Iirola et al. Journal of Medical Case Reports 2010, 4:73 http://www.jmedicalcasereports.com/content/4/1/73 Page 3 of 5 liquid chromatography with tandem mass spectro- metric detection (PE Sciex API4000 instrument; PE Sciex, Foster City, California, US) as described pre- viously [2]. The rates of the dexmedetomidine and propofol infu- sions, as well her plasma concentration results of dex- medetomidine, are presented in Figure 1. In calculating the dexmedetomidine dose, we used her preoperative weight of 89 kg. Because the dose rate of dexmedetomidine remained constant for relatively long periods of time during three separate intervals, we calculated the plasma clearance of dexmedetomidine during these intervals by dividing the infusion rate by the plasma concentration. The calculated clearance was 55 L/h, 92 L/h and 87 L/h during the 2nd to 6th, 14th to 20th and 21st to 23rd day of the dexmede- tomidine infusion, respectively. A list of drugs adminis- tered during her ICU stay is presented in Table 1. Table 1 Drugs administered during our patient’s stay at the intensive care unit. Start (day) Stop (day) Dosage Regularly administered drugs Calcium glubionate Enoxaparin Sodium polystyrene sulfonate Pantoprazol Imipenem Ondansetron Lactulose Vancomycin Metronidazole Fluconazole Hydrocortisone Ciprofloxacin Tigecycline Infusions Short-acting insulin Furosemide Norepinephrine Propofol Dexmedetomidine Metoprolol Clonidine Drugs administered when needed Propofol Diazepam Lorazepam Haloperidol Fentanyl Oxycodone Acetaminophen Furosemide Ephedrin Rocuronium Indapamide Metoprolol 3 3 10 3 3 3 3 6 8 11 19 12 13 18 39 3 3 6 3 3 17 38 40 3 3 26 36 3 3 11 3 3 3 15 26 21 9 54 3 54 39 3 9 54 19 26 51 15 39 54 54 3 36 31 36 41 40 51 37 3 41 55 31 53 21 52 3 32 15 42 90 mg × 2 - 6 iv 20 mg to 40 mg when needed for CVVHDF 40 mg × 1 sc 30 g × 1 pr 40 mg × 1 iv 250 mg to 1000 mg × 3 iv 4 mg × 2 iv 20 g × 3 po 1000 mg × 2 iv (based on the serum concentration) 400 mg × 3 po 500 mg × 3 iv 400 mg × 1 iv 100 mg × 3 iv 400 mg × 2 iv 50 mg × 2 iv 0.5 - 20 IU/h 1000 mg/day 70 - 1000 mg/day Maximum dose 0.19 μg/kg/min See Figure 1. See Figure 1. 1 - 2 mg/h Maximum dose 2.2 μg/kg/h 20 - 50 mg iv 2.5 mg iv 1 - 4 mg iv 2.5 - 5 mg iv Occasional doses of 50 - 200 μg iv 5 - 10 mg iv Occasional doses of 1000 mg po/iv 5 - 10 mg iv 5 mg iv Occasional doses of 10 - 50 mg iv 2.5 mg × 1 Occasional doses of 2.5 - 5 mg iv Days refer to postoperative days. IV, intravenous; po, per os; pr, per rectum; IU, international units; CVVHDF, continuous veno-venous hemodiafiltration.