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PubMed1979

Digoxin removal from a patient with renal failure by hemoperfusion with Amberlite XAD-4 resin.

A digitoxic patient with severe renal failure underwent two hemoperfusion treatments with Amberlite XAD-4 resin. Digoxin clearances calculated from plasma flow rates and plasma digoxin concentrations, as well as from the amount of digoxin eluted from the used columns, were superior to those previously described for peritoneal dialysis, hemodialysis and charcoal hemoperfusion. There was a temporary improvement in the patient's life-threatening digitoxic cardiac rhythm with the first hemoperfusion, and a permanent improvement after the second hemoperfusion. It is submitted that hemoperfusion with this resin may significantly lessen manifestations of digoxin poisoning and may hasten digoxin elimination in digitoxic patients with renal failure.

Aged↗
PubMed1979

Influence of hemoperfusion on the concentrations of calcitonin, testosterone and cortisol in blood plasma.

The influence of hemoperfusion with a cellulose-acetate-coated charcoal column (Adsorba 300-C, Gambro, Lund, Sweden) on plasma concentrations of calcitonin, testosterone and cortisol was studied in five psoriatic patients during 12 treatment periods. Calcitonin, testosterone and cortisol were effectively removed from blood plasma by the charcoal column with average plasma clearances of 34.0, 14.5 and 27.6 ml/min, respectively, at 30 minutes of hemoperfusion, and 4.9, 15.4 and 24.4 ml/min, respectively, at 180 minutes of hemoperfusion. After three hours of hemoperfusion, significant decreases of testosterone and cortisol were found in peripheral venous blood, while calcitonin fell insignificantly. It remains to be elucidated whether long-term use of hemoperfusion would require a detailed control of possible effects on the endocrine status of patients.

Acetates↗
PubMed1982

Efficacy of charcoal hemoperfusion in paraquat poisoning.

We studied the efficiency of in vitro and in vivo charcoal hemoperfusion for the removal of paraquat. At a flow rate of 200 ml/min, 93-99% of paraquat in 4 L of solution (5, 10, 100 ppm) was removed in less than 160 min. The disappearance half-time was 16 min 10 sec. At 100 ml/min, it was 49 min 30 sec. Of 23 paraquat poisoning cases, 15 patients underwent hemoperfusion (HP) of which 10 died of respiratory failure within 28 days (7.6 +/- 2.9) and 5 survived without pulmonary complications. Of eight patients who did not receive HP, six died of respiratory failure within 97 days (33.4 +/- 18.8), even when their general condition was good upon admission. Two who vomited the ingested paraquat immediately survived without HP, and their paraquat concentration in urine was less than one ppm on admission. In one patient, whose paraquat concentration in blood was followed serially, 99% of the paraquat was removed from circulating blood by a single hemoperfusion. We conclude that charcoal hemoperfusion is effective for the removal of paraquat from blood in vivo and from solution in vitro. Hemoperfusion may also improve survival after paraquat ingestion, but further data are needed.

Adolescent↗
PubMed1984

Leukopenia, hypoxemia, and complement activation during a single hemoperfusion.

White blood cell count, acid-base balance, PO2, and complement function in five uremic patients undergoing a single hemoperfusion employing activated charcoal coated with methacrylate were studied. After 20 min on hemoperfusion, a marked leukopenia [ranging from 6,080 +/- 526 to 3,740 +/- 1,124 (p less than 0.02)] and hypoxemia [ranging from 106 +/- 13.8 to 80.2 +/- 11.9 mm Hg (p less than 0.02)] were observed. At the same time, total hemolytic complement decreased from 135 +/- 15.7 to 123 +/- 14.7 U/ml (p less than 0.001) and alternative pathway activity from 38.1 +/- 5.1 to 33.1 +/- 6.7 U/ml (p less than 0.005). C3 and B cleavage fragments were detected in the samples tested, thus demonstrating the activation of the complement alternative pathway. After 60 min, the different parameters tended to increase but did not reach the baseline levels. A direct correlation between the degree of leukopenia and the reduction of PO2 throughout the hemoperfusion period was found. pH PCO2, and HCO-3 did not change throughout the hemoperfusion period. The results demonstrate that complement activation, leukopenia, and hypoxemia occur during hemoperfusion.

Acid-Base Equilibrium↗
PubMed1990

Sequential and simultaneous "in series" hemodialysis and hemoperfusion in the management of theophylline intoxication.

Hemodialysis and hemoperfusion have been evaluated, and both are effective in removing theophylline. We report two consecutive cases of theophylline intoxication in which the sequential treatment of charcoal hemoperfusion and hemodialysis is contrasted to the simultaneous "in series" treatment of hemodialysis and charcoal hemoperfusion. Analysis of the two methodologies shows that the combined in series technique offers several advantages, including increased extraction efficiency, decreased time of hemoperfusion cartridge saturation, and rapid correction of electrolyte and acid-base abnormalities, and that it is well tolerated clinically. Simultaneous hemodialysis and charcoal hemoperfusion should be considered in cases of extreme theophylline intoxication.

Charcoal↗
PubMed1987

Hemoperfusion and immunocorrection in acute stage of severely burned patients.

The goal of this study was to explore the therapeutic effect of hemoperfusion and immunocorrection therapy in acute period of burn disease in severely injured patients. Hemoperfusion was performed in severely burned patients 1-3 times in the period from the 2nd to 10th day. The hemoperfusion procedures in severely burned patients were combined with immunocorrecting therapy. To prevent the development of septic complications in the early periods after the injury the patients were treated with passive immunotherapy supplemented with immunocorrecting substances. The patients were divided into two groups. The first group (26 persons) included patients treated with hemoperfusion followed by immunocorrection. The second group (11 persons) consisted of patients treated according to routine schemes. The studies carried out show that hemoperfusion with subsequent immunocorrection produced normalizing effect on indices of cellular and humoral immunity in severely burned patients. The efficacy of detoxication is attained both owing to blood depuration and due to detoxifying influence of directional effect immunoglobulins.

B-Lymphocytes↗
PubMed1991

The cytochemical changes and the adherence of neutrophil during cross-linked agarose encapsulated activated charcoal hemoperfusion.

After one hour cross-linked agarose encapsulated activated charcoal hemoperfusion, there was slight increase of total white cells and neutrophil count, but the neutrophil adherence was 16.87 +/- 5.26% and marked lower than that before hemoperfusion (59.91 +/- 5.26%, p less than 0.05). Using glassball hemoperfusion as control, the neutrophil adherence also decreased but not so obvious as the former. Adherence is a cell property that may affect granulocyte margination, diapedesis, chemotaxis and phagocytic function, so the above investigations showed that both the hemoperfusion process and the charcoal itself may reduce the host defence mechanism. There were no change of the peroxidase and alkaline phosphatase activities of neutrophils during one hour cross-linked agarose encapsulated activated charcoal hemoperfusion.

Alkaline Phosphatase↗
PubMed1981

An activated charcoal hemoperfusion system for the treatment of barbital or ethylene glycol poisoning in dogs.

The efficacy of activated charcoal (AC) hemoperfusin therapy was studied in dogs acutely poisoned with lethal doses of barbital or ethylene glycol (EG). Two of three barbital-poisoned dogs treated with AC hemoperfusion survived; the dog tha died was only hemoperfused for 1.5 h. Although AC hemoperfusion of EG-poisoned dogs reduced the blood level of the toxicant considerably, this was not enough to effect survival. The use of AC hemoperfusion was an effective therapeutic measure for dogs poisoned with lethal doses of barbital. The use of the AC hemoperfusion system with existing drugs of therapy for EG poisoning may be beneficial.

Animals↗
PubMed1992

[Secondary decontamination: when are hemodialysis and hemoperfusion indicated?].

Invasive methods of active removal, i.e., hemodialysis and hemoperfusion, are indicated for severely poisoned patients with substances causing tissue damage. Both methods will only be efficacious if the relative contribution of the extracorporal clearance to the overall elimination for a given substance is high and if the toxin has a relatively low apparent volume of distribution and a low tissue binding. Hemodialysis is recommended in severe life threatening intoxications with methanol, ethylene glycol, isopropyl alcohol, salicylates and lithium. Hemoperfusion is effective in removing theophylline and barbiturates. Patients with severe acute theophylline intoxication will benefit from hemoperfusion. Despite the very high clearance rates of barbiturates that can be obtained with hemoperfusion, the clinical usefulness of hemoperfusion remains to be proven.

1-Propanol↗
PubMed2005

How tightly can a drug be bound to a protein and still be removable by charcoal hemoperfusion in overdose cases?

BACKGROUND: Charcoal hemoperfusion is a very effective extracorporeal treatment in cases of drug overdose. The volume of distribution of a drug is the most important factor in limiting the efficacy of the treatment. Typically, drugs with a small volume of distribution are more efficiently removed by this treatment. In contrast, the effect of the plasma protein binding properties of drugs on their removal is not well understood, but it is clear that this binding percentage is an additional factor that affects the treatment. OBJECTIVE: To clarify the role of protein binding of a drug on the effectiveness of charcoal hemoperfusion and to define a guideline for this treatment based on the percentage of drug binding. STUDY DESIGN AND METHODS: Twelve patients with drug overdoses involving 20 different (a total of 32) drugs were hemoperfused using a charcoal column at Japanese Red Cross Kumamoto Hospital in 2000. Immediately after the beginning of the treatment, the plasma concentrations of the drugs in the blood entering (A) and leaving (V) the charcoal column were determined. The extraction efficiency, (A-V)/A, of each drug was then calculated. RESULTS: The efficacy of drug removal through adsorption to activated charcoal was found to be dependent on the binding affinity which is related to the protein binding percentage. The relationship between the extraction efficiencies of a charcoal column and the plasma protein binding percentages of the drug(s) showed that drugs that were bound at levels of 90-95%, or less, were effectively removed from the blood. CONCLUSIONS: Charcoal hemoperfusion can effectively remove drugs with a protein binding percentage as high as 95%. In addition to the volume of distribution, the plasma protein binding percentage of the drug can be used as a determinant for clearance by hemoperfusion especially in cases of a drug that binds tightly to a protein.

Adsorption↗
PubMed1987

Effect of hemoperfusion of cross-linked agarose coated activated charcoal (CAAC-II) on T-lymphocyte function in rats and guinea pigs.

Blood of rats and guinea pigs on cross-linked agarose coated activated charcoal (CAAC-II) hemoperfusion was analyzed over a follow-up period of 48 hours for the capacity of T-lymphocyte to transform under the stimulation of mitogen (PHA) in vivo and in vitro respectively. In the rate hemoperfusion, the in vivo T-lymphocyte transformation and lymphocyte count of peripheral blood were involved. In guinea pigs, the lymphocyte cultures were labelled with 3H-TdR and the radioactive incorporation was measured on the liquid scintillation counter. Our results revealed that the T-lymphocyte transformation function remained unchanged after 60-minute CAAC-II hemoperfusion although there was a transient and incomplete suppression of the T-lymphocyte transformation function both in vivo and in vitro immediately after the anesthesia and operation with blood vessel cannulation. The peripheral blood lymphocyte count also remained stable during the 60-minute CAAC-II hemoperfusion on rats and guinea pigs. We concluded that the charcoal hemoperfusion can be used as an important method of treatment for drug intoxication, uremia and hepatic coma with no harm to the body's immune function.

Animals↗
PubMed1979

[Is hemoperfusion effective in the treatment of digoxin intoxication? (author's transl)].

Digitalis therapy is frequently accompanied by adverse drug reactions. Severe digitalis intoxications are still a problem. Therapeutical methods, which could be used in the case of a life threatening digoxin intoxication, are known, but not yet generally available. Hemodialysis has only a minor effect on digoxin excretion. This study was planned to test the hypothesis that hemoperfusion across dextran-cocoated charcoal or the resin Amberlite XAD 4 could be more effective in the therapy of digoxin intoxications. The ability of hemoperfusion to eliminate digoxin was tested in a patient who had to undergo treatment beacuse of a severe bromcarbamide intoxication. Additionally we compared the effect of several modifications on this method in 12 dogs, which had received 0.05 mg/kg body weight per day for three days prior to the experiment. Although hemoperfusion across Amberlite XAD 4 may eliminate as much digoxin as normal human kidneys during the few hours of treatment, the amount of digoxin removed after all is only a small percentage of the total body pool. Thus compared to the risks of hemoperfusion as an invasive treatment its effect is small. According to our results, hemoperfusion cannot be recommended as a standard therapy of severe digoxin intoxications.

Adult↗
PubMed1977

[Treatment of the experimental chronic digitalisintoxication by hemoperfusion (author's transl)].

In 5 adult dogs experimental chronic digitalis intoxication was produced by oral administration of different digitalis-types (digoxin, beta-methyl-, beta-acetyl-digoxin, digitoxin). 18 to 24 hours after the last application of digitalis, charcoal hemoperfusion was performed in Dipidolor-N2O-anesthesia and serum digitalis-concentrations in the arterial and venous lines of the hemoperfusion system were determined by RIA J125. The Ecg was registered continuously as a simple clinical parameter of cardiac digitalis intoxication. Initial multiple cardiac arrhythmias (AVII degree, SAII degree, tachycardia of the atrium) subsided in the dogs with digoxin, beta-methyl- and beta-acetyl-digoxin during hemocolperfusion within 130 to 160 min. The disturbances of rhythm persisted up to 200 min after onset of hemoperfusion in the dog intoxicated by digitoxin. The clearances of digoxin and derivatives (35.8--43.1 ml/min) are higher than the digitoxin clearance (17--23.2 ml/min) which is supposed to be the reason for cardiac detoxication in the digoxin-intoxicated dogs. Hemoperfusion using polymer coated charcoal appears to be effective for the elimination of digoxin leading to a marked improvement of cardiac arrhythmias. By contrast digitoxin induced cardiac arrhythmias are not influenced during hemoperfusion.

Animals↗
PubMed1980

[The problem of hemoperfusion in poisonings: ineffectiveness in maprotiline poisoning].

A case of self-poisoning with maprotiline presenting with coma stage III was treated by resin hemoperfusion for 9 hours using an XAD-4 resin cartridge. Plasma levels of about 800 ng/ml maprotilin were initially found. After 5 hours of hemoperfusion progredient clinical improvement was noticed without decreasing tendency of the blood drug levels. The theoretical extraction efficiency calculated from the maprotiline blood levels and the perfusion rate yielded 50 mg for maprotiline and 16 mg for desmethylmaprotiline and was in good agreement with 60.5 mg of maprotiline and 17.3 mg of desmethylmaprotiline recovered from the resin cartridge at the end of the hemoperfusion. The in vitro binding capacity for maprotiline was estimated to be 230 mg per g of resin. These results demonstrate that XAD-4 resin efficiently binds maprotiline. However, because of the very low blood concentrations due to the large volume of distribution, whole body concentrations are minimally affected by resin hemoperfusion. Main complications consisted in thrombocytopenia extending over 24 hours after stopping hemoperfusion, anemia, a short initial decrease of blood pressure and an episode of premature ventricular beats.

Anthracenes↗
PubMed1982

Neutrophil adherence during hemoperfusion in fulminant hepatic failure.

Neutrophil adherence to nylon fibre packed in plastic syringes was determined in blood from patients with fulminant hepatic failure, both before and during charcoal hemoperfusion carried out with prostacyclin infusion and resin hemoperfusion without prostacyclin. During charcoal hemoperfusion there was a progressive decrease in neutrophil adherence, reaching the lowest value at 4 h (30.4 +/- SE 4.8%). After completion of hemoperfusion the adherence value returned to the pre-perfusion level (53.0 +/- 8.4%). These effects are probably attributable to the PGI2 infusion. No marked changes in neutrophil adherence were observed during resin hemoperfusion.

Cell Adhesion↗
PubMed1994

Enhanced elimination of biotinylated antibodies by avidin-based hemoperfusion in rats.

We designed a hemoperfusion system using immobilized avidin for selective removal of biotinylated therapeutic antibodies from rats. Two prototype therapeutic antibodies, ovine antidigoxin Fab fragment and murine monoclonal 8A1 against Escherichia coli J5 lipopolysaccharide endotoxin, were biotinylated using biotin-long-chain-N-hydroxysuccinimide ester. Biotinylated antibodies were administered i.v. to anesthetized rats which were instrumented for measurement of cardiovascular parameters and connected to avidin-hemoperfusion devices. By using several different protocols of antibody administration and hemoperfusion, we found that the half-lives and areas under the time vs. concentration curves of biotinylated antibodies were reduced significantly after passage over immobilized avidin. Avidin hemoperfusion was not associated with adverse changes in blood pressure, heart rate or excess hemolysis. These data suggest that avidin hemoperfusion affords a means for selective removal of biotinylated ligands from serum, and that other therapeutic and potentially toxic compounds could be removed in this manner.

Animals↗
PubMed1977

[Hemoperfusion with coated activated charcoal for treating acute poisoning by remedies, plant protectants, and fungi. III. Fungi (author's transl)].

Four patients with foudroyant liver dystrophy due to ingestion of fungi of the Amanita phalloides species were treated by hemoperfusion with coated activated charcoal. Three patients survived the poisoning. One patient died in a coma due to hepatic disintegration with cardiac and respiratory insufficiency. One female patient suffering from hemolytic syndrome and acute anuresis due to ingestion of fungi of the Paxillus involutus species recovered completely after treatment of combinated hemodialysis and hemoperfusion. The first hemoperfusion in the patients with Amanita phalloides poisoning were performed two to three days after ingestion of the fungus. At that time there were only traces of amanitines in the blood of one of the surviving patients. These Amanita phalloides toxins were only detected in the first 24-hour urine in the other 3 patients. It is thus not to be expected that toxicologically relevant quanities of the toxins will be eliminated from the blood by hemoperfusion carried out two to three days following ingestion of the fungus, Amanita phalloides. No coherence of restitutio ad integrum and hemoperfusion could be pointed out in the female patients suffering from hemolytic syndrom and anuresis due to Paxillus involutus.

Adult↗
PubMed1976

Efficacy of gut lavage, hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication.

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents. Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1-2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1-2 ppm, the clearance values for hemoperfusion were some 5-7 times higher than those for hemodialysis. In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquats less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

Adult↗