[For which cases should clinicians perform blood purification in the management of acute poisoning? Clinical and pharmacological analyses].
Indications for performing blood purification such as direct hemoperfusion (DHP), hemodialysis (HD) and hemodiafiltration (HDF) in patients with acute poisoning were retrospectively analyzed. Although a quick improvement in consciousness level was achieved by an intensive treatment with DHP for three hours in 27 patients suffering from acute tranquilizer poisoning, a slow but safe recovery was surely obtained in another 111 cases who received general supportive care. The medical costs of patients treated by DHP were 2.07 times greater than those of cases treated by general supportive care. Plasma and urine concentrations of theophylline could be obtained simultaneously during the treatment by DHP. The excretion rate of DHP at 1, 2, 3 and 6 hours after starting DHP ranged from 99.4% to 96.0%. At the end of DHP, the clinical findings markedly improved and sufficient elimination from the body could be obtained. The rebound phenomenon was observed after three hours DHP in one case of acute anilin poisoning and the patient died of fatal fulminant hepatic failure at 9th hospital day. In this case, further DHP was needed. DHP is presently becoming less prevalent due to concerns over such issues as rapid metabolism and elimination efficacy in acute organophosphate and aconitine poisoning. In a case of 23-year old female who took a potentially fatal dose of 100 g of acetaminophen, blood purification was not performed and oral N acetylcysteine antidotal therapy was quite effective in order to prevent hepatic injury. The serum acetaminophen concentration was 287 microg/ml on her admission and the value fell to 28.8 microg/ml after 35 hours. These results indicate that blood purification is not always necessary because of it's poor elimination efficacy in some kinds poisoning. Nevertheless, in severe cases it was quite an effective and useful extracorporeal elimination technique for both improvement of clinical outcome and clearance of poisons. Although it is difficult to draw a definitive conclusion from this study, it is suggested that a rapid and prudent decision should be made as to perform blood purification.
Yokoyama
Takashi
T
Department of Nephrology, Sapporo Tokushukai Hospital.
D000082:Acetaminophen / Q000097:blood / Q000506:poisoning; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D017583:Hemodiafiltration / Q000191:economics; D006464:Hemoperfusion / Q000191:economics; D006801:Humans; D006993:Hypnotics and Sedatives / Q000097:blood / Q000506:poisoning; D008297:Male; D008875:Middle Aged; D011041:Poisoning / Q000628:therapy*; D011619:Psychotropic Drugs / Q000097:blood / Q000506:poisoning; D006435:Renal Dialysis / Q000191:economics; D012189:Retrospective Studies; D013806:Theophylline / Q000097:blood / Q000506:poisoning
D006993:Hypnotics and Sedatives; D011619:Psychotropic Drugs; D000082:Acetaminophen; D013806:Theophylline