RESUMO
OBJECTIVE: To report a case of ketorolac tromethamine-induced acute renal failure and to discuss the risk factors that make patients more susceptible to the renal effects of nonsteroidal antiinflammatory drugs (NSAIDs). DATA SOURCES: Case reports and review articles identified by MEDLINE. Indexing terms included ketorolac, renal failure, and NSAIDs. DATA EXTRACTION: Data were abstracted from pertinent published English-language sources and were reviewed by all authors. DATA SYNTHESIS: Ketorolac is an intramuscularly administered NSAID with many of the same adverse effects associated with other oral NSAIDs. Although reversible depression of renal function has been associated with several NSAIDs, to date there have been no published reports of acute renal failure secondary to ketorolac administration. A 71-year-old woman received three doses of ketorolac to control the pain associated with pelvic and T11-T12 compression fractures. Over the next two days, the patient developed signs and symptoms of acute renal failure, including significant increases in blood urea nitrogen, serum creatinine, and peripheral edema. These signs and symptoms resolved over the next three to four days. Certain risk factors, several of which were present in this woman, make individual patients more susceptible to the renal affects of NSAIDs. These risk factors include advanced age, cirrhosis, volume depletion, congestive heart failure, gastrointestinal bleeding, and preexisting mild renal dysfunction. CONCLUSIONS: Caution should be taken when initiating ketorolac or any NSAID therapy with specific attention to risk factors that predispose a patient to renal dysfunction.
Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Falência Renal Crônica/induzido quimicamente , Tolmetino/análogos & derivados , Trometamina/efeitos adversos , Idoso , Anti-Inflamatórios não Esteroides/administração & dosagem , Combinação de Medicamentos , Feminino , Humanos , Injeções Intramusculares , Cetorolaco de Trometamina , Tolmetino/administração & dosagem , Tolmetino/efeitos adversos , Trometamina/administração & dosagemRESUMO
The relationship between the ejection fractions calculated from 'uncorrected' radionuclide time activity curves (UEF) and angiographic ejection fractions (AEF) in 200 catheterized patients yielded the regression equation AEF = 1.74 UEF + 0.21. It follows from this linear relationship that the left ventricular ejection fraction can be estimated by linear regression without explicit background correction: RREF = 1.74 UEF + 0.21, where RREF is the radionuclide regression ejection fraction. We first investigated the possibility that changes in photon self-attenuation within the cardiac chambers cause the observed mathematical characteristics of the cardiac background, B. Self-attenuation was calculated for cylindrical and spherical ventricular models. The results were insensitive to the particular geometry and would have only a small effect on the observed EF. Alternatively, the 'background' may result from extra-ventricular radiation scattering from the heart into the detector. If we assume that B should be proportional to the ventricular scattering volume, Bd = Kd EDC for diastole and Bs = Ks ESC for systole, the background corrected ejection fraction will be BCEF = K UEF + (1-K) where K = (1-Ks)/(1-Kd). This agrees with the form of the empirical regression equation.