The clinical applications of plasmapheresis are rapidly increasing in number and scope. This trend is also observed in the application of plasmapheresis as a method of detoxification in clinical toxicology. Because of a lack of large controlled series, the rationale for using plasmapheresis must be confirmed in each type of intoxication by evidence of effective clearance, as well as by high plasma protein binding and a low volume of distribution of the toxic substance. Plasmapheresis is used mostly to treat phalloid mushroom intoxications. In this potentially fatal intoxication, for which there is no antidote, plasmapheresis is at least as effective as haemoperfusion in reducing mortality from as high as 30-50% with conventional therapy to <20%. In our series of 28 patients treated with plasmapheresis, mortality was 17.8%. In our experience, plasmaphe-resis is also very effective in the treatment of life-threatening intoxications with tricyclic (amitriptyline) and 4-cyclic (maprotyline) antidepressants. We confirmed a 63% reduction in the plasma level of amitriptyline in one patient after single plasmapheresis. Other drugs such as L-thyroxine, verapamil, diltiazem and carbamazepime are also removed effectively by plasmapheresis, as are theophylline and heavy metals (mercury and vanadate). Phosphoroorganic substances are not removed effectively. We measured the plasma concentrations of dimethoate in two patients with this intoxication and did not find clinically significant clearance with plasmapheresis.
PURPOSE: This retrospective study was conducted to follow out acute intoxications with neuroleptics in Varna region, to assess the frequency and proportion depending on other drug and non-pharmacological poisonings. METHODS: The objects of the study are 193 patients with acute neuroleptic intoxications treated in the Clinic of toxicology of the Military Medical Academy-Varna, Bulgaria. The study is retrospective and covers a period of 20 years (1991-2010). RESULTS: The incidence of acute poisonings with neuroleptics was 7.5% of all drug poisonings and 2.5% of general poisonings. Poisoning occurs more commonly in women and the majority of poisonings were in people of working age. CONCLUSION: In recent years, there is a trend for an increase in the absolute number and the proportion of poisonings with neuroleptics. Lethality in these poisonings is not high-0.4 percent.
Phosphides are mainly binary compounds of phosphorus and more electroposititive chemical elements, therefore they can be considered, even if only formally, as salts of phosphine, РН 3. Phosphides cannot be found in nature but for some very rare exceptions. They find application as semiconductors (1) and rodenticides (chemicals, used to kill rodentsrats, mice, beavers, squirrels, etc.) (2,3). Their significance for clinical toxicology is connected to rodenticide poisonings.
Organophosphorus pesticides (OPs) are widely used in agriculture as insecticides, fungicides and rodenticides. They have a specific unpleasant odor. Due to their widespread use and high lethality, intoxications with them are a global problem (1,2). More than 200,000 people die each year after poisoning with OPs (3). Patients with acute organophosphorus intoxications require immediate treatment to prevent complications and lethal outcome. Despite the con-ABSTRACT Acute intoxications with organophosphorus pesticides (OPs) are a challenge for the clinical toxicology, because they are common, severe and with high lethality. Most OPs are lipophilic. In recent years, intravenous lipid emulsion (ILE) has been successfully used to treat acute poisoning with lipophilic xenobiotics. A clinical case of a 64-year-old male hospitalized after oral intake of 50 ml of fenitrothion is reported. He had been hospitalized with tachypnea and depressed consciousness-8 by Glasgow Coma Scale (GCS). Treatment standardized for this type of intoxication was initiated. On the 3rd hour treatment with Intralipid 20% was started, with a bolus dose of 1.5 ml/kg followed by infusion at a rate of 0.25 ml/kg/min to a total dose of 1000 ml. At the 16th hour consciousness was restored to GCS-15. In severe OPs intoxications ILE can be used as an additional method of controlling cardiotoxic and neurotoxic effects.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.