Renal replacement therapy in acute poisonings--one center experience.

The authors described three groups of patients after acute poisonings. In the first group were 60 patients after carbon tetrachioride poisoning, the second group consisted of 81 patients after mushroom poisoning and 20 patients after ethylene glycol poisoning were in the third group. Besides two patients with rare poisonings after potassium dichromate and after paraquat poisoning were analysed. All groups of patients with the kidney damage were presented from the diagnostic, differential diagnostic, conservative, ntra- and extracorporeal elimination treatment point of view. In the group of patients suffering from acute carbon tetrachloride poisoning and with acute renal failure following therapy was used: conservative treatment, exchange blood transfusion--in 4 patients in hepatic coma, renal replacement therapy (peritoneal dialysis, haemodialysis, plasmapheresis). From the total number of 60 patients 58 survived and 2 patients died in liver coma. Survival of patients after mushroom poisoning depended on amount of oral use of mushroom (Amanita phalloides), on early admission in dialysis centre and on early beginning of renal replacement therapy within 24 hr after acute poisoning. Twenty four patients from 81 patients of this group died. Main clinical signs of ethylene glycol poisoning were various neurological symptoms (cramps, hemiparesis, coma), severe metabolic acidosis (pH = 7.06 +/- 0.14), leucocytosis (26.4 +/- 5.5x 10(9)/L) and the signs of acute toxic hepatitis and of acute renal failure. Calcium oxalic crystals in urine were present in 17 patients and leucocytosis was observed in every patient. In the first 4 patients we administered intravenously ethylalcohol as an antidotum and later in other patients we used ethylalcohol in dialysis solution. The concentration of ethylalcohol in dialysis solution was 100 mg%. Severe metabolic acidosis improved in 17 patients using bicarbonate haemodialysis and 3 patients died before the possibility to use bicarbonate haemodialysis. Eighty-four hours after acute potassium dichromate poisoning and 24 hours after exchange blood transfusion during haemodialysis a 41-year old man died in haemorhagic shock, which developed after the extensive chemical burns of mucous membrane of gastrointestinal tract caused by this poison. Our patient after paraquat poisoning was treated by repeated charcoal haemoperfusion and haemodialysis. Despite of that therapy the patient died in severe respiratory insufficiency.

Vitamins and quality of life in hemodialysis patients.

BACKGROUND: Dialysis patients have decreased quality of life compared to healthy controls. In recent years the quality of life in hemodialysis patients has been considered from many points of view. The aim of this retrospective study was to improve quality of life in dialysis patients by supplementing some important vitamins. PATIENTS AND METHODS: Eighty-three patients underwent hemodialysis treatment 3 x 4 hr/weekly using a standard dialyzer with a cellulose membrane. During the investigation of plasma and erythrocyte vitamin E, vitamin E-coated dialyzer was used. Patients who were treated with erythropoietin (EPO) were supplemented over 3 months with Pyridoxine: 20 mg/day, folic acid: 10 mg/week, vitamin C: 60 mg/day. Some erythrocyte and plasma vitamins and plasma malondialdehyde were investigated in all patients. Erythrocyte vitamin B6 was determined by indirect enzymatic method as an effect of pyridoxal-5-phosphate (PLP). Erythrocyte folic acid was determined by radioimmunoassay method, erythrocyte vitamin E and plasma malondialdehyde were determined by fluorometric methods, plasma vitamin C was determined by spectrophotometric method. RESULTS: During above mentioned EPO treatment and supplementation, vitamins significantly increased blood hemoglobin (from 100+/-5 to 110+/-4 g/L, p<0.05), erythrocyte vitamin B6 that means decreased effect of PLP (from 30.4+/-2.4 to 16.4+/-1.9%, p<0.01), increased erythrocyte folic acid (from 343.3+/-72 to 734.5+/-98 ng/mL) and plasma vitamin C (from 63.5+/-15 to 88.3+/-10 micromol/L). Three-month use of vitamin E-coated dialyzer led to the increase of erythrocyte vitamin E (from 6.7+/-0.5 to 7.4+/-0.4 micromol/L, p<0.05) and to the significant decrease of plasma malondialdehyde (from 2.8+/-0.5 to 2.2+/-0.4 micromol/L, p<0.01). CONCLUSIONS: 1. Investigated vitamins were decreased in hemodialysis patients and after supplementation increased to normal range. 2. Increased plasma malondialdehyde, as a product of lipid peroxidation, significantly decreased during the use of vitamin E-coated dialyzer. 3. Adequate supplementation of above mentioned vitamins led to increased quality of life in hemodialysis patients from some clinical points of view.