Intravenous analgesic use in dialysis patients.

Intravenous analgesic use in dialysis patients We would like to congratulate Dr Pauli-Magnus and his cholesterol, triglyceride, alkaline phosphatase, creatine colleagues for their work that further elucidates the pharm-kinase, lactate dehydrogenase, aspartate aminotransferase acokinetics and hazards of the use of morphine in ESRD and alanine aminotransferase. Ascorbate leads to well-known confusions in biochemical [1]. Opioids have been a mainstay of pain relief for centuries values related to oxidation of redox dye [10]. Ascorbic acid [2] (perhaps to the remotest period to which history extends) is known to falsely increase values for apparent uric acid as [3], yet they remain an essential part of our present day measured by the phosphotungstate method used with the therapeutic armamentarium. More than 20 distinct alkaloids SMAC [3]. In contrast, it artifactually decreases uric acid have been identified from opium and a variety of synthetic values assayed by the uricase dye oxidation procedure used agonists and antagonists have been developed. However, on autoanalyzer II [4,11]. In our study, the effect of the when we performed a survey in February 1997, of 79 hospital-lowest dose vitamin C led to a net positive interference based pharmacies in the US, we found that the two most whereas higher doses produced a net negative interference. commonly prescribed intravenous analgesics for haemodia-Besides, we observed a decrease in uric acid level with the lysis patients, morphine and meperidine, were the most noted highest doses of vitamin C which started to increase with for serious problems (Figure 1). the prolongation of the treatment (Table 1). Aspartate amin-Morphine is primarily an agonist at the m receptors with otransferase levels can be erroneously elevated while errone-pain relief at m 1 and respiratory depression and constipation ous decreases can occur with serum bilirubin and lactate resulting from agonist behaviour at m 2 receptors [4]. Previous dehydrogenase [2–5,12]. Serum glucose, triglyceride and studies of morphine kinetics in renal failure have shown cholesterol levels were measured lower than real levels [10]. accumulation of morphine 6-glucuronide which has potent We did not find any significant change in other laboratory analgesic properties [5,6 ] and severe and prolonged respirat-parameters studied. ory depression [7] which has resulted in the mistaken dia-Our results suggest that the relationship between the gnosis of cerebral damage in renal failure patients in intensive vitamin C dose and serum uric acid levels can be complex. care [8], and unpredictable levels of sedation [9]. One group Detailed …