Document Type : Case Report
Authors
- Zohreh Oghabian 1
- Maral Ramezani 2
- Shahin Shadnia 3
- Farah Pouramiri 4
- Babak Mostafazadeh 3
- Masoomeh Varzandeh 4
- Peyman Erfan Talab Evini 3
- Shahrad Tajaddini 4
- Mitra Rahimi 3
1 Department of Pharmacology and Toxicology, Medicine and Religion Research Center , School of Pharmacy, Kerman University of Medical Sciences, Kerman,Iran
2 2Department of Pharmacology, School of Medicine, Arak University of Medical Sciences, Arak, Iran 3Department of Pharmacology, Traditional and Complementary Medicine Research Center, Arak University of Medical Sciences, Arak, Iran
3 Department of Clinical Toxicology,Toxicological Research Center, Excellence Center of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Clinical Toxicology and Poisoning, Afzalipour Hospital, Faculty of Medicine , Kerman University of Medical Sciences, Kerman, Iran
Abstract
Objective: Paraquat poisoning is a critical condition with a high mortality rate, and there are currently no established treatment guidelines for managing this toxin. Hemoperfusion constitutes an alternative treatment for paraquat poisoning. This study aimed to evaluate the efficacy of hemoperfusion therapy using the Jafron HA330 hemoperfusion cartridge in patients with paraquat poisoning.
Case Presentations: This case series study was conducted on paraquat poisoning patients in Tehran’s Loghman Hakim and Kerman’s Afzalipour hospitals. In addition to the standard treatment of poisoning patients, the patients underwent hemoperfusion using the HA330 cartridge three times at 24-hour intervals, each time lasting 180–240 minutes. Before and following the completion of the treatment program, patients’ information and laboratory results were meticulously documented. Statistical analysis was performed using SPSS software version 21. The study noted that eight of the nine patients passed away. A notable finding was the significant reduction in potassium levels in the blood. Seven patients required intubation. A notable reduction in hemoglobin levels was detected following treatment. Furthermore, a decline in bicarbonate and pH levels was observed in patients, in post-treatment, though this decrease did not attain statistical significance. Conversely, the total bilirubin levels exhibited an increase in patients following treatment; however, this change was not statistically significant.
Conclusion: The findings of this study suggest that hemoperfusion with HA330 cartridges does not yield a substantial improvement in the survival of patients poisoned by paraquat.
Keywords
Main Subjects
- Alizadeh S, Anani-Sarab G, Amiri H, Hashemi M. Paraquat induced oxidative stress, DNA damage, and cytotoxicity in
lymphocytes. Heliyon. 2022;8(7):e09895. doi: 10.1016/j.heliyon.2022.e09895.
2. Kim JW, Kim DS. Paraquat: toxicology and impacts of its ban on human health and agriculture. Weed Sci. 2020;68(3):208-13. doi: 10.1017/wsc.2019.70.
3. Delirrad M, Majidi M, Boushehri B. Clinical features and prognosis of paraquat poisoning: a review of 41 cases. Int J
Clin Exp Med. 2015;8(5):8122-8.
4. Goldfrank LR, Hoffman RS. Goldfrank’s Toxicologic Emergencies. McGraw-Hill; 2016.
5. de Almeida RM, Yonamine M. Gas chromatographic mass spectrometric method for the determination of the
herbicides paraquat and diquat in plasma and urine samples. J Chromatogr B Analyt Technol Biomed Life Sci. 2007;853(1-2):260-4. doi: 10.1016/j.jchromb.2007.03.026.
6. Oghabian Z, Williams J, Mohajeri M, Nakhaee S, Shojaeepour S, Amirabadizadeh A, et al. Clinical features, treatment,
prognosis, and mortality in paraquat poisonings: a hospitalbased study in Iran. J Res Pharm Pract. 2019;8(3):129-36. doi:
10.4103/jrpp.JRPP_18_71.
7. Casarett LJ. Casarett and Doull’s Toxicology: The Basic Science of Poisons. New York: McGraw-Hill; 2008.
8. Awadalla EA. Efficacy of vitamin C against liver and kidney damage induced by paraquat toxicity. Exp Toxicol Pathol.
2012;64(5):431-4. doi: 10.1016/j.etp.2010.10.009.
9. Okolonkwo BN, Amadi CF, Chikwubike UO, Nyenke CU. The comparative effects of vitamin E + C on the chronic toxicity of paraquat in albino rats (Rattus norvegicus). Eur J Med Plants. 2022;33(6):7-13. doi: 10.9734/EJMP/2022/v33i630469.
10. Okolonkwo BN, Brisibe N, George-Opuda IM. Assessing short-term vitamin E and C treatment effect in paraquat
liver poisoning. Medicine. 2023;3(2):9-16. doi: 10.58614/jahsm322.
11. Moon JM, Chun BJ. The efficacy of high doses of vitamin C in patients with paraquat poisoning. Hum Exp Toxicol.
2011;30(8):844-50. doi: 10.1177/0960327110385633.
12. Li C, Cai H, Meng F, Meng F, Tang Z, Tang Y, et al. Case report: lung transplantation for treatment of paraquat intoxication: timing of transplantation. Front Pharmacol. 2023;14:1205689.doi: 10.3389/fphar.2023.1205689.
13. Wu Y, Li N, Li S, Song S. Lung transplantation in a woman with paraquat poisoning that led to pulmonary fibrosis-widely reported by the media: a case report. Medicine (Baltimore).2022;101(49):e32263. doi:10.1097/md.0000000000032263.
14. Ghannoum M, Bouchard J, Nolin TD, Ouellet G, Roberts DM. Hemoperfusion for the treatment of poisoning: technology, determinants of poison clearance, and application in clinical practice. Semin Dial. 2014;27(4):350-61. doi: 10.1111/sdi.12246.
15. Shi Y, Bai Y, Zou Y, Cai B, Liu F, Fu P, et al. The value of plasma paraquat concentration in predicting therapeutic effects of haemoperfusion in patients with acute paraquat poisoning. PLoS One. 2012;7(7):e40911. doi: 10.1371/journal.
pone.0040911.
16. Hsu CW, Lin JL, Lin-Tan DT, Chen KH, Yen TH, Wu MS, et al. Early hemoperfusion may improve survival of severely
paraquat-poisoned patients. PLoS One. 2012;7(10):e48397. doi: 10.1371/journal.pone.0048397.
17. Nasr Isfahani S, Farajzadegan Z, Sabzghabaee AM, Rahimi A, Samasamshariat S, Eizadi-Mood N. Does hemoperfusion in combination with other treatments reduce the mortality of patients with paraquat poisoning more than hemoperfusion alone: a systematic review with meta-analysis. J Res Med Sci. 2019;24:2. doi: 10.4103/jrms.JRMS_478_18.
18. Chen YJ, Li N, Wang Y. [Experimental research on Paraquat clearance rate after hemoperfusion adsorption]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2010;28(5):358-60.[Chinese].
19. Xiao Q, Wang W, Qi H, Gao X, Zhu B, Li J, et al. Continuous hemoperfusion relieves pulmonary fibrosis in patients with acute mild and moderate paraquat poisoning. J Toxicol Sci. 2020;45(10):611-7. doi: 10.2131/jts.45.611.
20. King JD, Kern MH, Jaar BG. Extracorporeal removal of poisons and toxins. Clin J Am Soc Nephrol. 2019;14(9):1408-15. doi:10.2215/cjn.02560319.
21. Cole L, Bellomo R, Davenport P, Tipping P, Ronco C. Cytokine removal during continuous renal replacement therapy: an ex vivo comparison of convection and diffusion. Int J Artif Organs. 2004;27(5):388-97. doi: 10.1177/039139880402700507.
22. Houschyar KS, Pyles MN, Rein S, Nietzschmann I, Duscher D, Maan ZN, et al. Continuous hemoadsorption with a cytokine adsorber during sepsis - a review of the literature. Int J Artif Organs. 2017;40(5):205-11. doi: 10.5301/ijao.5000591.
23. Malard B, Lambert C, Kellum JA. In vitro comparison of the adsorption of inflammatory mediators by blood purification devices. Intensive Care Med Exp. 2018;6(1):12. doi: 10.1186/s40635-018-0177-2. 24. Ronco C, Bellomo R. Hemoperfusion: technical aspects and state of the art. Crit Care. 2022;26(1):135. doi: 10.1186/s13054-022-04009-w.
25. Gil HW, Kim SJ, Yang JO, Lee EY, Hong SY. Clinical outcome of hemoperfusion in poisoned patients. Blood Purif. 2010;30(2):84-8. doi: 10.1159/000318585.
26. Park S, Islam MI, Jeong JH, Cho NJ, Song HY, Lee EY, et al. Hemoperfusion leads to impairment in hemostasis
and coagulation process in patients with acute pesticide intoxication. Sci Rep. 2019;9(1):13325. doi: 10.1038/s41598-019-49738-1.
27. Li H, Li WQ. Effect of hemoperfusion on internal environment of patients with acute poisoning. J Hainan Med Univ. 2016;22(10):103-7.
28. Guo H, Yuan Y, Ma Y, Shi J, Gu H. Effects of early repeated hemoperfusion combined with hemodialysis on the prognosis of patients with paraquat poisoning. Am J Transl Res. 2023;15(9):5613-23.
29. Yeh YT, Chen CK, Lin CC, Chang CM, Lan KP, How CK, et al. Does hemoperfusion increase survival in acute paraquat poisoning? A retrospective multicenter study. Toxics. 2020;8(4):84. doi: 10.3390/toxics8040084.
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