| Title: |
Towards an algorithm-based tailored treatment of acute neonatal hyperammonemia |
| Authors: |
Eloot, Sunny; De Rudder, Jonathan; VERLOO, PATRICK; Dhont, Evelyn; Raes, Ann; Van Biesen, Wim; Snauwaert, Evelien |
| Source: |
TOXINS ; ISSN: 2072-6651 |
| Publication Year: |
2021 |
| Collection: |
Ghent University Academic Bibliography |
| Subject Terms: |
Medicine and Health Sciences; Toxicology; Health; Toxicology and Mutagenesis; hyperammonemia; inborn errors of metabolism; hemodialysis; infant; RENAL REPLACEMENT THERAPY; UREA CYCLE DISORDERS; INBORN-ERRORS; MANAGEMENT; SURVIVAL; MACHINE; INFANTS |
| Description: |
Acute neonatal hyperammonemia is associated with poor neurological outcomes and high mortality. We developed, based on kinetic modeling, a user-friendly and widely applicable algorithm to tailor the treatment of acute neonatal hyperammonemia. A single compartmental model was calibrated assuming a distribution volume equal to the patient's total body water (V), as calculated using Wells' formula, and dialyzer clearance as derived from the measured ammonia time-concentration curves during 11 dialysis sessions in four patients (3.2 +/- 0.4 kg). Based on these kinetic simulations, dialysis protocols could be derived for clinical use with different body weights, start concentrations, dialysis machines/dialyzers and dialysis settings (e.g., blood flow Q(B)). By a single measurement of ammonia concentration at the dialyzer inlet and outlet, dialyzer clearance (K) can be calculated as K = Q(B)center dot[(C-inlet - C-outlet)/C-inlet]. The time (T) needed to decrease the ammonia concentration from a predialysis start concentration C-start to a desired target concentration C-target is then equal to T = (-V/K)center dot LN(C-target/C-start). By implementing these formulae in a simple spreadsheet, medical staff can draw an institution-specific flowchart for patient-tailored treatment of hyperammonemia. |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| Relation: |
https://biblio.ugent.be/publication/8717150; https://doi.org/10.3390/toxins13070484; https://biblio.ugent.be/publication/8717150/file/8717154 |
| DOI: |
10.3390/toxins13070484 |
| Availability: |
https://biblio.ugent.be/publication/8717150; https://hdl.handle.net/1854/LU-8717150; https://doi.org/10.3390/toxins13070484; https://biblio.ugent.be/publication/8717150/file/8717154 |
| Rights: |
info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.A28EA184 |
| Database: |
BASE |