4 (median, 2.84 [range, 1.52-4.44] μmol/L) with seven of the ten patients exhibiting levels of >2 μmol/L. In the ranitidine group, there were no significant elevations in aluminum levels above baseline. Analysis 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 intervals 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. Alternative agents should be considered for prophylaxis in these patients.",
keywords = "Acute, Aluminum, Critical illness, Drug toxicity, Hemofiltration, Histamine H, Kidney failure, Mechanical ventilation, Plasma, Receptor antagonists, Renal replacement therapy, Stress ulcer prophylaxis, Sucralfate",
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TY - JOUR

T1 - Plasma aluminum levels during sucralfate prophylaxis for stress ulceration in critically ill patients on continuous venovenous hemofiltration

T2 - A randomized, controlled trial

AU - Mulla, Hussain

AU - Peek, Giles J.

AU - Upton, David

AU - Lin, Edward

AU - Loubani, Mahmoud

PY - 2001

Y1 - 2001

N2 - Objective: To investigate plasma aluminum levels in critically ill patients requiring continuous venovenous hemofiltration (CVVH), while receiving sucralfate 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 failure were randomized into two groups for concurrent stress ulcer prophylaxis. Group 1 (n = 10) received nasogastric sucralfate, and group 2 patients received intravenous ranitidine. Plasma aluminum samples were analyzed at baseline 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 support (median, 5.5 [range, 2-32] days, and median, 3 [range, 2-18] days, respectively) and duration of prophylaxis (median, 12 [range, 4-42] days, and median, 16 [range, 3-62] days, respectively) were similar. There were no significant differences in the baseline aluminum concentrations (median, 0.37 [range, 0.15-1.63] μmol/L, vs. median, 0.32 [range, 0.11-1.0] μmol/L; p = .79). On initiation of therapy, aluminum levels in the sucralfate group increased dramatically on day 1 (median, 0.87 [range, 0.26-4.4] μmol/L) and peaked on day 4 (median, 2.84 [range, 1.52-4.44] μmol/L) with seven of the ten patients exhibiting levels of >2 μmol/L. In the ranitidine group, there were no significant elevations in aluminum levels above baseline. Analysis 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 intervals 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. Alternative agents should be considered for prophylaxis in these patients.

AB - Objective: To investigate plasma aluminum levels in critically ill patients requiring continuous venovenous hemofiltration (CVVH), while receiving sucralfate 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 failure were randomized into two groups for concurrent stress ulcer prophylaxis. Group 1 (n = 10) received nasogastric sucralfate, and group 2 patients received intravenous ranitidine. Plasma aluminum samples were analyzed at baseline 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 support (median, 5.5 [range, 2-32] days, and median, 3 [range, 2-18] days, respectively) and duration of prophylaxis (median, 12 [range, 4-42] days, and median, 16 [range, 3-62] days, respectively) were similar. There were no significant differences in the baseline aluminum concentrations (median, 0.37 [range, 0.15-1.63] μmol/L, vs. median, 0.32 [range, 0.11-1.0] μmol/L; p = .79). On initiation of therapy, aluminum levels in the sucralfate group increased dramatically on day 1 (median, 0.87 [range, 0.26-4.4] μmol/L) and peaked on day 4 (median, 2.84 [range, 1.52-4.44] μmol/L) with seven of the ten patients exhibiting levels of >2 μmol/L. In the ranitidine group, there were no significant elevations in aluminum levels above baseline. Analysis 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 intervals 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. Alternative agents should be considered for prophylaxis in these patients.

KW - Acute

KW - Aluminum

KW - Critical illness

KW - Drug toxicity

KW - Hemofiltration

KW - Histamine H

KW - Kidney failure

KW - Mechanical ventilation

KW - Plasma

KW - Receptor antagonists

KW - Renal replacement therapy

KW - Stress ulcer prophylaxis

KW - Sucralfate

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M3 - Article

VL - 29

SP - 267

EP - 271

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

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