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PubMed1976

[Carbromal intoxication: influence of hemodialysis and hemoperfusion].

It has been demonstrated with an in vitro model that hemoperfusion through Amberlite XAD4 or coated charcoal containing cartridges eliminates carbromal and its ureid derivatives more efficiently than hemodialysis. The following clearancs were measured in vitro (blood flow: 200 ml/min): Coil dialyser (1 m2): 55-85 ml/min, charcoal hemoperfusion 100-125 ml/min, Amberlite XAD4 hemoperfusion: 200 ml/min. The data of one patient who had been hemoperfused after the ingestion of 35 g Carbromal with the Haemocol cartridge (SMith & Nephews) are depicted. Our results permit to draw the conclusion that hemoperfusion at this time is the most efficient means to eliminate Carbromal from intoxicated patients.

Charcoal↗
PubMed1983

Use of hemoperfusion for treatment of theophylline intoxication.

We review our experience in the management of patients with plasma theophylline concentrations of 30 micrograms/ml or greater. Over a two-and-a-half-year period, 22 patients (Group 1) had plasma theophylline concentrations of 37 +/- 1 micrograms/ml (mean +/- SE) and experienced no severe toxicity (i.e., ventricular extrasystoles or tachycardia, seizures, cardiovascular collapse, or death). Six patients (Group 2) took overdoses of theophylline (92 +/- 12 micrograms/ml) and one died. Eight patients (Group 3) were iatrogenically intoxicated (48 +/- 6 micrograms/ml) and three died. Six patients from Groups 2 and 3 underwent hemoperfusion and did well, except for one patient, in whom seizures developed before hemoperfusion was initiated. We conclude from this experience that charcoal hemoperfusion is a useful procedure for the treatment of theophylline intoxication because of: (1) the serious morbidity and mortality of theophylline intoxication, (2) the prevention of complications with hemoperfusion, and (3) the relative safety of the procedure. We provide tentative guidelines for the initiation of hemoperfusion for the treatment of theophylline intoxication.

Adolescent↗
PubMed1977

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

From the clinico-toxicological standpoint, the most important plant protectants are the insecticides (bipyridylium compounds). In vitro trials and investigations on poisoned patients have shown that it is fundamentally possible to eliminate such plant protectants from the blood by hemoperfusion with coated activated charcoal. With both the lipophilic alkyl phosphate, nitrostigmine (E605 forte), and by the two hydrophilic alkyl phosphates, demetone-S-methyl sulfoxide (Metasystox R) and dimethoate (Roxion), it was possible to measure hemoperfusion clearance values around 60 to 85 ml/min at a blood flow rate of 100 ml/min. Only the two hydrophilic alkyl phosphates were able to be eliminated by hemodialysis, the clearance values being, however, lower. Thus in severe alkyl phosphate intoxications the use of hemoperfusion may considered alongside the standard therapy. The bipyridylium compounds, paraquat (Gramoxone) and diquat (Reglone), are readily dialysed, but can be better eliminated from the blood by hemoperfusion. This therapeutic measure must be initiated as rapidly as possible independent of the clinical picture, for only when hemoperfusion is begun prior to the fixation of paraquat or diquat at tissue are there any prospects of success.

2,2'-Dipyridyl↗
PubMed1976

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

Hemoperfusion with coated activated charcoal is a novel procedure for treating acute poisoning. It enables the elimination of both, water-soluble and liposoluble toxins. Hemoperfusion with coated activated charcoal has proved to be superior to hemodialysis in the treatment of barbiturate or bromocarbamide poisoning both under experimental conditions as well as in the ward. Analogous statements may be made for the therapy of glutethimide poisoning. Methaqualone, on the other hand, could not be eliminated sufficiently well in animal trials. Intoxications by "mild" analgetics, such as paracetamol and acetylsalicylic acid, may be treated successfully with hemoperfusion. Treatment of acetylsalicylic acid poisoning is equally effective with hemoperfusion as with hemodialysis. Prospects for the success of hemoperfusion in treating intoxication from tricyclic antidepressants and neuroliptics are slight. It is simply the danger of antidepressant poisoning that justifies using this method of treatment in the first few hours after ingestion in order to reduced the flow of the psychopharmaceutical substance into the tissue.

Acetaminophen↗
PubMedDate not supplied

The pharmacokinetics of thiabendazole and its metabolites in an anephric patient undergoing hemodialysis and hemoperfusion.

The pharmacokinetics of thiabendazole and its metabolites were determined after the first dose and during hemodialysis and hemoperfusion in an anephric female patient treated for a strongyloides infection. The half-live, volume of distribution, and clearance for thiabendazole were 1.17 hour, 2.76 liters/kg, and 27.2 ml/min . kg, respectively. While thiabendazole and the 5-OH metabolite did not accumulate during multiple dosing, the glucuronide and sulfate esters accumulated extensively despite hemodialysis and hemoperfusion. Hemodialysis clearances for all compounds were poor. Hemoperfusion removal was much better but declined rapidly after the first hour. If rapid removal of thiabendazole and its metabolites is required, the hemoperfusion column should be changed hourly.

Adult↗
PubMed1982

Pharmacokinetics of bretylium in dogs and the effect of hemoperfusion on elimination.

The pharmacokinetics of bretylium in dogs and the efficacy of hemoperfusion with a resin column in its removal from the body following intravenous administration of bretylium tosylate were investigated. Five mongrel dogs weighing 18-26 kg were given a bolus dose of 15 mg/kg. Serial blood samples were taken for 24 hr. Hemoperfusion, through a resin column, was then initiated and continued for 4 hr under pentobarbital anesthesia. During hemoperfusion, arterial and venous blood samples were collected several times; venous blood samples were then withdrawn for an additional 8 hr. Urine was collected from each dog in three portions for up to 48-54 hr. Pharmacokinetics of bretylium in dogs could be characterized by a two-compartment open model with a distribution half-life of 7 min and biological half-life of 15.9 +/- 1.9 hr. Plasma levels declined rapidly from approximately 20 microgram/ml at 6 min to less than 2 microgram/ml within 1 hr. The ratio of intercompartmental rate constants, k12/k21, was 16.7, and the volume of the central compartment and apparent volume of distribution were 0.245 and 5.22 liter/kg, respectively, indicating a wide distribution of bretylium into the tissues. Plasma dialysis clearance averaged 29.7 ml/min, which is 30% of the total body clearance (98.8 ml/ min). These data suggest that resin hemoperfusion may not be useful in the treatment of bretylium intoxication.

Animals↗
PubMed1978

Digoxin and digitoxin elimination in man by charcoal hemoperfusion.

Since there is no widely used causal means of reducing the severity of massive digitalis intoxication the capability of hemoperfusion with coated activated charcoal to remove toxicologically relevant amounts of digoxin and digitoxin was evaluated in vitro and in man. At a blood flow rate of 100 ml/min the digoxin clearance by hemoperfusion in vitro was 51 +/- 8 ml/min in comparison to 24.3 +/- 11.3 ml/min by hemodialysis. The average hemoperfusion clearance of digitoxin was 31.7 +/- 13.4 ml/min, whereas almost no digitoxin was removed by hemodialysis. These clearance values point to the ability of hemoperfusion of eliminating digitalis glycosides from the blood. They do not clarify the essential question whether it is possible to lower the toxic concentrations in the tissues.

Charcoal↗
PubMed1999

Repeat charcoal hemoperfusion treatments in life threatening carbamazepine overdose.

A 16-month-old female experienced a massive carbamazepine ingestion resulting in a peak serum carbamazepine concentration of 55 microg/ml. Clinical manifestations included generalized seizures, coma, shock, and gastrointestinal hypomotility. Gut decontamination was attempted using multiple-dose activated charcoal and cathartics. Because of the severity of illness, charcoal hemoperfusion was initiated. The patient underwent three sessions of charcoal hemoperfusion, each utilizing a fresh cartridge, with one session immediately following the other. Serum carbamazepine and carbamazepine-10,11-epoxide concentrations decreased from 54 microg/ml to 23 microg/ml, and 30 microg/ml to 17 microg/ml, respectively, during charcoal hemoperfusion. There were no complications. The patient recovered completely and was discharged on the 4th hospital day. Charcoal hemoperfusion should be considered for life-threatening carbamazepine intoxication, especially when drug-induced gastrointestinal hypomotility prevents elimination via the gut.

Carbamazepine↗
PubMed2000

Charcoal hemoperfusion in the treatment of phenytoin overdose.

In the case of phenytoin, a drug that is generally highly protein bound, there is a lack of consensus on the use of charcoal hemoperfusion in cases of overdose. We performed charcoal hemoperfusion on a phenytoin-overdosed patient to assess the effectiveness of this treatment. The plasma concentrations of total and free phenytoin fell rapidly, from 40.0 microg/mL and 3.6 microg/mL to 16.2 microg/mL and 1.5 microg/mL, respectively, after 3 hours of hemoperfusion. The total phenytoin elimination half-life was 3.9 hours. The fraction of protein-bound phenytoin was constant (90.8% +/- 0.5%) before, during, and after the procedure. The relations between the in vitro protein binding and adsorption of phenytoin to activated charcoal were also examined. Interestingly, bound phenytoin was found to dissociate from plasma proteins in the presence of activated charcoal and subsequently became adsorbed to the activated charcoal. Considering that phenytoin is bound to albumin with a large number of binding sites (n = 6) and a small binding constant (K = 6 x 10(3/)mol/L), the extent of adsorption to activated charcoal may depend on the magnitude of the binding constant of the drug to plasma proteins. The current results suggest that charcoal hemoperfusion is effective for the removal of drugs that bind to plasma proteins with a low binding constant.

Adult↗
PubMed1987

Chlorpropamide overdose in renal failure: management with charcoal hemoperfusion.

A potentially lethal chlorpropamide overdose in a patient with chronic renal failure on long-term hemodialysis was treated by two courses of charcoal hemoperfusion. Hemoperfusion shortened the half-life clearance of the drug from a mean value of 93.6 to 3.4 hours. Calculation of the fractional extraction indicated that hemoperfusion reduced the body burden of the drug by 24% and 19% (mean values) during the first and second hours of treatment, respectively. We conclude that charcoal hemoperfusion should be considered a definitive therapeutic option in such cases.

Adult↗
PubMed1980

Resin hemoperfusion in dogs intoxicated with ethychlorvynol (Placidyl).

Kinetic parameters were studied to determine the effectiveness of hemoperfusion in removing ethychlorvynol from the plasma and red blood cells (RBC) of intoxicated dogs. Perfusion columns contained polystyrene/divinyl benzene resin (XAD-4 Amberlite. Column clearances of ethchlorvynol averaged 96.5 +/- 0.4% of the plasma flow rate (mean +/- SEM, 9 dogs). Plasma ethchlorvynol t 1/2's during preperfusion periods averaged 94.1 hr. During hemoperfusion, t 1/2's averaged 3.8 hr, or 90.3 hr shorter than at the endogenous rate of detoxication. There was no significant difference between preperfusion and postperfusion half lives. An estimate based on plasma column clearance suggests that 1.5 +/- 0.1 g ethchlorvynol, or 19.0 +/- 2.8% of the dose, was removed by hemoperfusion. The amount eluted from the resin was 2.9 +/- 0.3 g (37.2 +/- 5.8% of the dose), or about twice the amount apparent from plasma clearance alone. Further, the volume of distribution of ethchlorvynol was 2.3 +/- 0.2 liters/kg, suggesting significant distribution to intracellular and extravascular compartments. The results show that resin hemoperfusion removes a large fraction of ethchlorvynol from intoxicated dogs, and greatly adds to endogenous mechanisms for elimination. Ethchlorvynol was removed from RBC directly, and ultimately from extravascular sites as well.

Animals↗
PubMed1999

Effect of charcoal hemoperfusion on clearance of cibenzoline succinate (cifenline) poisoning.

BACKGROUND: Management of cibenzoline succinate (cifenline) poisoning by symptomatic treatment is recommended because it has been reported cibenzoline succinate is not effectively removed by hemodialysis. The use of charcoal hemoperfusion for patients with cibenzoline succinate poisoning has not been reported previously. CASE REPORT: An 80-year-old woman with permanent right ventricular pacing was admitted to our hospital with general fatigue and clouding of consciousness. She had been receiving cibenzoline succinate for 1 month. The patient was clearly in shock on admission. Electrocardiogram showed a prolonged QRS and QTc interval and pacing failure. Hemodynamic failure, electrocardiographic abnormalities including pacing failure, and liver and renal dysfunction were compatible with cibenzoline succinate poisoning. Symptomatic treatment was provided. On day 4, charcoal hemoperfusion was initiated because of the development of hypoglycemia accompanied by liver and renal dysfunction. After charcoal hemoperfusion, the hypoglycemia, liver and renal dysfunction, prolonged QRS and QTc interval, and pacing threshold resolved. She was discharged on digoxin. We present a case of cibenzoline succinate poisoning treated with charcoal hemoperfusion which resulted in a rapid reduction of cibenzoline plasma concentrations with a significant clinical improvement.

Aged↗
PubMed1977

Treatment of severe drug overdosage with charcoal hemoperfusion.

Mortality from severe poisoning remains excessively high in patients managed conservatively. In this report, charcoal hemoperfusion was used as a therapeutic aid to active drug removal in 10 patients (9 of whom were in Grade IV coma) intoxicated with a variety of drugs and a further 3 patients poisoned with the highly lethal herbicide, paraquat. All 10 patients who ingested drugs recovered. One of the 3 patients ingesting paraquat survived. The hemoperfusion treatments were associated with demonstrated drug removal. Complications associated with hemoperfusion were minor. Decreases in platelet levels were observed but were not accompanied by clinically important bleeding. The technique of hemoperfusion is simple and provides a therapeutic aid in the care of the severely poisoned patient.

Adolescent↗
PubMed1992

Experience with hemoperfusion for organophosphate poisoning.

OBJECTIVE: To evaluate the usefulness of extracorporeal clearance techniques in the treatment of organophosphate poisoning, particularly hemoperfusion. DESIGN: Retrospective study. SETTING: An ICU of a general hospital. PATIENTS: Ten patients with organophosphate poisoning initially received classic treatment with gastric lavage and washing of the whole skin surface, as well as the administration of cathartics, activated charcoal, atropine, and obidoxime or pralidoxime. All patients underwent one to three hemoperfusions. MEASUREMENTS AND MAIN RESULTS: Plasma insecticide concentrations and cholinesterase activity were determined daily. Two to three biopsies of fat tissue were carried out at 1- to 2-wk intervals. The amount of the insecticide removed during hemoperfusions was also determined. Five patients presented with a prolonged nicotinic syndrome. Two of these patients showed sequelae of delayed neurotoxicity. Another two of the five patients died and the remaining patient recovered without sequelae. In none of the patients could > 0.1% of the total absorbed poison be removed by hemoperfusion. No changes in symptoms were observed after these procedures. Fat tissue concentrations of the insecticide were 20 to 50 times higher than the concentrations in plasma. Atropine decreased the intestinal transit time, and 10 days after poisoning, a powerful cathartic treatment indicated the persistence of gut content, which probably caused prolonged absorption of the toxin. CONCLUSIONS: Extracorporeal cleansing mechanisms did not remove any clinically important amount of insecticide from our patients due to the high lipid solubility of these agents and no changes in symptoms were observed after these methods. The use of atropine decreases bowel peristalsis. Early use of powerful cathartics could avoid protracted absorption of the poison stored in the gut, although the potential benefits of this therapy require confirmation by the performance of prospective, controlled investigations.

Adult↗
PubMed1981

Hemoperfusion in quinidine intoxication.

A case report on quinidine intoxication is presented. After having ingested 8.1 g quinidine the patient had clinical and ECG signs of a severe intoxication and a serum quinidine level of 8.5 mg 1. She was treated for six hours with charcoal hemoperfusion. Serum quinidine was on an average 36% lower after than before the cartridge. The mean quinidine clearance of hemoperfusion was 24 ml/min. All clinical and ECG signs of quinidine intoxication were normalized during hemoperfusion. The data justify that hemoperfusion is probably the best way to treat severe quinidine intoxication.

Adult↗
PubMed1984

Charcoal hemoperfusion for treatment of serious carbamazepine poisoning.

A case of severe carbamazepine intoxication (total dose 80 g) is reported. Because of deep coma and cardiovascular symptoms, intensive care and hemoperfusion were employed. The carbamazepine hemoperfusion clearance rate was 80-90 ml/min, but due to a probable ongoing absorption from the gut the effect of hemoperfusion was limited. Long hemoperfusion periods are recommended due to the pharmacokinetic pattern of carbamazepine.

Adult↗
PubMed1978

Adsorptive capacities of hemoperfusion devices in clinical use.

Five different hemoperfusion devices have been used in the treatment of patients, intoxicated with barbiturates. The changes in drug clearance values which occurred during hemoperfusion varied according to the device used. Even after very long periods of hemoperfusion, however, drug clearance values never fell to zero. Using data collected from comparable cases, it has been shown that the rate of uptake of drug from the blood is independent of the amount of adsorbent in the columns, those containing 100 gm charcoal having the same efficiency as the conventional 300 gm. The prime factor which determines the rate of drug uptake has been shown to be the arterial plasma drug concentrations. Other factors, such as the deposition of cellular debris and proteins as hemoperfusion progresses, are also thought to influence the efficiency of drug removal.

Adsorption↗
PubMed1979

Albumin-coated Amberlite XAD-7 resin for hemoperfusion in acute liver failure. Part II: in vivo evaluation.

Albumin-coated Amberlite XAD-7 has been previously shown to be blood compatible in in vitro hemoperfusion experiments whith human blood. In this study, the preliminary results are reported on single hemoperfusions with albumin-coated XAD-7 resin in four patients with acute liver failure. The mean platelet count was 116+/-SE 16.3% of the initial arterial value and the mean white cell count was 96+/-SE 6.5% of initial at the end of four hours of hemoperfusion. Removal of bilirubin, phenols and substances in the middle molecular weight range by the resin was demonstrated. These preliminary results suggest albumin-coated Amberlite XAD-7 resin to be blood compatible and capable of removing protein-bound and middle molecular weight substances from patients with acute liver failure. Further clinical evaluation of repeated resin hemoperfusion is required to determine whether this treatment will be beneficial to patient survival.

Acrylic Resins↗