Abstract
Intravenous morphine infusions have been administered to 12 critically-ill patients during controlled ventilation. Acute oliguric renal failure was present in 4 patients, who were treated with a combination of haemofiltration and haemodialysis. Severity of physiological disturbance was assessed using a modified APACHE Score, level of sedation by a linear-analogue scale, and blood morphine levels by high-pressure liquid chromatography. Morphine clearance was impaired in renal failure, and was dependent on haemofiltration volumes; accumulation of morphine did not occur during this form of treatment. Conscious level was clearly more closely related to the degree of physiological disturbance than blood morphine levels; and for a given blood morphine level, depression of consciousness was more pronounced the greater the degree of physiological disturbance. Use of a physiological sickness score may help to clarify some of the factors influencing cerebral function during critical illness. Careful clinical monitoring of level of sedation is important in patients with oliguric renal failure receiving morphine, and haemofiltration appears to reduce the risk of morphine accumulation in these patients.
Similar content being viewed by others
References
Lambert A, Mitchell R, Frost J, et al. (1983) Direct in vitro inhibition of adrenal steroidogenesis by etomidate. Lancet 2:1085–1086
Watt I, Ledingham IMcA (1984) Mortality amongst multiple trauma patients admitted to an intensive therapy unit. Anaesthesia 39:973
Morgan M, Whitwam JG (1985) Editorial. Anaesthesia 40:121
Knaus WA, Draper EA, Wagner DP (1984) APACHE II: Final form and national validation results of a severity of disease classification system. Crit Care Med 12:11, 975
Bion JF, Edlin SA, Ramsay G, et al. (1985) Validation of a prognostic score in critically ill patients undergoing transport. Br Med J 291:432
Dodd NJ, O'Donovan RM, Bennett-Jones DN, et al. (1983) Arteriovenous haemofiltration: a recent advance in the management of renal failure. Br Med J 287:1008
Logan BK, Oliver JS, Smith H (1984) The routine detection of morphine in post-mortem blood by high performance liquid chromatography with electrochemical detection. Proceedings of the 21st Annual Conference of the International Association of Forensic Toxicologists, Brighton (in press)
Shargel L, Cheung W, Yu ABC (1979) High pressure liquid chromatographic analysis of antipyrine in small plasma samples. J Pharm Sci 68:1052
Ball M, Moore RA, Fisher A, et al. (1985) Renal failure and the use of morphine in intensive care. Lancet April 6:784–786
Ossenkopple GJ, van der Meulen J, Bronsveld W, et al. (1985) Continuous arteriovenous haemofiltration as an adjunctive therapy for septic shock. Crit Care Med 13:2, 102
Sawe J, Kager L, Svensson Eng O, et al. (1985) Oral morphine in cancer patients: in vivo kinetics and in vitro hepatic glucuronidation. Br J Pharmac 19:495
Bullingham RES, Moore RA, Symonds HW, et al. (1984) A novel form of dependency of hepatic extraction ratio of opioids upon the portal vein concentration of drug. Life Sci 34:2047
Bianchetti G, Graziani G, Brancaccio D, et al. (1976) Pharmacokinetics and effects of propranolol in terminal uraemic patients and in patients undergoing regular dialysis treatment. Clin Pharmacokinet 1:373
Maddocks JL, Wake CJ, Harber MJ (1975) The plasma halflife of antipyrine in chronic uraemic and normal subjects. Br J Clin Pharmacol 2:339
Joel SP, Osborne RJ, Nixon NS, et al. (1985) Morphine-6-Glucuronide, an important metabolite. Lancet 1:1099
Shimomura K, Kamato O, Ueki S, Ida S, Oguri K, et al. (1971) Analgesic effects of morphine glucuronides. Tohoku J Exp Med 105:45
Tubaro E, Borelli G, Croce C, et al. (1983) Effect of morphine on resistance to infection. J Infect Dis 148:656
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bion, J.F., Logan, B.K., Newman, P.M. et al. Sedation in intensive care: morphine and renal function. Intensive Care Med 12, 359–365 (1986). https://doi.org/10.1007/BF00292926
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00292926