Theoretical removal predictions can differ from measured concentrations in severe illness.
A fifteen-year-old with septic shock and multiorgan failure received ECMO, hemofiltration and therapeutic plasma exchange. Serial sampling around exchange sessions showed reduced midazolam concentrations, with other drugs and metabolites following different patterns.
This is one patient receiving overlapping extracorporeal therapies. Sampling, redistribution, organ failure and changing delivery complicate attribution. A plasma decrease does not alone establish the amount physically removed by one device or the degree of clinical effect.
Preserve matrix, sampling time, infusion changes and every circuit when interpreting results. The case cannot provide a universal replacement dose or correction factor. An individual exposure opinion needs measured concentrations and clinical observations rather than assuming a theoretical protein-binding calculation determines the entire course.
Source: PMC12549725, supplied full-text paper. Findings are paraphrased; forensic implications are an interpretation.
Related: Extinction Before Reactivation Changed Midazolam’s Fear-Memory Effect in Rats.