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Objective To study the adsorption effect of activated charcoal suspension on paraquat (PQ) in gastrointestinal tract of beagles exposed to PQ.Methods Twenty healthy male beagles were randomly divided into experimental group and control group,with 6 beagles in each group.20％ PQ solution (a dose of 30 mg/kg) was prescribed through stomach for beagles in both groups.After exposure to PQ for 30 minutes,the beagles in experimental group were given activated charcoal suspension (1.0 g/kg of type Ⅰ activated charcoal powder mixed with 100 mL of normal saline) by gavage,while the control group was only given equal volume of normal saline.After exposure to PQ for 10 minutes,30 minutes,and 1,2,4,8,12,24,and 48 hours,blood was collected from hepatic portal veins and peripheral veins to detect the PQ concentration change in the plasma.The toxicokinetics software DAS 2.1.1 was applied to analyze PQ concentration and compare the change in toxicokinetics parameters between the both groups.The change in vital signs including heart rate (HR),respiratory rate (RR) and pulse oxygen saturation (SpO2) was dynamically monitored 10 minutes before exposure,4 hours and each day from the 1st to the 7th day after exposure.Results After exposure to PQ,the poison concentration in the plasma of hepatic portal veins and peripheral veins in the control group rose quickly and reached peak 4 hours later.It fell quickly at first,and fell slowly 8 hours later.But in the experimental group,the increase rate to the peak was significantly slow.Besides,PQ peak fell more obviously than that in the control group and it was about 50％ of the control group (μg/L:123.50 ± 11.67 vs.255.18 ± 12.29 in blood from hepatic portal veins,122.35± 11.72 vs.250.86± 11.15 in blood from peripheral veins).After 8 hours it fell much more quickly than that of the control group.After exposure to PQ for 48 hours,PQ concentration in the plasma was still lower than that of the control group (μg/L:0.53 ± 0.18 vs.15.98 ± 5.58 in blood from hepatic portal veins,0.31 ± 0.01 vs.15.03 ± 4.82 in blood from peripheral veins,both P ＜ 0.01).With the toxicokinetics analysis,compared with the control group,the maximum concentration (Cmax) and area under the curve (AUC) of PQ in the plasma of hepatic portal veins and peripheral veins in the experimental group were significantly decreased [Cmax (μg/L):125.07 ± 9.49 vs.255.18 ± 12.29 in blood from hepatic portal veins,123.38 ± 9.52 vs.250.86 ± 11.15 in blood from peripheral veins;AUC (mg· L-1· h-1):1.6±0.2vs.3.3 ± 0.4 in blood from hepatic portal veins,1.5 ± 0.2 vs.3.2 ± 0.3 in blood from peripheral veins],time to the peak (Tmax) of PQ was slowed (hours:5.3 ± 1.9 vs.4.0 ± 0.0 in blood from hepatic portal veins,4.7 ± 1.5 vs.4.0 ± 0.0 in blood from peripheral veins),and PQ plasma half-life (t1/2) and mean retention time (MRT) were significantly shortened [t1/2 (hours):3.8 ± 1.2 vs.15.4± 3.7 in blood from hepatic portal veins,3.5 ± 1.0 vs.15.5 ± 2.7 in blood from peripheral veins;MRT (hours):8.0± 1.5 vs.13.4± 1.2 in blood from hepatic portal veins,7.6± 1.3 vs.13.3± 1.2 in blood from peripheral veins;all P ＜ 0.01].After exposure to PQ,HR and RR in both the experimental group and the control group increased and reached to the peak about the 4th day and then the increase rate began to slow down gradually;SpO2slowed down gradually and reached to the valley about the 4th day and then it began to recover,but the change range of vital signs in the experimental group was smaller than that of the control group,and the parameters were significantly better than those of control group [4-day HR (bpm):134.50±3.00 vs.142.00±6.43,4-day RR (times/min):31.00±0.58 vs.34.33±0.94,4-day SpO2:0.900±0.006 vs.0.873±0.005,all P ＜ 0.05].Conclusion Activated charcoal administrated at 30 minutes after PQ poisoning can slow down the increase rate of PQ concentration in the plasma,decrease the peak concentration and has less influence on vital signs in beagles.
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Objective@#To determine the scavenging effect and the change of metabolism of paraquat (PQ) using hemoperfusion (HP) once and twice within 12 hours after intoxication and explore the better scheme of HP.@*Methods@#18 beagles were randomly divided into 3 groups. Single HP group, Double HP group and Control group. Peripheral veins blood was collected at different times within 48 hours after exposure in each group. Toxin concentration was measured, analyzed and compared among 3 groups.@*Results@#6 hours after exposure, Single HP group and Double HP group has finished the first HP treatment, and the concentration of PQ was lower than that of the control group, the difference was statistically significant (P<0.05) . 10 hours after exposure, there was no statistical difference of toxin concentration among 3 groups (P>0.05) . 12 hours after exposure, Double HP group has finished the second HP treatment, the concentration of PQ was significantly lower than that of Single HP group and Control group (P<0.05) . 24 hours and 48 hours after exposure, there was no statistical difference of toxin concentration among 3 groups (P>0.05) . Statistical difference were not observed in toxicokinetical parameters among 3 groups (P>0.05) .@*Conclusion@#HP treatment once and twice within 12 hours after intoxication could effectively reduce the toxin concentration in the peripheral veins blood after HP for about 4 hours, then the toxin concentration would return to the same level as Control group quickly. It was suggested that at the beginning of poisoning, HP treatment once or twice could not significantly change the metabolism of paraquat.
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Objective To explore the incidence of early complications within 72 hours among patients with six kinds of acute organophosphorus pesticide poisoning,thus to provide reference for the clinical treatment.Methods The retrospective study analyzed the clinical data of 335 cases with acute oral organophosphorus pesticide poisoning treated in Emergency Department of 307 Hospital of PLA from July 2008 to December 2015.Patients were divided into six groups according to the results of serum toxicology tests:acute phorate group (group A),acute dichlorvos group (group B),acute omethoate group (group C),acute dimethoate group (group D),acute phoxim group (group E) and acute parathion group (group F).The incidence of complications among the six groups were compared.The main analysis method was ranks test.Results There were no significant differences among the six groups in the incidence of cerebral edema,liver injury,kidney injury,myocardial injury,gastrointestinal hemorrhage and acute pancreatitis (P ＞ 0.05),while the mortality and the incidence of sudden cardiac arrest (SCA),respiratory failure,circulatory failure,multiple organ dysfunction syndrome (MODS),coagulation disorders and capillary leak syndrome (CLS) were significantly different among the six groups (P ＜ 0.05).The incidence of SCA wihin 24 hours in acutedichlorvos group reached up to 17.8％,and in other groups was as follows:acute parathion group (11.1％),acute dimethoate group (8.9％),acute phorate group (7.8％) and acute omethoategroup (1.5％).However,no one developed SCA in acute phoxim group.The total incidence of circulatory failure in all patients was 10.1％;dichlorvos group 31.1％ and dimethoate group (22.2％) had higher rates than other groups.The incidence of respiratory failure in all groups reached over 20％,while the total incidence was 36.7％,whereby,acute phorate group with a high of 46.7％,acute dichlorvos group with 44.4％,acute parathion group with 44.4％ and acute dimethoate group with 42.2％,respectively.The total incidence of coagulation disorders was 9.6％,while the incidences of the acute dichlorvos group (24.4％),acute phorate group (11.6％) and acute parathion group (11.1％) were higher than 10％.CLS confined to occur in acute dichlorvos group (11.1％) and acute phorate group (2.5％).However,MODS occurred mainly in acute dichlorvos group (28.9％) and acute parathion group (22.2％).Conclusions The incidences of early complications among the six groups are different,while acute oral dichlorvos poisoning patients tend to occur SCA.Within 72 h of poisoning,acute phorate poisoning group is more prone to respiratory failure,and acute dichlorvos poisoning group is more likely to develop coagulopathy disorders,circulation failure,CLS and MODS.Those patients in acute omethoate and acute phoxim poisoning groups have less risk to develop life-threatening complications except respiratory failure.
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Objective To observe the effects of early pulse therapy with large dose of methylprednisolone associated with cyclosporine A on mortality and incidence of pulmonary fibrosis in the patients with peroral paraquat poisoning.Methods Initial pulse therapy with large dose of methylprednisolone associated with cyclosporine A was given in early period,in addition to regular gastric lavage and hemoperfusion,after acute peroral paraquat poisoning in 38 patients.The indexes of arterial blood gas analysis,findings of lung CT,and the function of kidney and liver were all monitored periodically.At the same time,the data of mortality and incidence of pulmonary fibrosis of the patients with peroral paraquat poisoning were statistically analyzed.Results 13 of 38 patients died,the mortality was 34.2%.Among the dead,12 patients died of multiple organ failure within 1 week after paraquat poisoning,and the remaining one died of pulmonary fibrosis.During hospitalization of the other 25 patients who survived,blood oxygenation index declined in different degrees in 18 cases,the thoracic computed tomography showed interstitial changes in the lung in 17 cases,and dysfunction of more than two organs(lung,liver and kidney)was found in 13 cases.Conclusion The pulse therapy of large dose of methylprednisolone associated with cyclosporine A given in early period may markedly improve the prognosis of patients with acute peroral paraquat poisoning.But a large sample with randomized double blind study is needed in order to further evaluate the clinical efficacy.
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AIM: To observe the efficacy of hemoperfusion (HP) to treat one case suffering from overdose digoxin poisoning. METHODS: HA 330 ml and YT 160 hemoperfusion cartridges were used and blood vessel was femoral vein, single needle and two chamber catheter. Four HP were done. RESULTS: The blood digoxin level were 16 ?g?L -1 before and after the 1st HP, 9.22 ?g?L -1 at the 2nd, 12.4 ?g?L -1 before the 3th, 10.45 ?g?L -1 after the 3th, 3.22 ?g?L -1 before the 4th, and 2.84 ?g?L -1 after the 4th HP. CONCLUSION: This case demonstrats that multiple HP at different period may decrease the blood digoxin level step by step.
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Objective To sum up the therapeutic experiences and to analyze the causes of multiple organ dysfunction syndrome (MODS) occurred in a patient who subjected to an accidental 60 Co exposure. Methods The patient was diagnosed as MODS by clinical manifestation, the auxiliary examinations and pathologic autopsy. In therapeutic aspects, intensive care, ventilator-assisted breathing, anti-infection, nutritional support treatment and protection management of important organs were given. Results After a successful transplantation of HLA-identical allogeneic peripheral blood stem cell, the complaints of MODS emerged repeatedly as fever, lung infection, respiratory failure, cardiac arrhythmia, circulatory failure, hepatic injury, decreased urine output and paralytic ileus. At last, the patient died of multi-organ failure 75 days after exposure to radiation. The results of auxiliary examinations showed enlargement of heart and cardiac arrhythmia. Biochemical examination also indicated the increased hyper-sensitive C-reactive protein. The results of pathologic autopsy indicated the existence of fungous infections in whole body, pulmonary fibrosis, myocardium degeneration and necrosis and radiation enteritis. In addition, congestive hepatopathy, renal hemorrhage and intracerebral hemorrhage were also found in the examination. Conclusion Some special clinical features were found in this case, and the cause of MODS is mainly related to radiation injury of important organs, low level of immunity and infection. So the measures of anti-infection and protective treatment of multiple organs should be taken. The key and difficulty for preventing such a kind of MODS might be to improve the patient's immunity and to help the tissue reparation after radiation injury.