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Case Reports
. 2025 Mar-Apr;38(2):152-155.
doi: 10.1111/sdi.13233. Epub 2024 Dec 16.

Simultaneous Treatment of Two Severe Acute Intoxication and Acute Kidney Injury

Fulvia Zappulo  1 , Laura Martano  2 , Ines Ullo  1 , Veronica Catalano  2 , Sara Donini  2 , Anna Scrivo  1 , Anna Laura Croci Chiocchini  1 , Gaetano La Manna  1   2
Affiliations
Case Reports

Simultaneous Treatment of Two Severe Acute Intoxication and Acute Kidney Injury

Fulvia Zappulo et al. Semin Dial. 2025 Mar-Apr.

Abstract

Extracorporeal therapies could be required for treatment of life-threatening severe acute intoxication. We present the case of an 82-year-old patient admitted to our Nephrology Unit because of metformin-associated lactic acidosis (MALA) and acute kidney injury (AKI stage III AKIN criteria). The patient also presented severe intoxication of digoxin and apixaban. The electrocardiogram presented a junctional escape rhythm with atrial fibrillation (AF) and lateral ST-segment depression that, despite fab-fragments' administration, has not regress. Due to patient's hemodynamic instability, an 8 h of sustained low-efficiency diafiltration (SLED) was prescribed. This treatment allowed to reduce serum concentration of apixaban and digoxin. Similarly, patient's hemodynamic and ECG trace improved with the resolution of junctional rhythm and persistence of AF. Even if continuous renal replacement therapy (CRRT) is the first choice in critical ill patients, SLED could represent a valid option for patients without indication to ICU.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
(A) ECG at admission:junctional escape rhythm with atrial fibrillation (AF) and lateral ST‐segment depression. (B) ECG after CytoSorb hemoadsorption:resolution of junctional rhythm and persistence of AF.
FIGURE 2
FIGURE 2
(A) Serum concentration of Apixaban and Digoxin. (B) Serum concentration of II‐6, Free Light Chain (FLC) ‐ κ, FLC ‐ λ and Albumin.
See this image and copyright information in PMC

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