Early plasma exchange for treating ricin toxicity in children after castor bean ingestion

Wang, Chengfeng; Nie, Xiaojing; Chen, Guangming; Yu, Zhongxin; Li, Zheng; Sun, Zhiwen; Weng, Zeng-feng; Yang, Yuyun; Chen, Shulian; Zheng, Si-rui; Luo, Yinzhu; Lu, Y T; Cao, Hui-Qin; Zhan, H X

doi:10.1002/jca.21351

Cited by 15 publications

(8 citation statements)

References 7 publications

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“…7,8 Some publications have revealed that there are cases of death due to cardiovascular collapse and multiple organ failure with reported rhythm disorders and sinus arrhythmia. 6,12 In our presentation, the blood pressure of all patients was within the normal range, but two adult patients were observed having sinus tachycardia with a heartbeat rate of over 100 beats per min. We believe this was caused by dehydration due to fluid loss.…”

Section: Discussionmentioning

confidence: 58%

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Stranger in the garden: Ricinus communis, 17 cases of intoxication

Boğan¹,

Oktay

Sabak³

et al. 2019

Hong Kong Journal of Emergency Medicine

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Introduction: Ricinus communis is used as a decoration in landscape gardening in Turkey. In industrialized countries, however, it is used in many sectors, including the chemical, pharmaceutical, and fertilizer sectors; it is also used in cosmetics and biodiesel fuel production. In this presentation, 17 patients who ingested R. communis seeds are examined. Cases: Seventeen patients who ate the seeds of an unknown plant that grows in their gardens came to the emergency department with nausea, vomiting, and stomach ache complaints 4 h after ingesting the seeds. All patients were admitted to the critical care unit, monitored, and started on supportive treatment. After the treatment, patients’ vital signs and laboratory parameters were stable. Seven patients were discharged the next day upon the regression of symptoms. The remaining 10 patients were successfully discharged 2 days after the treatment. There are cases in medical literature where consumption of one-half of a R. communis seed resulted in death. In our presentation, each patient consumed one to four (2.18 on average) R. communis seeds, and the symptoms were over within 2 days. The clinical course ended without any cases of death, and all patients were discharged in good condition. Conclusion: Emergency physicians have to know the clinical course and medical methods regarding intoxication due to oral consumption of toxic plants. Severe toxicity and even mortality can be observed with the ingestion of the seeds of the plant. Similar symptoms (nausea, vomiting, and abdominal pain) were observed in all our cases, but no mortality was observed.

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Section: Discussionmentioning

confidence: 58%

“…However, in accordance with the literature, 1 g/kg of active charcoal was given orally to patients to reduce the GI absorption of toxic ricin. Cases with plasma exchange have been reported; 12 however, because our patients responded to symptomatic treatments, plasma exchange was not required.…”

Section: Discussionmentioning

confidence: 92%

Stranger in the garden: Ricinus communis, 17 cases of intoxication

Boğan¹,

Oktay

Sabak³

et al. 2019

Hong Kong Journal of Emergency Medicine

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“…The procedures were modified based on previous studies. 14,17 PE was conducted first followed by HF in an intermittent haemofiltration manner. Every complete procedure was undertaken over an interval of 1-3 days depending on the results of individual patient's blood and biochemical tests.…”

Section: Treatmentmentioning

confidence: 99%

“…1,13 The targeted substances that are planned to be removed include immune complexes, endotoxins, autoantibodies and lipoproteins, all of which are potentially related to immune-mediated disorders. 1,14 Haemofiltration (HF) is another haemopurification technique that removes excess body fluid across a haemofilter membrane using positive pressure and accumulates substances in patients with severe loss of kidney function that are critically ill. 15 However, HF is rarely reported for the management of both categories of TMA. 7 HF not only helps the removal of toxic substances from the bloodstream, but also improves the balance of electrolytes and acid-base.…”

Section: Introductionmentioning

confidence: 99%

Combination of plasma exchange and haemofiltration for treating thrombotic microangiopathy in children

Huang

Chen

et al. 2020

J Int Med Res

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Objective: To investigate the therapeutic effects of a combination of plasma exchange (PE) and haemofiltration (HF) for the treatment for paediatric patients with severe thrombotic microangiopathy (TMA). Methods: This retrospective study analysed data from paediatric patients who were diagnosed with severe TMA and managed with either supportive therapy and additional PE and HF (PE þ HF group) or supportive therapy alone (control group). Demographic and clinical characteristics, haemopurification and blood parameters and survival of the patients were compared between the two groups. Results: This study enrolled 32 patients: PE þ HF group (n ¼ 15) and control group (n ¼ 17). There were no significant differences between the two groups at baseline, including specific features for differentiating the two categories of TMA. The median time between onset and recovery, defined by the markers of platelet count, lactate dehydrogenase, blood urine nitrogen and hospital stay, were all significantly longer in the control group compared with the PE þ HF group. Kaplan-Meier curve analysis demonstrated that the cumulative survival rate was significantly higher in the PE þ HF group compared with the control group. Conclusion: The combination of PE and HF could be considered as one of the treatment choices for TMA.

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“…[ 1 ] Artificial detoxification methods, such as blood dialysis, gastric lavage, and the administration of active charcoal and antidotes, have been broadly applied in clinical practice. [ 2–5 ] According to the detoxifying mechanisms, antidote‐based detoxification mainly occurs via two approaches: pharmacodynamic or pharmacokinetic approaches. The pharmacodynamic approach targets the body by modulation or disrupting the action of biotoxin on its sites of action.…”

Section: Introductionmentioning

confidence: 99%

Supramolecular Detoxification of Macromolecular Biotoxin through the Complexation by a Large‐Sized Macrocycle

Zhao

Chen

Li³

et al. 2022

Adv Healthcare Materials

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Biotoxins are diverse, complex, and hypertoxic, ultimately serving as grave and lasting menaces to humanity. Here, it is aimed to introduce a new detoxification methodology for macromolecular biotoxin through complexation by a very large macrocycle. A 25‐mer peptide isolated from Lycosa erythrognatha spider venom (LyeTxI) is selected as the model macromolecular biotoxin. Quaterphen[4]arene, with a side length of ≈1.6 nm, has a sufficient cavity to bind LyeTxI. Hence, the water‐soluble derivative of Quaterphen[4]arene (H) is designed and synthesized. H exhibits an overall host–guest complexation toward LyeTxI, resulting in a considerably high association constant of (7.01 ± 0.18) × 107 m−1. This encapsulation of peptide is interesting as traditional macrocycles can only engulf the amino acid residues of peptides due to their limited cavity size. In vitro assay verifies that complexation by H inhibits the interactions of LyeTxI with cell membranes, thereby reducing its cytotoxicity, suppressing hemolysis, and decreasing the release of lactate dehydrogenase. Notably, the intravenous administration of H has a significant therapeutic effect on LyeTxI‐poisoned mice, alleviating inflammation and tissue damage, and markedly improving the survival rate from 10% to 80%. An efficient and potentially versatile approach is provided to detoxify macromolecular biotoxins, with giant macrocycle serving as an antidote.

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Early plasma exchange for treating ricin toxicity in children after castor bean ingestion

Cited by 15 publications

References 7 publications

Stranger in the garden: Ricinus communis, 17 cases of intoxication

Stranger in the garden: Ricinus communis, 17 cases of intoxication

Combination of plasma exchange and haemofiltration for treating thrombotic microangiopathy in children

Supramolecular Detoxification of Macromolecular Biotoxin through the Complexation by a Large‐Sized Macrocycle

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