Clinical effects of a sorbent suspension dialysis system in treatment of hepatic coma (the BioLogic-DT).
Fifteen patients with acute deterioration of liver function, high serum ammonium, and an average coma level of 3.9 were identified. Eleven of the patients were on respirator support, and eleven had kidney failure pursuant to the liver failure. The patients were treated for 8-12 hours daily with the BioLogic-DT system, in which membranes of a cellulosic plate dialyzer actively pump blood through a single access at over 200 ml/min, and the dialysate contains a suspension of powdered activated charcoal (300,000 square meters surface area) and cation exchanger (160 meq capacity). No anticoagulant was used. In spite of the declining condition of the patients prior to treatment, there was a statistically significant improvement in neurologic status during individual treatments, and a positive trend over 1-12 (average four) daily treatments. Four patients recovered liver function and another four improved enough to receive a liver transplant operation. The BioLogic-DT system appears to be safe in treatment of patients with hepatic insufficiency and coma. The neurologic improvement of these patients indicates that many toxins of hepatic failure are dialyzable across cellulosic membranes and bound by charcoal.
Ash
S R
SR
St. Elizabeth Hospital, Lafayette, Indiana.
Blake
D E
DE
Carr
D J
DJ
Carter
C
C
Howard
T
T
Makowka
L
L
D000208:Acute Disease; D002411:Cation Exchange Resins; D002606:Charcoal; D062787:Drug Overdose / Q000503:physiopathology / Q000628:therapy; D004867:Equipment Design; D005069:Evaluation Studies as Topic; D006464:Hemoperfusion / Q000295:instrumentation* / Q000379:methods; D006501:Hepatic Encephalopathy / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008567:Membranes, Artificial; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods
D002411:Cation Exchange Resins; D008567:Membranes, Artificial; D002606:Charcoal