Abstract: SA-PO044
Extracorporeal Treatment with Hemoperfusion in the Management of Acute Poisoning
Session Information
- AKI: Clinical, Outcomes, and Trials - Management
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Vasquez Jiménez, Enzo Christopher, Hospital Juarez de Mexico, Mexico City, Mexico City, Mexico
- Aviles, Mayra, Hospital Juarez de Mexico, Mexico City, Mexico City, Mexico
- Garcia-Flores, Octavio Rene, Hospital Juarez de Mexico, Mexico City, Mexico City, Mexico
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 |