pressure, CVP, HR, body temperature (core and peripheral) were continuously monitored: Urine out= put was measured hourly. None of the patients pre,.
Intensive Care Medicine
Intensive Care Med (1983) 9:21 -23
9 Springer-Verlag 1983
Antipyretic Therapy with Diclofenac Sodium Observations on Effect and Serious Side Effects in Critically Ill Patients
D. F. Zandstra, C. P. Stoutenbeek and J. P. Alexander Institute for Anaesthesiology and Intensive Care, State University Hospital, Groningen, The Netherlands
Abstract. The antipyretic actitivity of diclofenac sodiurn, 10O mg suppository was studied retrospectively in 21 applications in seven intensive care patients. Diclofenac sodium proved to be a very potent antipyretic agent with serious side effects. Acute oliguria and protracted circulatory shock occured after administration, necessitating the administration of increasing amounts of dopamine and i.v. fluids. Possible mechanisms involved are discussed. Key words: Antipyretic therapy - Diclofenac sodium - Acute oliguria - Circulation
Introduction
The potent antipyretic action of diclofenac sodium (DS) has brought it Jinto use in intensive care patients. However, severe oliguria and haemodynamic instability was occasionally observed in our ICU after DS administration. In the present retrospective study we analyse these important side effects. Diclofenac sodium (DS), (Voltaren | Geigy), is a nonsteroidal anti-inflammatory-drug (NSAID). Although the chemical structure differs from other drugs in this group the mechanism of action is similar to other NSAID, being based on the inhibition of prostaglandin biosynthesis [5, 131. Its antipyretic potency has been shown in animals and man [8, 9, 11].
Material and Methods
Seven hyperpyretic ICU patients, suffering from febrile illnesses of various causes (Table 1), were retrospectively studied.
Table 1.
Patients
Applications
bw/kg
Diagnosis
Age
1 2 3 4 5 6 7
3 1 2 3 8 2 2
72 65 65 70 68 130 100
Pneumonia Polytrauma Pneumonia Polytrauma Mediastinitis Polytrauma Pneumonia
20 25 33 76 38 51 42
• x x x x x x
All were mechanically ventilated. Arterial bloodpressure, CVP, HR, body temperature (core and peripheral) were continuously monitored: Urine out= put was measured hourly. None of the patients pre, sented with liver or kidney failure, protein and albumin plasma levels were normal during the study. All patients received adequate antibiotic therapy for longer than 6 h before starting antipyretic therapy with DS. This consisted of the single application of a suppository of 100 mg DS when the core temperature was 39.5 ~ or more. No other treatment of hyperpyrexia was used.
Results
Temperature Rectal temperature decreased significantly after DS (Fig. 1); the lowest point being registered 6 - 8 h after medication, and after 14 h the core temperature was still < 3 8 ~ There were no significant changes in Tskin, or AT.
Urine Production Urine production (Fig. 2) decreased very significantly immediately after DS administration. The lowest pro0342-4642/83/0009/0021/$01.00
22
oC 41~
~/: :3 I--" < r W e, uJ 1.-
MMH 160
N = 21
4O
PAIREDSTUI3ENT~S T--TEST 9.. P < 0,001
150
N = 21
PAIRED STUDENT'S T-TEST
i
9
p
