title: Therapeutic plasma exchange: an effective treatment in ethylene dibromide poisoning cases.
abstract: BACKGROUND
  Ethylene dibromide (EDB) poisoning is very common in Central India and has fatal outcome. EDB is highly protein bound and, therefore, it is suggested that therapeutic plasma exchange (TPE) may be useful in removing drug from body shortly after ingestion before EDB metabolizes and causes severe end organ damage. The aim of our study is to find the effect of time of start of TPE on survival outcome of EDB poisoning cases.
  
  
  METHODS
  Fifty-eight cases of EDB poisoning were reviewed from 2007 to 2012 in Department of critical care medicine in tertiary care hospitals at Indore. Five patients were discharged against medical advice and lost to follow up. TPE was done in 47 patients as early as possible and irrespective of appearance of clinical symptoms. TPE was not performed in six cases as they were hypotensive at admission.
  
  
  RESULTS
  The patients with EDB poisoning were 15-45 yrs old with 3:2 male to female ratio. Out of 47 who received TPE, 39 patients survived. TPE had started within 24 h of ingestions of EDB in 36 out of 39 survived patients. Survival outcome was nine times higher in patients who received TPE within 24 h than after 24 h of ingestion. Survival rate was increased to 100% in patients where TPE was done within 12 h of ingestion of EDB.
  
  
  CONCLUSIONS
  Early TPE help to remove plasma protein bound toxin with significant mortality reduction. However, delay in start of TPE after ingestion of poison has significant poor survival outcome.
authors.affiliation: Department of Nephrology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India.
authors.forename: Naresh
authors.initials: N
authors.lastname: Pahwa
authors.forename: Rajesh
authors.initials: R
authors.lastname: Bharani
authors.forename: Manish
authors.initials: M
authors.lastname: Jain
authors.forename: Suarabh
authors.initials: S
authors.lastname: Argal
authors.forename: Harish
authors.initials: H
authors.lastname: Soni
authors.forename: Susmit
authors.initials: S
authors.lastname: Kosta
authors.forename: Ravindra
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D002606:Charcoal / Q000627:therapeutic use; D015946:Ethylene Dibromide / Q000506:poisoning*; D005260:Female; D005751:Gastric Lavage; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000473:pathology; D008099:Liver / Q000187:drug effects / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010575:Pesticides / Q000506:poisoning; D010951:Plasma Exchange; D011041:Poisoning / Q000628:therapy*; D013406:Suicide, Attempted; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010575:Pesticides; D002606:Charcoal; D015946:Ethylene Dibromide
keywords: ethylene dibromide; hepatic toxicity; nephrotoxicity; therapeutic plasma exchange