Purpose: Cardiovascular or respiratory complications of acute intoxication are the most common causes of mortality. Advanced cardiac life support (ACLS) or specific antidotes help manage these cardiac or respiratory complications in acute intoxication. On the other hand, some cases do not respond to ACLS or antidotes and they require some special treatment, such as extracorporeal life support (ECLS). ECLS will provide the chance of recovery from acute intoxication. This study examined the optimal timing of ECLS in acute intoxication cases. Methods: This paper is a brief report of a case series about ECLS in acute poisoning. The cases of ECLS were reviewed and the effects of ECLS on the blood pressure and serum lactate level of the patients were analyzed. Results: A total of four cases were reviewed; three of them were antihypertensive agent-induced shock, and one was respiratory failure after the inhalation of acid. The time range of ECLS application was 4.8-23.5 hours after toxic exposure. The causes of ECLS implementation were one for recurrent cardiac arrest, two for shock that did not respond to ACLS, and one for respiratory failure that did not respond to mechanical ventilator support. Three patients showed an improvement in blood pressure and serum lactate level and were discharged alive. In case 1, ECLS was stared at 23.5 hours post toxic exposure; the patient died due to refractory shock and multiple organ failure. Conclusion: The specific management of ECLS should be considered when a patient with acute intoxication does not recovery from shock or respiratory failure despite ACLS, antidote therapies, or mechanical ventilator support. ECLS improved the hemodynamic and ventilator condition in complicated poisoned patients. The early application of ECLS may improve the tissue perfusion state and outcomes of these patients before the toxic damage becomes irreversible.
The decomposition of antibiotics (cefaclor) by gamma irradiation in aqueous solutions was experimentally evaluated. To obtain a mutual interaction between two factors (antibiotics concentrations and radiation doses) and to optimize these factors during the process, experimental design and statistical analysis were employed. The decomposition capability of the gamma radiation was also mathematically described as a function of cefaclor concentration and gamma-ray dose using the statistical analysis. The results showed that the cefaclor concentration (X1) in the response Y1 (Reduction of cefaclor concentration) and gamma-ray dose (X2) in the response Y2 (Removal efficiency (%) of cefaclor concentration) exhibited a significantly positive effect, whereas gamma-ray dose (X2) in the response Y1 showed a significantly negative effect. The estimated ridge of maximum responses and optimal conditions for Y1: (X1, X2) = (25 mg/L, 350 Gy) and Y2: (X1, X2) = (21 mg/L, 565 Gy) using canonical analysis were 4.37 mg/L of reduction of cefaclor concentration and 98.35% of removal efficiency of cefaclor concentration, respectively. The measurement values agreed well with the predicted ones, thereby confirming the suitability of the model for Y1 and Y2 and the success of the experimental design in optimizing the conditions of the gamma irradiation process.
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