Extracorporeal Treatment with Hemoperfusion in the Management of Acute Poisoning

Background: Acute poisonings are a major cause of morbidity and mortality in the world, especially in developing countries like Mexico. Hemoperfusion (HP) is a technique for clearing medium and large molecular weight, lipophilic and highly protein-binding molecules, based on the principle of adsorption through a sorbent. It can be used alone or combined with other renal replacement techniques. Hemoperfusion removes toxins from the blood or plasma by attaching to a surface incorporated into a cartridge or resin where the toxin is adsorbed. The advantage of adsorption when compared to diffusion is that it is not limited by the molecular weight or protein binding of the toxin. In this study, we present the experience of using hemoperfusion in acute poisoning by different poisons. Methods: Eight poisoned patients were treated with Hemoperfusion. Results: Results are shown in Table 1 Conclusion: Extracorporeal treatment of poisoning is considered in serious situations in which immediate elimination of the poison is indicated. Also in situations where there are no antidotes available or when toxicity is expected to be prolonged despite treatments to eliminate toxins. To make the decision to use ECT, some properties of the venom must be considered: molecular weight, protein binding, volume of distribution, and clearance pathway. Some of the indications where hemoperfusion has been used are in acute poisoning; in poisoning by drugs (valproate, carbamazepine, quetiapine), chemicals (paraquat, organophosphates) or natural toxic products (fungi, snake bite). Clinical experience in Hemoperfusion Treatment - Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Case 7 Case 8 Xenobiotic Paraquat Quetiapine Zinc Phosphide Zinc Phosphide Zinc Phosphide Quetiapine Zinc Phosphide Viper venom Exposition Intentional Intentional Intentional Intentional Intentional Intentional Intentional Accidental Basal GFR (ml/min/1.73m2) 126 125 135 90 114 101 107 90 AKI at admission Yes No Yes No Yes Yes No Yes KDIGO stage 1 1 1 1 2 HCO3 (mmol/L 17.6 16.2 8 15.3 13 17 10 15.3 Lactate (mmol/L) 0.9 2.6 10 3.6 7.5 2.5 5.5 3.3 Mechanical Ventilation No Yes No No No Yes No No Time until Hemoperfusion (hours) 38 50 32 12 29 25 31 36 Extracorporeal treatment HD + HP HP HDF + HP HP HDF + HP HDF + HP HDF + HP HDF + HP No of treatments 1 2 2 1 1 3 1 1 Outcome Survived Survived Survived Dead Dead Survived Survived Survived