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Paraquat®, or N,N'-dimethyl-4,4'-bipyridinium dichloride, is a bipyridyl compound used as a non-selective herbicide and desiccant that can cause acute poisoning through all routes of exposure. There is no known antidote, and the available treatments are based on avoiding its absorption and timely removing it, in adults and children. We describe a case series of 14 pediatric patients from the department of Cauca, Colombia, with acute intoxication after oral intake of paraquat. Patients were referred to a medium-high complexity hospital in southwestern Colombia and treated according to an institutional protocol for acute paraquat poisoning. Acute paraquat poisoning after oral ingestion is associated with a high mortality rate, even with timely medical attention, as the compound has no known antidote and quickly reaches systemic concentrations for fulminant poisoning. Based on the available literature, our center has proposed a clinical protocol including early standard management, immunosuppressive and antioxidant treatments, and systemic removal techniques. This protocol suggests an adequate approach to acute paraquat poisoning in the pediatric population.
El dicloruro de 1,1'-dimetil-4,4'-bipiridilo (Paraquat®) es un compuesto químico de la familia de las piridinas, utilizado como herbicida no selectivo y desecante. Este compuesto puede causar intoxicación aguda por todas las vías de exposición. En el momento, no hay un antídoto conocido y los tratamientos disponibles, incluidos los pediátricos, se basan en contrarrestar su absorción y propiciar su remoción oportuna. Se describe una serie de casos de 14 pacientes pediátricos, procedentes en su mayoría del departamento del Cauca, con intoxicación aguda por ingestión de paraquat. Los pacientes fueron remitidos y atendidos en un hospital de mediana a alta complejidad en el suroccidente colombiano, con un protocolo institucional para el manejo de la intoxicación aguda por el herbicida. La intoxicación aguda con paraquat por vía oral se asocia con una alta tasa de mortalidad, aún con atención médica oportuna, pues fácilmente se alcanzan concentraciones sistémicas para ser fulminante. Basado en la literatura disponible, el Hospital Universitario San José ha propuesto un protocolo clínico adecuado para la intoxicación aguda por paraquat en población pediátrica que incluye manejo estándar temprano, tratamiento inmunosupresor y antioxidante, y técnicas para su remoción sistémica.
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Algoritmos , Herbicidas , Paraquat , Humanos , Paraquat/intoxicação , Criança , Feminino , Masculino , Pré-Escolar , Adolescente , Herbicidas/intoxicação , Intoxicação/terapia , Intoxicação/tratamento farmacológico , Colômbia , Doença Aguda , Lactente , Antioxidantes/uso terapêutico , Protocolos Clínicos , Antídotos/uso terapêuticoRESUMO
Introduction: Coronavirus disease 2019 (COVID-19) induces organic damage mainly through the patient's immune overreaction. Hemoperfusion (HPF) can remove inflammatory cytokines and can reduce the negative effects of cytokine storm in COVID-19. We compared the mortality rate, inflammatory response, and acute kidney injury (AKI) prevalence among patients suffering from respiratory insufficiency secondary to COVID-19 treated with and without HPF with HA330 cartridge. Methods: Mortality rate, serum creatinine, and ferritin values were compared between patients suffering from respiratory insufficiency secondary to COVID-19 who received conventional treatment and another group of patients who additionally received four sessions of HPF with HA330. Results: Of 116 patients suffering from acute respiratory insufficiency secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), one group (n: 84) received support treatment and the other group (n: 32) additionally received HPF with HA330 cartridge. Both groups had no renal disease and similar age and comorbidities at admission, except for obesity and mechanical ventilation requirement, which were significantly higher in the HPF group. Mortality rate (61% vs. 31%, P: 0.008), serum creatinine (1.4 vs. 0.5 mg/dl, P < 0.001), and post-HPF serum ferritin (2868 vs. 1675, P < 0.001) were significantly lower in the HPF group. Conclusion: Mortality rate, serum ferritin, and AKI were significantly reduced in critical COVID-19 patients who received HPF with HA330 cartridge than in those who did not receive it. These results were obtained despite the HPF group risk factors, such as obesity and mechanical ventilation, worsening its prognosis.
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ABSTRACT Membranes and sorbents play a crucial role in extracorporeal blood purification therapies, which aim to remove harmful molecules and toxins from the blood. Over the years, advancements in hemodialysis (HD) membranes and sorbents have significantly enhanced their safety and effectiveness. This review article will summarize the latest breakthroughs in the development and clinical application of HD membranes and sorbents. We will commence with a concise examination of the mechanisms involved in solute transport across membranes and sorbents. Subsequently, we will explore the evolutionary path of HD membranes, from early cellophane membranes to high-flux membranes, including the development of high-cut-off membranes and the emergence of medium- cut-off membranes. We will discuss each type of HD membrane's advantages and limitations, highlighting the most promising advancements in novel biomaterials and biocompatibility, technologies, research in membrane performance, and their clinical applications. Furthermore, we will delve into the evolution and progress of sorbent technology, tracing its historical development, outlining its key characteristics, examining the mechanism involved in the adsorption process, and exploring its clinical application. This review aims to underscore the growth and future landscape of HD membranes and sorbents in extracorporeal blood purification techniques.
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Membranes and sorbents play a crucial role in extracorporeal blood purification therapies, which aim to remove harmful molecules and toxins from the blood. Over the years, advancements in hemodialysis (HD) membranes and sorbents have significantly enhanced their safety and effectiveness. This review article will summarize the latest breakthroughs in the development and clinical application of HD membranes and sorbents. We will commence with a concise examination of the mechanisms involved in solute transport across membranes and sorbents. Subsequently, we will explore the evolutionary path of HD membranes, from early cellophane membranes to high-flux membranes, including the development of high-cutoff membranes and the emergence of medium- cutoff membranes. We will discuss each type of HD membrane's advantages and limitations, highlighting the most promising advancements in novel biomaterials and biocompatibility, technologies, research in membrane performance, and their clinical applications. Furthermore, we will delve into the evolution and progress of sorbent technology, tracing its historical development, outlining its key characteristics, examining the mechanism involved in the adsorption process, and exploring its clinical application. This review aims to underscore the growth and future landscape of HD membranes and sorbents in extracorporeal blood purification techniques.
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Diálise Renal , Humanos , Diálise Renal/métodos , AdsorçãoRESUMO
Abstract We aimed to evaluate the effects of somatostatin combined with early hemoperfusion on inflammatory and stress responses during acute pancreatitis (AP) treatment. A total of 159 AP patients treated from September 2016 to January 2020 were randomly divided into three groups A-C (n=53). In addition to routine treatment, groups A-C were additionally given somatostatin, early hemoperfusion, and somatostatin combined with early hemoperfusion, respectively. Their inflammatory factors, stress response, intestinal mucosal barrier, hemorheological indices, recovery time, length of stay, clinical efficacy, and adverse reactions were compared. The levels of serum interleukin-10 (IL - 10), catalase and glutathione peroxidase rose in the three groups after ten days of treatment, compared with values before treatment, being the highest rise in group C. The levels of IL -18, tumor necrosis factor-α, soluble intercellular adhesion molecule-1, procalcitonin, high mobility group protein B1, lipid hydrogen peroxide, advanced oxidation protein products, epinephrine, cortisol, D-lactic acid, diamine oxidase, and endotoxin decreased after ten days of treatment compared with those before treatment, which were lowest in group C (P<0.05). After ten days of treatment, the levels of hemorheological indices were significantly lower than those before treatment (P<0.05). Compared with groups A and B, group C had a shorter recovery time of urine amylase, bowel sound and passing gas, remission time of abdominal pain, length of stay, and a higher total response rate (P<0.05). During AP treatment, somatostatin combined with early hemoperfusion effectively relieved inflammatory and stress responses, protected the intestinal mucosal barrier function and improved the hemorheology, thereby promoting the recovery and benefiting the prognosis of patients.
Resumen Nuestro objetivo fue evaluar los efectos de la somatostatina combinada con hemoperfusión temprana sobre las respuestas inflamatorias y de estrés durante el tratamiento de la pancreatitis aguda (PA). Un total de 159 pacientes con PA tratados entre septiembre de 2016 y enero de 2020 se dividieron aleatoriamente en tres grupos A-C (n=53). Con base en el tratamiento de rutina, los grupos A-C recibieron además somatostatina, hemoperfusión temprana y somatostatina combinada con hemoperfusión temprana, respectivamente. Se compararon sus factores inflamatorios, respuesta al estrés, barrera de la mucosa intestinal, índices hemorreológicos, tiempo de recuperación, tiempo de estancia, eficacia clínica y reacciones adversas. Los niveles séricos de interleucina-10 (IL -10), catalasa y glutatión peroxidasa aumentaron en los tres grupos después de 10 días de tratamiento, comparados con los valores antes del tratamiento, siendo más elevados en el grupo C. Los niveles de IL - 18, factor de necrosis tumoral α, molécula de adhesión intercelular 1 soluble, procalcitonina, proteína B1 del grupo de alta movilidad, peróxido de hidrógeno lipídico, los productos proteicos de oxidación avanzada, epinefrina, cortisol, ácido D-láctico, diaminooxidasa y endotoxina disminuyeron después de 10 días de tratamiento en comparación con los previos al tratamiento, que fueron más bajos en el grupo C (P<0,05). Después de 10 días de tratamiento, los índices hemorreológicos fueron significativamente menores que los previos al tratamiento (P<0,05). En comparación con los grupos A y B, el grupo C tuvo un tiempo de recuperación más corto de amilasa en orina, sonido y escape intestinal, tiempo de remisión del dolor abdominal y tiempo de estancia, y una tasa de respuesta total más alta (P<0,05). Durante el tratamiento de la AP, la somatostatina combinada con hemoperfusión precoz alivia eficazmente las respuestas inflamatorias y de estrés, protege la función de la barrera de la mucosa intestinal y mejora la hemorología, favoreciendo la recuperación y beneficiando el pronóstico de los pacientes.
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ABSTRACT Objective: To analyze the effect of CytoSorb® on mortality, interleukin levels, vasopressor use and adverse events in patients with sepsis. Methods: We searched MEDLINE®, Embase and the Cochrane Library for randomized controlled trials and cohort studies that reported the use of CytoSorb® among septic patients. The primary outcome was mortality, and secondary outcomes included the use of vasopressors, levels of inflammatory markers, predicted versus observed mortality, length of stay in the intensive care unit, and adverse events. Results: We included 6 studies enrolling 413 patients, and assessment for risk of bias indicated variations in study quality from high to moderate. The overall mortality rate was 45%, and no significant effect on mortality was found at 28 - 30 days (RR 0.98 [0.12 - 8.25] for the randomized clinical trial and RR 0.74 [0.49 - 1.13] for cohort studies). We did not perform a metanalysis for other outcomes due to the small number of studies found or the lack of data. Conclusion: Our study found very low certainty evidence, due to imprecision, risk of bias, and heterogeneity, thereby showing no benefit of CytoSorb® use in terms of mortality at 28 - 30 days. We cannot recommend the use of CytoSorb® in septic or septic shock patients outside clinical trials. Further high-quality randomized trials with a common intervention arm are needed to evaluate the influence of CytoSorb® in this population. PROSPERO register: CRD42021262219
RESUMO Objetivo: Analisar o efeito de CytoSorb® na mortalidade, nos níveis de interleucina, no uso de vasopressores e nos eventos adversos em pacientes com sepse. Métodos: Pesquisamos o MEDLINE®, o Embase e a Biblioteca Cochrane em busca de ensaios clínicos randomizados e estudos de coorte que relatassem o uso de CytoSorb® em pacientes com sepse. O desfecho primário foi a mortalidade, e os desfechos secundários incluíram uso de vasopressores, níveis de marcadores inflamatórios, mortalidade prevista versus observada, tempo de internação na unidade de terapia intensiva e eventos adversos. Resultados: Incluímos 6 estudos com 413 pacientes, e a avaliação do risco de viés indicou variações na qualidade do estudo de alta a moderada. A taxa de mortalidade geral foi de 45%, e não foi encontrado efeito significativo na mortalidade entre 28 e 30 dias (risco relativo de 0,98 [0,12 - 8,25] para o ensaio clínico randomizado e de 0,74 [0,49 - 1,13] para estudos de coorte). Não realizamos metanálise para outros desfechos, devido ao pequeno número de estudos encontrados ou à carência de dados. Conclusão: Nosso estudo encontrou evidências de certeza muito baixa, devido à imprecisão, ao risco de viés e à heterogeneidade, demonstrando nenhum benefício no uso de CytoSorb® em termos de mortalidade em 28 a 30 dias. Não podemos recomendar o uso de CytoSorb® em pacientes com sepse ou choque séptico fora dos estudos clínicos. São necessários mais estudos randomizados de alta qualidade com um braço de intervenção comum para avaliar a influência de CytoSorb® nessa população. Registro PROSPERO: CRD42021262219
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Resumen La enfermedad COVID-19 es una enfermedad infecciosa ocasionada por el virus SARS-CoV 2 cuya presentación clínica es muy heterogénea: puede ir desde personas asintomáticas hasta pacientes críticamente enfermos, con tormenta de citoquinas, distrés respiratorio agudo, disfunción de órganos e incluso la muerte. Las terapias actuales para su tratamiento van encaminadas a reducir el impacto de la cascada inflamatoria, y dentro de estas encontramos las tecnologías de hemoadsorción como la membrana CytoSorb. A continuación, presentamos un paciente masculino de 31 años de edad, quien consultó por sintomatología severa de COVID-19 y mostró una evidente mejoría clínica y bioquímica posterior al uso del dispositivo CytoSorb. Este es el único paciente documentado en Colombia al que se le haya realizado terapia de hemoperfusión con este dispositivo en conjunto con terapia de reemplazo renal intermitente prolongada y se hayan registrado desenlaces clínicos favorables.
Abstract The COVID-19 disease is an infectious disease caused by the SARS-CoV 2 virus whose clinical presentation is very heterogeneous: it can range from asymptomatic people to critically ill patients, with cytokine storm, acute respiratory distress, organ dysfunction and even death. Current therapies for its treatment are aimed at reducing the impact of the inflammatory cascade, and within these we find hemoadsorption technologies such as the CytoSorb membrane. Next, we present a 31-year-old male patient, who consulted due to severe symptoms of COVID-19 and showed an evident clinical and biochemical improvement after using the CytoSorb device. This is the only documented patient in Colombia who has undergone haemoperfusion therapy with this device in conjunction with prolonged intermittent renal replacement therapy and favorable clinical outcomes have been recorded.
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RESUMEN La hemoperfusión es una técnica de aclaramiento extracorpóreo de moléculas de mediano y gran peso molecular, lipofílicas y de alta unión a proteínas plasmáticas, basada en el principio físico de adsorción. Puede usarse de forma aislada o combinada con otras técnicas, como hemodiálisis convencional, hemodiálisis híbrida o terapia de reemplazo renal continua. Se reportantres pacientes (dos con pancreatitis severa y unocon sepsis asociada a leptospirosis) que desarrollaron injuria renal aguda y fueron tratados mediante hemoperfusión combinada con hemodiálisis convencional en la Unidad de Cuidados Intensivos (UCI).Se evidenció depuración significativa de toxinas urémicas y citoquinas proinflamatorias, además de otras moléculas como enzimas digestivas y creatinfosfokinasa. El futuro de esta técnica adsortiva,innovadora en el tratamiento de condiciones sistémicas inflamatorias, requiere todavía de mayor evidencia para demostrar su utilidad para prevenir la mortalidad de pacientes críticos.
ABSTRACT Hemoperfusion is a technique for extracorporeal clearance of medium and large molecular weight molecules, lipophilic and highly bound to plasma proteins based on the physical principle of adsorption. It can be used in isolation or in combination with other techniques such as conventional hemodialysis, hybrid hemodialysis or continuous renal replacement therapy. Three patients (two with severe pancreatitis and one with leptospirosis-associated sepsis) in which hemoperfusion combined with conventional hemodialysisin the Intensive Care Unit are reported. All three cases developed in addition to acute kidney injury. Significant clearance of uremic toxins and proinflammatory cytokines is evident, in addition to other molecules such as digestive enzymes and creatine phosphokinase. The future of this innovative adsorptive technique in the treatment of systemic inflammatory conditions requires even more evidence to demonstrate its benefit in the mortality of critically ill patients.
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OBJECTIVE: To examine the efficiency of hemoperfusion in removing South American rattlesnake (Crotalus durissus terrificus) venom from rats compared with neutralization by antivenom. DESIGN: An exploratory experimental investigation in rats involving the injection of snake venom with or without subsequent hemoperfusion or antivenom administration. SETTING: Basic animal research laboratory in a private university. ANIMALS: Normal, healthy male Wistar rats (0.29-0.40 kg, 3-6 months old) from a commercial breeder. INTERVENTIONS: Four experimental groups of randomly allocated rats (n = 3/group) were studied: Group 1: rats were injected with a single dose of venom (5 mg/kg, IM, in the right thigh) with no other treatment; blood samples were collected minutes before death to determine leukocyte, platelet, and erythrocyte counts; Group 2 (Control): rats underwent hemoperfusion alone for 60 min using a hemoperfusion cartridge designed for protein adsorption (by granulated charcoal) and protein precipitation (by tannic acid); Group 3 (Venom + antivenom): rats were injected with venom (5 mg/kg, IM) and, 10 min later, were treated with antivenom at the venom:antivenom ratio recommended by the manufacturer; Group 4 (Venom + hemoperfusion): Rats were injected with venom (5 mg/kg, IM) and, 10 min later, were hemoperfused for 60 min. In groups 2-4, blood samples were collected for leukocyte, platelet, and erythrocyte counts 24 h after venom. MEASUREMENTS AND MAIN RESULTS: Rats injected with venom alone (Group 1) developed signs of neurotoxicity and ataxia and died in 9.0 ± 0.43 h but showed no changes in leukocyte or erythrocyte counts. In contrast, there were no deaths in groups 2-4. The lack of deaths in Groups 3 and 4 indicated that antivenom and hemoperfusion, respectively, protected against the lethal effects of the venom. CONCLUSIONS: Hemoperfusion with a double-action hemoperfusion cartridge capable of protein adsorption and precipitation protected rats against C. d. terrificus venom.
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Venenos de Crotalídeos , Hemoperfusão/métodos , Animais , Antivenenos/uso terapêutico , Plaquetas/efeitos dos fármacos , Crotalus , Masculino , Ratos , Ratos WistarRESUMO
Resumen Objetivo: Actualizar los conocimientos acerca de las características desde el punto de vista toxicológico de las intoxicaciones por barbitúricos. Material y métodos: Se realizó un estudio donde se aplicó el método cualitativo, mediante una revisión bibliográfica y documental sobre el tema en fuentes de datos digitales. Se usaron los descriptores DeCs-MeSH: intoxicaciones, barbitúricos, tratamientos, hemoperfusión, toxicología. Se revisaron artículos publicados sobre el tema, a través de los buscadores habituales (Google, PubMed, Cochrane, Scielo, entre otros), teniendo en cuenta la calidad y la actualidad de ellos. Resultados: Tanto las dosis tóxicas como el comportamiento toxicocinético de estos fármacos son variables y dependen sobre todo del grupo al cual pertenezcan. Las intoxicaciones más frecuenten están relacionadas con los barbitúricos de acción prolongada. Debido a su alta liposolubilidad, los de acción ultracorta, pueden quedar acumulados en el tejido adiposo y al movilizarse estas reservas pueden ser fuente de toxicidad. Aunque no son comunes también hay que tener en cuenta la posible existencia de metabolitos activos. Conclusiones: Estos son fármacos en desuso debido a su estrecho margen terapéutico, la elevada dependencia y posterior tolerancia que provoca un aumento potencial de su toxicidad. Aun así, acompañados de una debida monitorización, pueden emplearse en situaciones concretas. Desafortunadamente todavía se producen numerosas muertes por sobredosis accidentales o con fines suicidas
Summary Object: To update the knowledge about the characteristics from the toxicological point of view of barbiturate intoxications. Materials and methods: A study was carried out where the qualitative method was applied, through a literature and documentary review on the subject in digital data sources. The DeCs-MeSH descriptors were used: intoxications, barbiturates, treatments, hemoperfusion, and toxicology. We reviewed articles published on the subject, through the usual search engines (Google, PubMed, Cochrane, Scielo, among others), taking into account the quality and topicality of them. Results: Both the toxic doses and the toxicokinetic behavior of these drugs are variable and depend mainly on the group to which they belong. The most common poisonings are related to long-acting barbiturates. Due to its high liposolubility, ultrashort action can be accumulated in the adipose tissue and these reserves can be a source of toxicity when mobilized. Although they are not common, one must also take into account the possible existence of active metabolites. Conclusion: These are drugs in disuse due to their narrow therapeutic margin, high dependence and subsequent tolerance that causes a potential increase in their toxicity. Even so, accompanied by a proper monitoring can be used in specific situations. Unfortunately, there are still many deaths due to accidental overdoses or suicide.
Résumé Objectif: Mettre à jour les connaissances sur les caractéristiques du point de vue toxicologique des intoxications aux barbituriques. Matériels et méthodes: Une étude a été réalisée où la méthode qualitative a été appliquée, à travers une revue documentaire et documentaire sur le sujet dans les sources de données numériques. Les descripteurs DeCs-MeSH ont été utilisés: intoxications, barbituriques, traitements, hémoperfusion, toxicologie. Nous avons revu les articles publiés sur le sujet, à travers les moteurs de recherche habituels (Google, Pub Med, Cochrane, Silo, entre autres), en tenant compte de la qualité et de l'actualité de ceux-ci. Résultats: Les doses toxiques et le comportement toxicocinétique de ces médicaments sont variables et dépendent principalement du groupe auquel ils appartiennent. Les empoisonnements les plus fréquents sont liés aux barbituriques à longue durée d'action. En raison de sa liposolubilité élevée, une action ultracourte peut être accumulée dans le tissu adipeux et ces réserves peuvent être une source de toxicité lorsqu'elles sont mobilisées. Bien qu'ils ne soient pas communs, il faut également tenir compte de l'existence possible de métabolites actifs. Conclusions: Ce sont des médicaments en désuétude en raison de leur marge thérapeutique étroite, de leur dépendance élevée et de leur tolérance subséquente qui entraîne une augmentation potentielle de leur toxicité. Même ainsi, accompagné d'un suivi approprié peut être utilisé dans des situations spécifiques. Malheureusement, il y a encore beaucoup de décès dus à des surdoses accidentelles ou à des suicides.
Resumo Objetivo: Atualizar o conhecimento sobre as características do ponto de vista toxicológico das intoxicações por barbitúricos. Materiais e métodos: Foi realizado um estudo onde o método qualitativo foi aplicado, através de uma literatura e revisão documental sobre o assunto em fontes de dados digitais. Os descritores DeCs-MeSH foram usados: intoxicações, barbitúricos, tratamentos, hemoperfusão, toxicologia. Revisamos artigos publicados sobre o assunto, através dos mecanismos de pesquisa habituais (Google, PubMed, Cochrane,Scielo, entre outros), levando em consideração a qualidade e a atualidade deles. Resultados: As doses tóxicas e o comportamento toxicocinético dessas drogas são variáveis e dependem principalmente do grupo ao qual pertencem. Os envenenamentos mais comuns estão relacionados a barbitúricos de ação prolongada. Devido à sua alta lipossolubilidade, a ação ultrital pode ser acumulada no tecido adiposo e essas reservas podem ser uma fonte de toxicidade quando mobilizadas. Embora não sejam comuns, é preciso também ter em conta a possível existência de metabolitos ativos. Conclusões: Trata-se de drogas em desuso devido à sua estreita margem terapêutica, alta dependência e subsequente tolerância que provoca um aumento potencial da sua toxicidade. Mesmo assim, acompanhado de um monitoramento adequado pode ser usado em situações específicas. Infelizmente, ainda há muitas mortes devido a sobredosagem acidental ou suicídio.
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Intoxicações acidentais e intencionais constituem- se em fonte significativa de morbimortalidade. Em emergências ou UTIs, frequentemente o Nefrologista é chamado como consultor para auxiliar na indicação de medidas de aumento da depuração renal de agentes tóxicos. Revisamos o emprego de diálise nas intoxicações agudas por medicamentos ou pesticidas, cujo suporte especializado toxicológico foi realizado por telefone pelo Centro de Informação Toxicológica do Rio Grande do Sul (CIT-RS). Avaliamos a correlação entre necessidade de diálise e óbitos em coorte retrospectivo (1998- 2000). Dos 36.055 atendimentos, 337 foram identificados como graves, 245 preenchendo os critérios de inclusão exigidos. A idade média foi 30 ± 18 anos; 53 por cento mulheres. Medicamentos frequentemente envolvidos foram anticonvulsivantes e antidepressivos, entre outros; quanto aos pesticidas, organofosforados, bipiridílicos e glifosato. Métodos de aumento da eliminação incluíram alcalinização urinária (n = 37) e métodos dialíticos. Diálise entre intoxicações severas ocorreu em 4,5 por cento (n = 11), 3,67 procedimentos/ano (1/22,7 relatos de casos severos). No grupo que dialisou, em 91 por cento, a circunstância foi tentativa de suicídio (principalmente fenobarbital e paraquat). Dois casos requereram hemoperfusão (cloranfenicol e paraquat). Óbitos entre pacientes graves não submetidos a diálise ocorreram em 25,6 por cento, versus 36,3 por cento entre dialisados (RR = 0,89; IC 95 por cento = 0,54-1,35). Os achados podem ser explicados pelo poder estatístico associado ao número de procedimentos realizados. O Nefrologista deve estar atento para situações que requerem o emprego de medidas dialíticas, ainda que não necessariamente para substituição renal, mas para aumento da depuração do agente tóxico.
Accidental and intentional poisonings or drug overdoses constitute a significant cause of aggregate morbidity and mortality, and health care expenditures. The nephrologist is frequently called to the emergency room and ICU as a consultant to help with the indication of measures to enhance renal depuration of toxic agents. This study reviews the use of dialysis in acute poisonings due to medications or pesticides, whose specialized toxicological support was provided via telephone by the poison control center of the state of Rio Grande do Sul (CIT-RS from Portuguese). The correlation between need for dialysis and death was assessed in a retrospective cohort (1998-2000). Of the 36,055 cases registered, 337 were identified as severe, and 245 met the inclusion criteria required. Mean age was 30 ± 18 years, and 53 percent of the patients were women. The most commonly involved medications were anticonvulsants and antidepressants, and the pesticides were organophosphates, bipyridyl compounds, and glyphosate. Techniques to enhance elimination included urinary alkalinization (n = 37) and dialysis. In severe poisonings, dialysis was performed in 4.5 percent of the cases (n = 11), 3.67 procedures/year (1/22.7 reports of severe cases). In the group undergoing dialysis, 91 percent involved a suicide attempt (mainly phenobarbital and paraquat). Two cases required hemoperfusion (chloramphenicol and paraquat). Death among non-dialyzed severely ill patients occurred in 25.6 percent, versus 36.3 percent of dialyzed patients (RR = 0.89; 95 percent CI = 0.54-1.35). The findings can be explained by the statistic power associated with the number of procedures performed. The nephrologist should be aware of situations requiring the use of dialysis, even if not necessarily aimed at renal replacement, but at enhancing depuration of a toxic agent.