Evaluation of Hemodialysis and Hemoperfusion in Poisoned Patients

Abstract

Aim:The aim of our study was to evaluate the demographic data, type of toxic substance, Glasgow Coma scale (GCS), Poisoning Severity score (PSS) and the prognosis of the patients who were admitted to the emergency department (ED) with a preliminary diagnosis of acute intoxication and then underwent hemodialysis (HD) or hemoperfusion (HP), and to compare this data with other studies. Materials and Methods:The study retrospectively analyzed the files of 36 poisoned patients who were admitted to the ED and who underwent HD or HP by using the hospital electronic data system. Results: HD was administered to 27 patients (75.0%) and HP was administered to nine patients (25.0%). Among the patients treated with HD, five (18.5%) were poisoned by valproic acid, one (3.7%) by amlodipine, one (3.7%) by organic phosphorus, one (3.7%) by paracetamol, four (14.8%) by mushroom, two (7.4%) by ethyl alcohol/ethanol, three (11.2%) by lithium and ten (37.0%) by methyl alcohol/methanol. Among the patients treated with HP, one (11.1%) was poisoned by organic phosphorus, seven (77.8%) by amitriptyline, and one (11.1%) by phenytoin. The median GCS score was 10, and the median PSS was 3. The deceased patients had significantly lower GCS scores while their PSS was significantly higher. Eleven patients died, and 25 patients were discharged with full recovery.Conclusion: This is a multifaceted study that investigated poisoned patients treated with HD or HP and presented treatment modalities that are currently used, and we think they will be used more widely in the future.

Exposure of patients with chronic kidney disease on dialysis to pesticides

“…Thus, patients exposed to pesticides may, from the dialysis process, have eliminated possible residues and toxins that may have remained in the body during exposure. Research has shown that the procedures currently used in nephrology may soon also be used more widely for the detoxification process of patients poisoned by pesticides 42 . This fact constitutes a probable argument for the lack of statistical difference between the laboratory tests of exposed and non-exposed patients in the present study.…”

Exposição de pacientes com doença renal crônica em tratamento dialítico aos agrotóxicos

“…Desse modo, pacientes expostos a agrotóxicos podem, a partir do processo dialítico, ter eliminado os possíveis resíduos e toxinas que porventura tenham permanecido no organismo durante a exposição. A pesquisa mostrou que os procedimentos, atualmente utilizados na nefrologia, podem, em breve, também ser utilizados de forma mais ampla para o processo de desintoxicação de pacientes envenenados por agrotóxicos 42 . Esse fato constitui-se um provável argumento do não aparecimento de diferença estatística entre os exames laboratoriais dos pacientes expostos e não expostos na presente pesquisa.…”

Hemodialysis treatment for poisoning patients in the emergency department

“…However, when toxins are evaluated, methanol poisoning in adult patients and salicylate poisoning in pediatric patients are more prominent. Therefore, impaired consciousness and treatment-resistant metabolic acidosis are among the vital HD indications in adult poisoning patients [15,16].…”

“…Although the mortality rate in our study seems to be high according to this report, it was found to be lower when compared to studies that included only critical poisoning patients who underwent HD. In a study that included 36 poisoning patients and used HD or HP as extracorporeal treatment, the mortality rate was 30.6%, while it was 27.3% in another similar study [16,17]. The most common reason for admission was impaired consciousness when all patients were evaluated.…”

“…In a similar study performed with 90 cases of pediatric and adolescent poisoning patients in the literature, HD was performed to increase elimination in 78 (86.6%) cases, renal failure in 12 (13.3%) cases, and unclear indications in three (3.3%) cases [15]. In a study of 36 adult patients (27 HD patients, 9 HP patients), HD was performed in 28 (77.8%) patients to increase elimination, due to renal failure in 3 (8.4%), hepatic failure in 2 (5.5%), and treatment‐resistant metabolic acidosis, hemodynamic and/or impaired consciousness in 3 (8.4%) [16]. When evaluated together with the exposed toxins, HD indications seem to be similar to our study.…”