id	author	title	date	pages	extension	mime	words	sentence	flesch	summary	cache	txt
dti-1400	Murakami, Takuya; Akimoto, Tetsu; Okada, Mari; Hishida, Erika; Sugase, Taro; Miki, Atsushi; Kohara, Marina; Yoshizawa, Hiromichi; Masuda, Takahiro; Kobayashi, Takahisa; Saito, Osamu; Muto, Shigeaki; Nagata, Daisuke	Valacyclovir Neurotoxicity and Nephrotoxicity in an Elderly Patient Complicated by Hyponatremia	2018	5	.pdf	application/pdf	4221	226	48	The withdrawal or discontinuation of the offending agent is the mainstay treatment for acyclovir or valacyclovir-mediated poisoning; however, there are several anecdotal reports suggest- ing that HD may play a role in the rapid reduction in serum acyclovir levels, thereby accelerating the recovery from renal and/or neurological disorders.4,8,11–14 Given the chemical and pharmacokinetic characteristics of acyclovir, including its small molecular weight (225 Da), limited protein-binding rate, low steady-state volume of distribution, and high water solubility, it can be readily removed with extracorporeal procedures, includ- ing HD, HF, and hemodiafiltration, with a high elimination rate in HD.4,8,12,15 In the present case, the concurrent hypona- tremia precluded us from promptly performing HD as the pro- cedure to remedy volume overload, azotemia, and abnormal serum electrolyte levels results in the rapid correction of the serum sodium level and predisposes patients to a risk of osmotic demyelination syndrome (ODS).16 In this context, we decided to perform HF, which may have a lower magnitude of sodium exchange than HD,17 as an initial mode of blood purification with the aim of correcting the hyperkalemia associated with AKI as well as active acyclovir removal, and it was not until the confirmation of successfully corrected serum sodium levels that HD was finally applied without any hesitation. A lack of infor- mation regarding the therapeutic benefit of HF in cases with valacyclovir or acyclovir toxicity18 also encouraged us to employ HP empirically as an adjunct treatment for the disease after confirming the normalization of the patient’s serum potassium levels, although acyclovir is not necessarily listed as an agent that can be removed by this procedure.19 Given our experience with the current patient, we believe that HF and/or HP are viable therapeutic options in patients with hyponatremia who are at risk of developing a rate of sodium correction with HD that far exceeds the safe recommendation, although it does not allow us to objectively determine the clinical impact of each procedure on this pathology.	cache/dti-1400.pdf	txt/dti-1400.txt