Trace metal elimination during continuous sedation with propofol containing EDTA in critically ill patients

Thomas L. Higgins, Michael J. Murray, Daniel H. Kett, Gerard J. Fulda, Katherine M. Kramer, David M. Gelmont, Harakh V. Dedhia, Howard Levy, Gary P. Zaloga, Karen Thompson

Research output: Contribution to journalArticle

Abstract

Introduction: Little is known about changes in serum and urinary zinc, cobalt, copper, iron, and calcium levels in the critically ill, or the effect of sedative agent preservatives such as disodium edetate (EDTA) on trace metal levels and elimination. Methods: ICU patients likely to need >24 hours of ventilator support in 23 ICUs were stratified by APACHE II score and randomized to receive propofol containing 0.005% EDTA (n=106) or sedative agents without EDTA (n=104). 24-hr urine samples were collected on days 2,3,7, and every 7 days thereafter for zinc, cobalt, copper, iron, and calcium excretion, EDTA levels, urine osmolality, albumin, and glucose. BUN, serum trace metals, creatinine and albumin were assessed at baseline and during each 24-hour urine collection. Results: 210 patients (144 men and 66 women age 18-88) completed the study. Baseline APACHE II scores and demographics were not significantly different. Mean sedation time was 149.1 (6.7-645) hrs. Vital signs, hematology, urinalysis and serum chemistry values, and incidence of adverse events were similar. Mean urinary zinc and iron excretion were higher on day 2 and 3, (p <0.05) and mean serum zinc levels on day 3 were lower for patients receiving propofol/EDTA than for patients receiving sedatives without EDTA. Urinary calcium excretion was lower in propofol/EDTA pts. on day 2 and 3. Mean serum iron concentrations were normal in both groups. No other clinically or statistically significant differences were observed. Renal function did not deteriorate during ICU sedation with either regimen. Conclusions: Propofol with EDTA was well tolerated by critically ill ICU patients. No adverse events indicative of trace metal deficiency were observed during a mean of 6.2 days. EDTA did not appear to compromise renal function.

Original languageEnglish (US)
JournalCritical Care Medicine
Volume27
Issue number12 SUPPL.
StatePublished - 1999

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Propofol
Critical Illness
Metals
Zinc
Iron
Hypnotics and Sedatives
Serum
APACHE
Cobalt
Calcium
Copper
Albumins
Urine
Kidney
Urine Specimen Collection
Urinalysis
Vital Signs
Blood Urea Nitrogen
Hematology
Mechanical Ventilators

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Higgins, T. L., Murray, M. J., Kett, D. H., Fulda, G. J., Kramer, K. M., Gelmont, D. M., ... Thompson, K. (1999). Trace metal elimination during continuous sedation with propofol containing EDTA in critically ill patients. Critical Care Medicine, 27(12 SUPPL.).

Trace metal elimination during continuous sedation with propofol containing EDTA in critically ill patients. / Higgins, Thomas L.; Murray, Michael J.; Kett, Daniel H.; Fulda, Gerard J.; Kramer, Katherine M.; Gelmont, David M.; Dedhia, Harakh V.; Levy, Howard; Zaloga, Gary P.; Thompson, Karen.

In: Critical Care Medicine, Vol. 27, No. 12 SUPPL., 1999.

Research output: Contribution to journalArticle

Higgins, TL, Murray, MJ, Kett, DH, Fulda, GJ, Kramer, KM, Gelmont, DM, Dedhia, HV, Levy, H, Zaloga, GP & Thompson, K 1999, 'Trace metal elimination during continuous sedation with propofol containing EDTA in critically ill patients', Critical Care Medicine, vol. 27, no. 12 SUPPL..
Higgins TL, Murray MJ, Kett DH, Fulda GJ, Kramer KM, Gelmont DM et al. Trace metal elimination during continuous sedation with propofol containing EDTA in critically ill patients. Critical Care Medicine. 1999;27(12 SUPPL.).
Higgins, Thomas L. ; Murray, Michael J. ; Kett, Daniel H. ; Fulda, Gerard J. ; Kramer, Katherine M. ; Gelmont, David M. ; Dedhia, Harakh V. ; Levy, Howard ; Zaloga, Gary P. ; Thompson, Karen. / Trace metal elimination during continuous sedation with propofol containing EDTA in critically ill patients. In: Critical Care Medicine. 1999 ; Vol. 27, No. 12 SUPPL.
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T1 - Trace metal elimination during continuous sedation with propofol containing EDTA in critically ill patients

AU - Higgins, Thomas L.

AU - Murray, Michael J.

AU - Kett, Daniel H.

AU - Fulda, Gerard J.

AU - Kramer, Katherine M.

AU - Gelmont, David M.

AU - Dedhia, Harakh V.

AU - Levy, Howard

AU - Zaloga, Gary P.

AU - Thompson, Karen

PY - 1999

Y1 - 1999

N2 - Introduction: Little is known about changes in serum and urinary zinc, cobalt, copper, iron, and calcium levels in the critically ill, or the effect of sedative agent preservatives such as disodium edetate (EDTA) on trace metal levels and elimination. Methods: ICU patients likely to need >24 hours of ventilator support in 23 ICUs were stratified by APACHE II score and randomized to receive propofol containing 0.005% EDTA (n=106) or sedative agents without EDTA (n=104). 24-hr urine samples were collected on days 2,3,7, and every 7 days thereafter for zinc, cobalt, copper, iron, and calcium excretion, EDTA levels, urine osmolality, albumin, and glucose. BUN, serum trace metals, creatinine and albumin were assessed at baseline and during each 24-hour urine collection. Results: 210 patients (144 men and 66 women age 18-88) completed the study. Baseline APACHE II scores and demographics were not significantly different. Mean sedation time was 149.1 (6.7-645) hrs. Vital signs, hematology, urinalysis and serum chemistry values, and incidence of adverse events were similar. Mean urinary zinc and iron excretion were higher on day 2 and 3, (p <0.05) and mean serum zinc levels on day 3 were lower for patients receiving propofol/EDTA than for patients receiving sedatives without EDTA. Urinary calcium excretion was lower in propofol/EDTA pts. on day 2 and 3. Mean serum iron concentrations were normal in both groups. No other clinically or statistically significant differences were observed. Renal function did not deteriorate during ICU sedation with either regimen. Conclusions: Propofol with EDTA was well tolerated by critically ill ICU patients. No adverse events indicative of trace metal deficiency were observed during a mean of 6.2 days. EDTA did not appear to compromise renal function.

AB - Introduction: Little is known about changes in serum and urinary zinc, cobalt, copper, iron, and calcium levels in the critically ill, or the effect of sedative agent preservatives such as disodium edetate (EDTA) on trace metal levels and elimination. Methods: ICU patients likely to need >24 hours of ventilator support in 23 ICUs were stratified by APACHE II score and randomized to receive propofol containing 0.005% EDTA (n=106) or sedative agents without EDTA (n=104). 24-hr urine samples were collected on days 2,3,7, and every 7 days thereafter for zinc, cobalt, copper, iron, and calcium excretion, EDTA levels, urine osmolality, albumin, and glucose. BUN, serum trace metals, creatinine and albumin were assessed at baseline and during each 24-hour urine collection. Results: 210 patients (144 men and 66 women age 18-88) completed the study. Baseline APACHE II scores and demographics were not significantly different. Mean sedation time was 149.1 (6.7-645) hrs. Vital signs, hematology, urinalysis and serum chemistry values, and incidence of adverse events were similar. Mean urinary zinc and iron excretion were higher on day 2 and 3, (p <0.05) and mean serum zinc levels on day 3 were lower for patients receiving propofol/EDTA than for patients receiving sedatives without EDTA. Urinary calcium excretion was lower in propofol/EDTA pts. on day 2 and 3. Mean serum iron concentrations were normal in both groups. No other clinically or statistically significant differences were observed. Renal function did not deteriorate during ICU sedation with either regimen. Conclusions: Propofol with EDTA was well tolerated by critically ill ICU patients. No adverse events indicative of trace metal deficiency were observed during a mean of 6.2 days. EDTA did not appear to compromise renal function.

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