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Ke J, Wei Y, Chen B. Application of Hemoperfusion in the Treatment of Acute Poisoning. Blood Purif 2023; 53:49-60. [PMID: 37918359 DOI: 10.1159/000532050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/29/2023] [Indexed: 11/04/2023]
Abstract
Rescue of acute poisoning is a race against time, and it is particularly important to remove toxic substances in time. Traditional methods include gastric lavage, promoting elimination, chelating agents, and other treatments. Hemoperfusion is a common blood purification technique. In the clinical practice of acute poisoning, hemoperfusion can directly remove toxic substances through its unique adsorption effect, showing its excellent efficacy. This paper reviews the experience of hemoperfusion in the treatment of various drug overdoses, pesticides, biological toxins, and industrial poisons, even drug addiction. It is hoped to provide a reference for clinicians in acute poisoning rescue.
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Affiliation(s)
- Jianting Ke
- Department of Nephrology, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Yuting Wei
- Department of Nephrology, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Binhuan Chen
- Department of Nephrology, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
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Yu G, Li Y, Jian T, Shi L, Cui S, Zhao L, Jian X, Kan B. Clinical Analysis of Acute Organophosphorus Pesticide Poisoning and Successful Cardiopulmonary Resuscitation: A Case Series. Front Public Health 2022; 10:866376. [PMID: 35712275 PMCID: PMC9196733 DOI: 10.3389/fpubh.2022.866376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/06/2022] [Indexed: 12/04/2022] Open
Abstract
Acute organophosphorus pesticide poisoning (AOPP) with cardiac arrest has an extremely high mortality rate, and corresponding therapeutic strategies have rarely been reported. Therefore, this study aimed to explore the prognostic factors and effective treatments of AOPP-related cardiac arrest. This retrospective study was conducted in our department in the years 2018–2021. We conducted a descriptive analysis of the clinical manifestations, rescue strategies, and prognosis of patients with AOPP who had experienced cardiac arrest and successful cardiopulmonary resuscitation. This study included six cases of patients with AOPP in addition to cardiac arrest; in four cases, cardiac arrest occurred <12 h after ingestion, and in two, cardiac arrest occurred more than 48 h after ingestion. Five patients had not undergone hemoperfusion therapy before cardiac arrest, and all six were treated with atropine during cardiopulmonary resuscitation and subsequent pralidoxine. Four patients recovered and were discharged from the hospital, one died in our department, and one was transferred to a local hospital and died there 2 h later. The last two patients had severe pancreatic injuries and disseminated intravascular coagulation. This, along with their death, might have been related to their prognosis. Cardiac arrest can occur in patients with severe AOPP for whom antidote administration was insufficient or not timely. Application of atropine and pralidoxine in a timely manner after cardiac arrest following AOPP is the key to successful treatment. This study provides useful guidelines for the treatment of similar cases in the future.
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Affiliation(s)
- Guangcai Yu
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Yaqian Li
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Tianzi Jian
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
- Department of Digestive Internal Medicine, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Longke Shi
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Siqi Cui
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liwen Zhao
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiangdong Jian
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Xiangdong Jian
| | - Baotian Kan
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
- Department of Geriatric Medicine, School of Nursing, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
- Baotian Kan
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Countermeasures in organophosphorus intoxication: pitfalls and prospects. Trends Pharmacol Sci 2022; 43:593-606. [DOI: 10.1016/j.tips.2022.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/14/2022] [Accepted: 04/17/2022] [Indexed: 11/24/2022]
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Sazonov V, Tobylbayeva Z, Saparov A, Jubaniyazov B, Issakov S, Gaipov A. New Therapeutic Approach to Reduce Methotrexate Toxicity after High-Dose Chemotherapy in a Child with Acute Lymphocytic Leukemia: Efficacy and Safety of Hemoadsorption with HA-230 Adsorber. Blood Purif 2021; 51:91-95. [PMID: 33725693 DOI: 10.1159/000514135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND High-dose methotrexate (HDMTX) is likely to cause a number of side effects and manifest itself as hepatotoxicity, nephrotoxicity, mucositis, and neurotoxicity. A several studies demonstrated the efficacy of extracorporeal detoxification methods such as plasma exchange, hemodialysis (HD), HD filtration, and hemoperfusion for the treatment of MTX delayed clearance. However, none of the existing methods as effective as expected and limited for general implementation due to a procedure-related complication. CASE REPORT Here, we report a successful implementation of HA-230 hemoadsorption procedure to remove cumulated MTX from the body and reduce its toxicity in a child with ALL after high-dose chemotherapy. RESULTS AND CONCLUSION Based on our results, single-hemoadsorption procedure with the HA-230 adsorber in case of delayed methotrexate clearance was safe and well-tolerated in a pediatric patient with ALL and would significantly improve the patient's condition. Further studies need to demonstrate its safety and efficacy in a large number of pediatric patients.
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Affiliation(s)
- Vitaliy Sazonov
- Pediatric Anesthesiology and Intensive care Unit, "University Medical Center" National Research Center for Maternal and Child Health, Nur-Sultan, Kazakhstan, .,Department of Biomedical Sciences, Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan,
| | - Zaure Tobylbayeva
- Pediatric Anesthesiology and Intensive care Unit, "University Medical Center" National Research Center for Maternal and Child Health, Nur-Sultan, Kazakhstan
| | - Askhat Saparov
- Pediatric Anesthesiology and Intensive care Unit, "University Medical Center" National Research Center for Maternal and Child Health, Nur-Sultan, Kazakhstan
| | - Bolatbek Jubaniyazov
- Pediatric Anesthesiology and Intensive care Unit, "University Medical Center" National Research Center for Maternal and Child Health, Nur-Sultan, Kazakhstan
| | - Samat Issakov
- Pediatric Anesthesiology and Intensive care Unit, "University Medical Center" National Research Center for Maternal and Child Health, Nur-Sultan, Kazakhstan
| | - Abduzhappar Gaipov
- Department of Clinical Sciences, Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan
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Omar S, Bahemia IA, Toerien L, San Pedro KM, Khan AB. A retrospective comparison of the burden of organophosphate poisoning to an Intensive Care Unit in Soweto over two separate periods. Afr J Emerg Med 2021; 11:118-122. [PMID: 33680732 PMCID: PMC7910160 DOI: 10.1016/j.afjem.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/31/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Organophosphate poisoning (OPP) is a major health-care burden in South Africa. Recently, we have observed that patients admitted to our Intensive Care Unit (ICU) with OPP have followed a more complicated course in comparison to previous years. Objectives To describe the differences in the clinical course and costs of patients with OPP between two time periods, namely 2012 and 2017. Methods Retrospective comparison of patients admitted to the Intensive Care Unit (ICU) of Chris Hani Baragwanath Academic Hospital between January 2012 to December 2012 and January 2017 to December 2017. Results Forty-one patients were found in the database. Patients from our 2017 cohort showed a significantly longer total median (IQR) length of stay 8 (4–17) days vs. 2 (2–3) days, p = 0.000, duration of antidote therapy 5 (3−10) days vs. 2 (2–3) days, p = 0.004 and duration of ventilation 4 (2−11) days vs 1 (1–2) day, p = 0.003. Patients presenting in 2017 were more likely to be admitted to ICU, odds ratio 5.6 (CI 1.2–26). There was a 31- fold increase in ICU costs between 2012 and 2017. Conclusion Based on our experience, the clinical course of OPP requiring ICU admission has evolved into a condition with a longer length of stay, duration of antidote therapy, ventilatory support, increased risk of complications and additional costs.
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Alozi M, Rawas-Qalaji M. Treating organophosphates poisoning: management challenges and potential solutions. Crit Rev Toxicol 2020; 50:764-779. [DOI: 10.1080/10408444.2020.1837069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Maria Alozi
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Mutasem Rawas-Qalaji
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
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Farooqui WA, Uddin M, Qadeer R, Shafique K. Trajectories of vital status parameters and risk of mortality among acute organophosphorus poisoning patients - a latent class growth analysis. BMC Public Health 2020; 20:1538. [PMID: 33046064 PMCID: PMC7552362 DOI: 10.1186/s12889-020-09637-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/30/2020] [Indexed: 01/24/2023] Open
Abstract
Background Acute organophosphorus (OP) poisoning is one of the major causes of mortality among patients presenting to emergency departments in developing countries. Although various predictors of mortality among OP poisoning patients have been identified, the role of repeated measurements of vital signs in determining the risk of mortality is not yet clear. Therefore, the present study examined the relationship between trajectories of vital signs and mortality among OP poisoning patients using latent class growth analysis (LCGA). Methods This was a retrospective cohort study using data for 449 OP poisoning patients admitted to Civil-Hospital Karachi from Aug’10 to Sep’16. Demographic data and vital signs, including body temperature, blood pressure, heart rate, respiratory rate, and partial-oxygen pressure, were retrieved from medical records. The trajectories of vital signs were formed using LCGA, and these trajectories were applied as independent variables to determine the risk of mortality using Cox-proportional hazards models. P-values of < 0.05 were considered statistically significant. Results Data for 449 patients, with a mean age of 25.4 years (range 13–85 years), were included. Overall mortality was 13.4%(n = 60). In trajectory analysis, a low-declining systolic blood pressure, high-declining heart rate trajectory, high-remitting respiratory rate trajectory and normal-remitting partial-oxygen pressure trajectory resulted in the greatest mortality, i.e. 38.9,40.0,50.0, and 60.0%, respectively, compared with other trajectories of the same parameters. Based on multivariable analysis, patients with low-declining systolic blood pressure were three times [HR:3.0,95%CI:1.2–7.1] more likely to die compared with those who had a normal-stable systolic blood pressure. Moreover, patients with a high-declining heart rate were three times [HR:3.0,95%CI:1.5–6.2] more likely to die compared with those who had a high-stable heart rate. Patients with a high-remitting respiratory rate were six times [HR:5.7,95%CI:1.3–23.8] more likely to die than those with a high-stable respiratory rate. Patients with normal-remitting partial oxygen pressure were five times [HR:4.7,95%CI:1.4–15.1] more likely to die compared with those who had a normal-stable partial-oxygen pressure. Conclusion The trajectories of systolic blood pressure, heart rate, respiratory rate and partial-oxygen pressure were significantly associated with an increased risk of mortality among OP poisoning patients.
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Affiliation(s)
- Waqas Ahmed Farooqui
- Department of Statistics, University of Karachi, Karachi, Pakistan. .,School of Public Health, Dow University of Health Sciences, Karachi, Pakistan.
| | - Mudassir Uddin
- Department of Statistics, University of Karachi, Karachi, Pakistan
| | - Rashid Qadeer
- Department of Medicine, Dr. Ruth K.M. Pfau/Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Pakistan
| | - Kashif Shafique
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan.,Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Understanding the Interaction Modes and Reactivity of Trimedoxime toward MmAChE Inhibited by Nerve Agents: Theoretical and Experimental Aspects. Int J Mol Sci 2020; 21:ijms21186510. [PMID: 32899591 PMCID: PMC7554915 DOI: 10.3390/ijms21186510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 11/17/2022] Open
Abstract
Organophosphorus (OP) compounds are used as both chemical weapons and pesticides. However, these agents are very dangerous and toxic to humans, animals, and the environment. Thus, investigations with reactivators have been deeply developed in order to design new antidotes with better efficiency, as well as a greater spectrum of action in the acetylcholinesterase (AChE) reactivation process. With that in mind, in this work, we investigated the behavior of trimedoxime toward the Mus musculus acetylcholinesterase (MmAChE) inhibited by a range of nerve agents, such as chemical weapons. From experimental assays, reactivation percentages were obtained for the reactivation of different AChE–OP complexes. On the other hand, theoretical calculations were performed to assess the differences in interaction modes and the reactivity of trimedoxime within the AChE active site. Comparing theoretical and experimental data, it is possible to notice that the oxime, in most cases, showed better reactivation percentages at higher concentrations, with the best result for the reactivation of the AChE–VX adduct. From this work, it was revealed that the mechanistic process contributes most to the oxime efficiency than the interaction in the site. In this way, this study is important to better understand the reactivation process through trimedoxime, contributing to the proposal of novel antidotes.
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de Castro AA, Assis LC, Soares FV, Kuca K, Polisel DA, da Cunha EFF, Ramalho TC. Trends in the Recent Patent Literature on Cholinesterase Reactivators (2016-2019). Biomolecules 2020; 10:biom10030436. [PMID: 32178264 PMCID: PMC7175240 DOI: 10.3390/biom10030436] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/22/2022] Open
Abstract
Acetylcholinesterase (AChE) is the key enzyme responsible for deactivating the ACh neurotransmitter. Irreversible or prolonged inhibition of AChE, therefore, elevates synaptic ACh leading to serious central and peripheral adverse effects which fall under the cholinergic syndrome spectra. To combat the toxic effects of some AChEI, such as organophosphorus (OP) nerve agents, many compounds with reactivator effects have been developed. Within the most outstanding reactivators, the substances denominated oximes stand out, showing good performance for reactivating AChE and restoring the normal synaptic acetylcholine (ACh) levels. This review was developed with the purpose of covering the new advances in AChE reactivation. Over the past years, researchers worldwide have made efforts to identify and develop novel active molecules. These researches have been moving farther into the search for novel agents that possess better effectiveness of reactivation and broad-spectrum reactivation against diverse OP agents. In addition, the discovery of ways to restore AChE in the aged form is also of great importance. This review will allow us to evaluate the major advances made in the discovery of new acetylcholinesterase reactivators by reviewing all patents published between 2016 and 2019. This is an important step in continuing this remarkable research so that new studies can begin.
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Affiliation(s)
- Alexandre A. de Castro
- Department of Chemistry, Federal University of Lavras, Lavras 37200-000, Brazil; (A.A.d.C.); (L.C.A.); (F.V.S.); (D.A.P.); (E.F.F.d.C.)
| | - Letícia C. Assis
- Department of Chemistry, Federal University of Lavras, Lavras 37200-000, Brazil; (A.A.d.C.); (L.C.A.); (F.V.S.); (D.A.P.); (E.F.F.d.C.)
| | - Flávia V. Soares
- Department of Chemistry, Federal University of Lavras, Lavras 37200-000, Brazil; (A.A.d.C.); (L.C.A.); (F.V.S.); (D.A.P.); (E.F.F.d.C.)
| | - Kamil Kuca
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 500 03 Hradec Kralove, Czech Republic
- Correspondence: (K.K.); (T.C.R.)
| | - Daniel A. Polisel
- Department of Chemistry, Federal University of Lavras, Lavras 37200-000, Brazil; (A.A.d.C.); (L.C.A.); (F.V.S.); (D.A.P.); (E.F.F.d.C.)
| | - Elaine F. F. da Cunha
- Department of Chemistry, Federal University of Lavras, Lavras 37200-000, Brazil; (A.A.d.C.); (L.C.A.); (F.V.S.); (D.A.P.); (E.F.F.d.C.)
| | - Teodorico C. Ramalho
- Department of Chemistry, Federal University of Lavras, Lavras 37200-000, Brazil; (A.A.d.C.); (L.C.A.); (F.V.S.); (D.A.P.); (E.F.F.d.C.)
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 500 03 Hradec Kralove, Czech Republic
- Correspondence: (K.K.); (T.C.R.)
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Affiliation(s)
- Kartik Gupta
- University of Alabama at Birmingham, Birmingham, AL
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