Hemoperfusion and continuous veno-venous hemofiltration for treatment of paraquat poisoning.
- Author:
Hee Jong NOH
1
;
Ja Ryong KOO
;
Jeong Yeol LEE
;
Min Ha JOO
;
Man Jo JEON
;
Jin Cheol KIM
;
Gheun Ho KIM
;
Rho Won CHUN
;
Hyung Jik KIM
;
Dong Wan CHAE
;
Jung Woo NOH
Author Information
1. Department of Nephrology, College of Medicine, Hallym University, Chunchon, Korea.
- Publication Type:Original Article
- Keywords:
Paraquat;
Hemoperfusion;
Hemofiltration
- MeSH:
Charcoal;
Chromatography, High Pressure Liquid;
Creatinine;
Dithionite;
Eating;
Hemofiltration*;
Hemoperfusion*;
Humans;
Kidney;
Korea;
Mortality;
Mouth;
Oxygen;
Paraquat*;
Plasma;
Poisoning*;
Prognosis;
Pulmonary Fibrosis;
Ultrafiltration
- From:Korean Journal of Medicine
2000;59(6):651-656
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: In Korea, paraquat accounts for most of fatal poisoning with 500 or more deaths per year. It has been known that patients who ingested more than 1/2 mouthful of 20% concentrate paraquat usually die of multiorgan failure and pulmonary fibrosis. But the effect of charcoal hemoperfusion which can enhance elimination of paraquat remains controversial. Because acute paraquat poisoning is also characterized by multiorgan failure including kidney and marked rebound in plasma paraquat level after hemoperfusion, Continuous veon-venous hemofiltration(CVVH) may have theoretical benefits in the treatment of paraquat poisoning. So we evaluated the effect of early charcoal hemoperfusion and prophylactic CVVH after hemoperfusion in patients with paraquat poisoning. METHODS: There were 80 patients with paraquat poisoning admitted within 24 hours after ingestion (August 1996 - March 1998). All of them were treated with hemoperfusion (duration of hemoperfusion, 6.4+/-3.0 hours) within 24 hours of ingestion. The amount of ingestion was 2.1+/-1.0 mouthful (as 20% concentrate) and 78 (98%) were urine sodium dithionite test positive which is a poor prognosis factor. Forty-four patients received hemoperfusion only and 36 were followed by CVVH (duration, 50.4+/-20.9 hours; ultrafiltration volume, 33.8+/-3.9 L/day) after hemoperfusion. RESULTS: There was no difference between the hemoperfusion group and hemoperfusion+CVVH group in age, sex, initial serum creatinine, arterial oxygen saturation, severity of poisoning (as assessed by serum paraquat level determined by HPLC and amount of ingestion), or in the time elapsed from ingestion to the beginning of hemoperfusion. The total mortality was 65% (52/80) with no difference between the hemoperfusion group (64%, 28/44) and hemoperfusion+CVVH group (67%, 24/36). The mortality according to amount of ingestion was as follows: < 1 mouthful, 0% (0/5); 1 mouthful, 53% (8/15); 2 mouthful, 65% (11/17); > or = 3 mouthful, 82% (27/33); unknown, 60% (6/10). CONCLUSION: Early hemoperfusion can be effective in reducing mortality in patients who ingest less than 2 mouthful. Even though prophylactic CVVH after hemoperfusion has no additional benefit in reducing mortality in paraquat poisoning, it prolonged the time to death after ingestion.
