Haemoperfusion: a useful therapy for a severely poisoned patient?

Although it is many years since a haemodialysis and haemoperfusion over uncoated and later coated charcoal columns have been used for the treatment of intoxicated patients, the clinical efficacy of these extracorporeal techniques in the treatment of severely poisoned patients remains a matter of debate. Some of the reasons for this controversy may be the indiscriminate use of haemoperfusion in any form of intoxication, the lack of well-controlled studies and the wrong interpretation of the high haemoperfusion clearance values sometimes obtained. Simple pharmacokinetic principles are applied to this type of treatment and some practical guidelines as to how and when haemoperfusion should be applied or presented are reviewed.

[Poisoning by hypochlorite-containing disinfectants. A retrospective analysis of 594 cases of poisoning].

Hypochlorite-containing disinfectants or bleaching fluids, if inhaled, may lead to life-threatening poisoning (56% of moderately severe cases, 5% of severe cases) through the immediate liberation of chlorine gas, if they are used together with another cleansing fluid which is very acid. A rough estimate suggests that there must be about 700 cases of such poisonings per year in the Federal Republic of Germany. The characteristic symptom is a respiratory distress syndrome when the liberated chlorine gas is inhaled.

[Poisoning with leather-impregnation sprays. A retrospective analysis of 224 cases of poisoning].

Annually, there are about 100-200 intoxications in the Federal Republic of Germany caused by inhalation of leather impregnation sprays. The course of these intoxications is moderately severe in 60% and severe in 18% of the cases. The signs and symptoms are characterized by a respiratory distress syndrome which sets in about 15-60 min after spraying and which requires several days of hospitalisation in severe cases.

Acute toxicity of pyrazolones.

Pyrazolone intoxication accounts for most (52 percent) mild analgesic poisonings in West Germany. Severe and fatal intoxication with pyrazolones is, however, rare. In the German literature, only 50 cases have been described in the past 62 years; 80 to 90 percent of these were caused by aminopyrine, which was withdrawn from the West German market in 1978 and replaced by propyphenazone.