Experimental model for removal of snake venom via hemoperfusion in rats.

OBJECTIVE: To examine the efficiency of hemoperfusion in removing South American rattlesnake (Crotalus durissus terrificus) venom from rats compared with neutralization by antivenom. DESIGN: An exploratory experimental investigation in rats involving the injection of snake venom with or without subsequent hemoperfusion or antivenom administration. SETTING: Basic animal research laboratory in a private university. ANIMALS: Normal, healthy male Wistar rats (0.29-0.40 kg, 3-6 months old) from a commercial breeder. INTERVENTIONS: Four experimental groups of randomly allocated rats (n = 3/group) were studied: Group 1: rats were injected with a single dose of venom (5 mg/kg, IM, in the right thigh) with no other treatment; blood samples were collected minutes before death to determine leukocyte, platelet, and erythrocyte counts; Group 2 (Control): rats underwent hemoperfusion alone for 60 min using a hemoperfusion cartridge designed for protein adsorption (by granulated charcoal) and protein precipitation (by tannic acid); Group 3 (Venom + antivenom): rats were injected with venom (5 mg/kg, IM) and, 10 min later, were treated with antivenom at the venom:antivenom ratio recommended by the manufacturer; Group 4 (Venom + hemoperfusion): Rats were injected with venom (5 mg/kg, IM) and, 10 min later, were hemoperfused for 60 min. In groups 2-4, blood samples were collected for leukocyte, platelet, and erythrocyte counts 24 h after venom. MEASUREMENTS AND MAIN RESULTS: Rats injected with venom alone (Group 1) developed signs of neurotoxicity and ataxia and died in 9.0 ± 0.43 h but showed no changes in leukocyte or erythrocyte counts. In contrast, there were no deaths in groups 2-4. The lack of deaths in Groups 3 and 4 indicated that antivenom and hemoperfusion, respectively, protected against the lethal effects of the venom. CONCLUSIONS: Hemoperfusion with a double-action hemoperfusion cartridge capable of protein adsorption and precipitation protected rats against C. d. terrificus venom.

[Extracorporeal cytokine hemadsorption for the treatment of refractory septic shock. Report of two cases]. / Adsorción extracorpórea de citoquinas en el tratamiento del shock séptico refractario. Casos clínicos.

If Septic shock (SS) evolves to refractory SS, mortality could reach 90%, despite giving an optimal treatment. Nowadays, extracorporeal devices which adsorb inflammatory cytokines are available, reducing the systemic inflammatory response syndrome. These devices can be used with continuous renal replacement therapy or conventional hemodialysis. We report two diabetic females aged 50 and 58 years, who underwent a total colectomy and amputation of diabetic foot and who developed a SS with high requirements of vasoactive drugs (norepinephrine and adrenaline) to maintain a mean arterial pressure about 60 mmHg. Both were subjected to hemodialysis, connected to a cytokine hemadsorption device. The most important finding was the progressive reduction of vasopressor doses, effect that was observed nine hours after the beginning of the hemadsorption and lasted until its removal at 26 hours. Both patients survived.

Adsorción extracorpórea de citoquinas en el tratamiento del shock séptico refractario: casos clínicos / Extracorporeal cytokine hemadsorption for the treatment of refractory septic shock: report of two cases

If Septic shock (SS) evolves to refractory SS, mortality could reach 90%, despite giving an optimal treatment. Nowadays, extracorporeal devices which adsorb inflammatory cytokines are available, reducing the systemic inflammatory response syndrome. These devices can be used with continuous renal replacement therapy or conventional hemodialysis. We report two diabetic females aged 50 and 58 years, who underwent a total colectomy and amputation of diabetic foot and who developed a SS with high requirements of vasoactive drugs (norepinephrine and adrenaline) to maintain a mean arterial pressure about 60 mmHg. Both were subjected to hemodialysis, connected to a cytokine hemadsorption device. The most important finding was the progressive reduction of vasopressor doses, effect that was observed nine hours after the beginning of the hemadsorption and lasted until its removal at 26 hours. Both patients survived.

Intoxicación pediátrica por paraquat (gramoxone) supervivencia en dos casos / Pediatric intoxication with paraquat (gramoxone) survival of two children

El paraquat es un plaguicida agricola bipiridilo, cuyos efectos tóxicos más severos son año hepato-renal y fibrosis pulmonar irreversible. Se reportan dos casos de intoxicación en niños, por ingestión accidental de paraquat; ellos desarrollaron sialorrea, vómitos azul verdoso, lesión digestiva cáustica. dificultad respiratoria, daño hepato-renal, alteraciones radiológicas y presencia de paraquat en orina y sangre. Ambos pacientes recibieron el tratamiento disponible entre 24-48 horas despues de la ingestion y tuvieron una evolución satisfactoria. El tratamiento consistió basicamente en diálisis gastrointestinal, diuresis forzada ácida, N-acetilcisteína y dexametasona.

Paraquat is a bipyridyl agricultural pesticide, whose more severe effects are hepatic-renal damage and irreversible pulmonary fibrosis. Two children with paraquat accidental poisoning are reported; they developed syalorrhea, blue greenish vomiting, caustic digestive injury, breathing difficulty, liver and kidney damage, radiographic changes and presence of paraquat in blood and urine. Both patients received the available treatment 24-48 hours after ingetion and had a satisfactory autcome. The consisted basically of gatrointestinal dialysis, acidic forced diuresis, N-acetylcysteine and dexamethasone.

Charcoal hemoperfusion in the treatment of levothyroxine intoxication.

BACKGROUND: Levothyroxine (l-thyroxine) intoxication may arise from intentional or accidental ingestion of excessive doses of the hormone and may cause symptoms equivalent to thyroid storm. We report a case of massive accidental l-thyroxine intoxication resulting from an error in the preparation of capsules to treat goiter. SUMMARY: A 61-year-old woman was admitted showing high levels of thyroid hormones, with serum-free l-thyroxine level of 955.90 nmol/L (74.1 ng/mL) (normal values: 11.61-27.09 nmol/L or 0.9-2.1 ng/mL). It was discovered that she had ingested 50 mg instead of 50 microg/day of l-thyroxine during 9 days. Following charcoal hemoperfusion, the levels of total thyroxine, serum-free l-thyroxine, and triiodothyronine declined dramatically, with a reproducible pattern of reduction in hormone levels observed after each of the three sessions. The patient recovered from her stuporous mental state, atrial fibrillation, and acute respiratory failure. CONCLUSION: The use of hemoperfusion with a charcoal filter appears to be a very important therapeutic tool for the treatment of acute and severe forms of thyrotoxicosis due to l-thyroxine intoxication.

Hemoperfusión con carbón activado en la intoxicación aguda por barbitúricos. A propósito de un caso / Charcoal hemoperfusion in the acute barbiturate poisoning. Apropos of a case

Se presenta el caso de una paciente de 19 años sin antecedentes patológicos. Ingresa a la Unidad de Cuidados Intensivos debido a una intoxicación barbitúrica aguda, grave, secundaria a la ingesta de 4 gramos de pentobarbital. Se realizó tratamiento en base a rescate del tóxico, asistencia respiratoria mecánica, apoyo inotrópico, diuresis forzada alcalina y reposición hidro-electrólitica. Asimismo se realizó depuración extrarrenal mediante hemodiálisis convencional, la cual por ser inefectiva fue sustituida al cabo de 6 horas por una hemoperfusión sobre cartucho de carbón activado, con lo que se objetivó una franca mejoría clínica. La distinta eficacia depuradora de ambos métodos fue asimismo corroborada por la dosificación del tóxico en orina y sangre(AU)

Tratamiento de intoxicaciones / Treatment of the intoxications

Se trataron 8 pacientes intoxicados por diferentes métodos: hemoperfusión, hemodiálisis, diálisis peritoneal afectados de diferentes tóxicos (se desarrolla botulismo, bromato de potasio y metanol), se discuten las indicaciones de tratamiento

Tratamiento de intoxicaciones / Treatment of the intoxications

Se trataron 8 pacientes intoxicados por diferentes métodos: hemoperfusión, hemodiálisis, diálisis peritoneal afectados de diferentes tóxicos (se desarrolla botulismo, bromato de potasio y metanol), se discuten las indicaciones de tratamiento

Manejo general del paciente intoxicado / General management of the poisoning patient

Las intoxicaciones constituyen un motivo frecuente de consulta a las salas de emergencia de los hospitales. Aunque pueden ocurrir en personas de cualquier edad. Son más frecuentes en niños, adolescentes y ancianos. Aparte de las medidas de manejo general que comprenden: mantenimiento de la vía aérea y adecuado balance hidroelectrolítico, así como el cuidado adecuado del paciente comatoso; están aquellas medidas orientadas a evitar la absorción del tóxico y/o promover su excreción con otros métodos destinados a la remoción activa del veneno (tal como la diálisis), las cuales constituyen opciones terapéuticas que resultan en la recuperación de la mayoría de las victimas

Treatment of an infant with severe chloramphenicol intoxication using charcoal-column hemoperfusion.

A 3,200 gm 12-day-old male infant with complex urologic problems underwent charcoal hemoperfusion for severe accidental chloramphenicol intoxication. Immediately prior to CH, with a serum chloramphenicol level of 98 micrograms/ml, the child was in profound shock, ashen-gray, hypothermic, and acidotic. Chloramphenicol levels indicated virtually complete removal of this drug by the CH column. Three hours of CH treatment resulted in a reduction of the chloramphenicol level to 13.5 micrograms/ml and complete reversal of the described clinical syndrome. No serious complications of CH were encountered. We conclude that chloramphenicol poisoning is treatable by CH and that this therapeutic modality may be safely carried out in infants and small children.