clinical question

[amyl]

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a resident at my program said something yesterday that i hadn't heard before and was wondering if any of you knew the answer. i could find it in MM or barash. Does diabetic neuropathy affect hoffman elimination?

 

[coprolalia]

Does diabetic neuropathy affect hoffman elimination?

Interesting. I wouldn't know how.

Hoffman elimination is a spontaneous degradation of pharmaceuticals in the plasma at body temperature. Perhaps the reference was secondary to some decrease in GFR related to renal insufficiency 🙂confused🙂.

I'm not sure that in a compensated diabetic this is really an issue. We transplant pancreas and kidneys in severe diabetics with chronic renal failure, and the drug of choice (at least at our institution) is cis-atricurium during the case. Haven't noticed a prolonged NMB effect in these patients, but that is just anecdotal.

-copro

 

[Planktonmd]

a resident at my program said something yesterday that i hadn't heard before and was wondering if any of you knew the answer. i could find it in MM or barash. Does diabetic neuropathy affect hoffman elimination?

😕

No

 

[amyl]

😕

No

i didn't think it sounded right but could find the answer in my books. thanks😀

 

[Noyac]

Liver disease does but not diabetes and why would neuropathy make it any different.

 

[pgg]

Liver disease does but not diabetes and why would neuropathy make it any different.

Correct me if I'm wrong, but I don't believe liver disease has any effect on Hoffman elimination. It's not enzyme dependent; it's pH & temperature dependent. Something to do with quaternary amines and NH2 groups picking up protons or something like that, ie organ independent.

 

[coprolalia]

Correct me if I'm wrong, but I don't believe liver disease has any effect on Hoffman elimination. It's not enzyme dependent; it's pH & temperature dependent. Something to do with quaternary amines and NH2 groups picking up protons or something like that, ie organ independent.

You are correct, sir!

I think that resident you met, Amy, may be sitting for the boards more than once.

-copro

 

[amyl]

ah...shes one of my fellow interns...lots of time to figure this s--t out. ;-)

 

[mille125]

a resident at my program said something yesterday that i hadn't heard before and was wondering if any of you knew the answer. i could find it in MM or barash. Does diabetic neuropathy affect hoffman elimination?

Sometimes even your fellow residents are full of it. I always made a point of asking them for the mechanism. You will quickly find out what they know.

 

[jetproppilot]

a resident at my program said something yesterday that i hadn't heard before and was wondering if any of you knew the answer. i could find it in MM or barash. Does diabetic neuropathy affect hoffman elimination?

UHHHHHHHH........jet looks back in his brain to Baby Miller, Tinker, Board Stiff....

NO.

OK.

Next question.