Therapeutic efficacy of charcoal hemoperfusion in patients with acute severe dichlorvos poisoning
Abstract
AIM:
To assess the efficacy of hemoperfusion (HP) in the treatment of the patients with acute severe dichlorvos (DDVP) poisoning.
METHODS:
One hundred and eight patients with acute severe DDVP poisoning in the two teaching hospitals were enrolled. Sixty-seven patients were treated with HP (HP group) and forty-one patients accepted traditional treatment only as the control. Serum concentration of DDVP was determined by gas chromatography.
RESULTS:
The duration of coma, impaired consciousness, ICU stay, and mechanical ventilation was significantly shorter in the HP group than that in the control. The cumulative dosages (mg) of atropine required either in the first 24 h on admission (442+/-436 vs 899+/-485 in the control, P<0.01) or within the hospital (568+/-574 vs 1228+/-982 in the control, P<0.01) were markedly reduced in the HP patients. The lower incidence of mechanical ventilation required (13.4 % vs 36.6 % P<0.01), respiratory muscular paralysis (4.5 % vs 17.1 %, P<0.05) and the lower mortality of death (7.5 % vs 34.1 %, P<0.01) were observed in the HP group. HP could accelerate the recovery of suppressed cholinesterase activity. After the procedure, the DDVP level was decreased from (11+/-4) to (7+/-3) mg/L in parallel with a decline in APACHE II Score or dopamine dose and a rise in Glasgow Coma Scale (P<0.05). In addition, the mean values of peak clearance and reduction rate were (87+/-17) mL/min and 44 %+/-11 %, respectively.
CONCLUSION:
The rapid fall in blood DDVP level and the dramatic clinical response suggest that HP is effective in the treatment of acute severe DDVP poisoning.
Keywords:
To assess the efficacy of hemoperfusion (HP) in the treatment of the patients with acute severe dichlorvos (DDVP) poisoning.
METHODS:
One hundred and eight patients with acute severe DDVP poisoning in the two teaching hospitals were enrolled. Sixty-seven patients were treated with HP (HP group) and forty-one patients accepted traditional treatment only as the control. Serum concentration of DDVP was determined by gas chromatography.
RESULTS:
The duration of coma, impaired consciousness, ICU stay, and mechanical ventilation was significantly shorter in the HP group than that in the control. The cumulative dosages (mg) of atropine required either in the first 24 h on admission (442+/-436 vs 899+/-485 in the control, P<0.01) or within the hospital (568+/-574 vs 1228+/-982 in the control, P<0.01) were markedly reduced in the HP patients. The lower incidence of mechanical ventilation required (13.4 % vs 36.6 % P<0.01), respiratory muscular paralysis (4.5 % vs 17.1 %, P<0.05) and the lower mortality of death (7.5 % vs 34.1 %, P<0.01) were observed in the HP group. HP could accelerate the recovery of suppressed cholinesterase activity. After the procedure, the DDVP level was decreased from (11+/-4) to (7+/-3) mg/L in parallel with a decline in APACHE II Score or dopamine dose and a rise in Glasgow Coma Scale (P<0.05). In addition, the mean values of peak clearance and reduction rate were (87+/-17) mL/min and 44 %+/-11 %, respectively.
CONCLUSION:
The rapid fall in blood DDVP level and the dramatic clinical response suggest that HP is effective in the treatment of acute severe DDVP poisoning.