Use of Therapeutic Plasmapheresis in Ethylene Dibromide Intoxication

Abstract

In view of high incidence of mortality with Ethylene dibromide poisoning, a retrospective study was conducted, with objectives to compare demographic, toxicological & clinical outcome in patients treated conservatively and those who underwent therapeutic plasmapheresis. Records of Forty patients from central India region, with ingestion of ethylene dibromide admitted over last six years were reviewed .The majority of patients were less than 30 years (77.5%). Gastrointestinal symptoms (87.5%) were predominant at presentation. Amongst biochemical parameters hepatotoxicity was seen in 26 (65%), cardio toxicity in 19 (47.5%) and renotoxicity was seen in 4 (10%). Fourteen patients (35%) had normal biochemical parameters. Out of 26 patients with hepatotoxicity, 13 were treated conservatively whereas 13 underwent plasmapheresis. In conservative group the mean liver enzymes level were 937.6 I.U./ml (range 96-3717) ,while in plasmapheresis group it was 2587.6 I.U./ml (126-11700). The mortality rate was 5/13(38.4%) in conservatively treated patients as compared to 3/13(23%) in plasmapheresis group. Mean length of hospital stay was 5.4 days (range 2-20 days).Best outcome was when the patient presented to the hospital within six hours of ingestion. Death occurred anywhere between twenty hours and five days. Ethylene dibromide is highly toxic substance with a reported mortality rates as high as 30-60%.In our study we found a 15.4% decrease in mortality in plasmapheresis group as compared to conservative. Thus plasmapheresis may be considered an important treatment modality for ethylene di bromide poisoning.

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