Massive digitoxin intoxication. Treatment by amberlite XAD 4 resin hemoperfusion

Abstract

Amberlite XAD 4 resin hemoperfusion was studied in the treatment of massive digitoxin overdosage. In vitro experiments using 4 hour resin hemoperfusion showed that digitoxin is removed 100 percent from an isotonic saline reservoir, 83 +/- 14 percent from plasma, and 42 +/- 7 percent from whole blood. In dogs, serum level reduction is fast: 50 +/- 12 percent in 15 minutes, 71 +/- 6 percent in 180 minutes; mean plasma clearance is 24 +/- 6.5 ml/min for a 150 ml/min plasma flow rate. Eleven patients with massive digitoxin overdosage recovered with resin hemoperfusion. Serum level reduction was 32 +/- 14 percent with a 325 g resin column, 59 +/- 6 percent with two 325 g resin columns in series as compared with a 4.5 +/- 1.7 percent reduction without perfusion. Hemoperfusion increased the rate of spontaneous removal of digitoxin 8.6 +/- 3.3 times with a 325 g resin column, and 14 +/- 7.4 times with two 325 g resin columns.

Hemoperfusion for the Treatment of Poisoning: Technology, Determinants of Poison Clearance, and Application in Clinical Practice

“…This effect of Q B on poison clearance has been confirmed in numerous in vivo and in vitro experiments for multiple poisons, as well as human reports, for both resin and charcoal columns . The relationship is particularly pronounced for poisons that are less bound to plasma proteins.…”

“…The larger the mass of adsorbent on the column, the more extensive is the poison clearance. This has been shown in vitro and in vivo for both resins and charcoal , although not confirmed in human studies . The reason for negative results in humans is not clear.…”

“…A single HP column is usually sufficient in the treatment of most poisonings, but it is possible to use two or more columns in series on some circuits to enhance poison removal. This leads to improved clearance in humans and animals poisoned with digitalis and tetramine poisoning, although the benefit is not additive . Furthermore, there is a risk of diminishing returns given the increasing cost and incidence of complications from HP.…”

Severe suicidal digoxin toxicity managed with resin hemoperfusion: A case report

“…[7–10] Digoxin has a molecular weight of 780.95 g/mol and is insoluble in water. Peak serum concentrations of digoxin, after oral ingestion, occur at 30 to 90 minutes.…”

“…[7] However, digoxin can be effectively removed by hemoperfusion with charcoal or resin filters. [8–10] Resin hemoperfusion has been shown to be useful in managing patients with various intoxications including tricyclic antidepressant, chloral hydrate, and mushroom poisoning. [11] Even though there are reservations regarding its use in digoxin overdose,[7] resin hemoperfusion may be tried for drugs like digoxin, which have a high lipid solubility and it has been used successfully in a few cases.…”