Clinical experience of integrated blood purification in treatment of patients with liver failure due to paraquat poisoning / 中国中西医结合急救杂志

ABSTRACT

The lung is a major target organ in acute paraquat (PQ) poisoning, but early PQ-induced severe liver failure is also an important life-threatening situation that can't be neglected. At present, toxin elimination through blood purification is a routine effective therapy recommended at the initial stage of PQ poisoning. However, the mode, therapeutic course and efficacy of blood purification for treatment of liver failure induced by PQ intoxication are still further to be explored. Theoretically, PQ is a substance with small molecule soluble in water, so hemofiltration (HF) is more suitable to be applied for treatment of PQ poisoning, but since PQ itself elimination rate (170 mL/min) from the kidney is far greater than the extracorporeal elimination rate of HF, it is suggested that HF be used only in cases with kidney functional injury caused by PQ poisoning. After PQ intoxication, a great amount of inflammatory mediators are produced; under this circumstance, if continuous veno-venous hemo-filtration (CVVH) is applied, its convection and dispersion features can remove the inflammatory mediators and toxin. Using hemoperfusion (HP) combined with CVVH not only can reduce the concentration of PQ but also can decrease plasma cytokine levels and ameliorate the organ damages. Thus, in cases with hepatic and renal functional damage, the application of combination of HP and CVVH is more effective for the treatment. Bilirubin adsorption can not only reduce bilirubin, but also can decrease PQ concentration, and it is also a means to treat PQ poisoning. In this article, the experience of using CVVH combined with HP, plasma separation and bilirubin adsorption for treatment of 1 case with liver failure induced by PQ poisoning was reported.