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      Sequential Hemoperfusion and Continuous Venovenous Hemofiltration in Treatment of Severe Tetramine Poisoning

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          Abstract

          Objective: It was the aim of this study to observe the effects of sequential hemoperfusion (HP) and continuous venovenous hemofiltration (CVVH) on patients with severe tetramine poisoning and to evaluate the ability of these modalities to remove tetramine. Methods: Eighteen patients diagnosed as having severe tetramine poisoning were treated by blood purification, additional to routine medical therapy. Blood purification procedures included HP using activated charcoal for 3–5 h and consecutive CVVH for 24–36 h. Patients’ clinical conditions, blood routine tests and serum chemical tests were evaluated every day after admission. Plasma tetramine concentrations were determined before and after HP. During CVVH, tetramine concentrations in plasma before and after passing through the filter and ultrafiltration at 2 and 12 h were also determined. Results: Eight patients received blood purification within 12 h after onset of poisoning, and 10 patients received blood purification more than 12 h later. Early-treated patients showed a higher cure rate (100 vs. 60.0%; p < 0.05, χ<sup>2</sup> test) and shorter coma time than late-treated patients (26.0 ± 23.2 h, range 5–70, vs. 59.7 ± 27.7 h, range 20–96; p < 0.01, rank test). The mean plasma tetramine concentrations in early- and late-treated patients were comparable (0.095 ± 0.036 vs. 0.134 ± 0.110 mg/l; p > 0.05). Mean plasma tetramine concentration was reduced from 0.124 ± 0.082 to 0.080 ± 0.055 mg/l after HP. At 2 h of CVVH, mean plasma tetramine concentration was 0.078 ± 0.064 mg/l, at 12 h of CVVH, 0.074 ± 0.059 mg/l, and the ultrafiltration sieving coefficient at 2 and 12 h was 0.839 ± 0.409 and 0.686 ± 0.253 mg/l, respectively. Conclusion: Early sequential HP and CVVH therapy may significantly improve the outcome of patients with severe tetramine intoxication. HP can rapidly reduce the plasma concentration of tetramine, and CVVH can attenuate the plasma tetramine concentration rebound after HP by continuously removing tetramine from the plasma.

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          Most cited references 5

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          Treatment of Life-Threatening Lithium Toxicity with High-Volume Continuous Venovenous Hemofiltration

          There is still debate as to the preferred extracorporeal treatment modality for severe lithium intoxication. Because lithium is readily diffusable, intermittent hemodialysis is usually performed. However, this bares the risk of a post-dialysis rebound concentration and, in the case of severe lithium poisoning collapse, aggravation of hemodynamic instability. Because of the relatively slow but continuous solute removal, continuous renal replacement therapy (CRRT) may be advantageous. We report the first case in the literature of severe lithium intoxication treated effectively with high-volume continuous venovenous hemofiltration (HV-CVVH). Results compared favorably to other forms of CRRT in terms of lithium clearance. Ease of implementation, the excellent tolerability and the superior lithium clearance without rebound phenomenon may make HV-CVVH the preferred treatment modality for severe lithium poisoning.
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            Rat poison and food security in the People’s Republic of China: focus on tetramethylene disulfotetramine (tetramine)

             Eric Croddy (2003)
            The last several years have seen a large number of mass poisonings in mainland China, particularly those caused by illicit rodenticides. One rat poison, tetramine (tetramethylene disulfotetramine) is responsible for a great percentage of death and injury in the People’s Republic of China (PRC). Tetramine is an acutely toxic substance with human oral toxicity estimated as low as 0.1 mg/kg, and is widely available in open markets in mainland China—this despite being prohibited for manufacture or sale in the PRC. Being a GABA antagonist, and having an extremely potent effect on the brain stem, many victims can quickly fall into convulsions and die within hours following ingestion. With no known effective antidote at this time, clinical data from the PRC show that acute cases of tetramine poisoning are extremely difficult to treat. The widespread use of tetramine—including its reported sale at a Malaysian outdoor market in September 2002—could exacerbate its hazard to public health, particularly in those areas having large overseas Chinese populations.
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              Reduction of tetramine toxicity by sedatives and anticonvulsants.

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                Author and article information

                Journal
                BPU
                Blood Purif
                10.1159/issn.0253-5068
                Blood Purification
                S. Karger AG
                0253-5068
                1421-9735
                2006
                December 2006
                21 December 2006
                : 24
                : 5-6
                : 524-530
                Affiliations
                Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
                Article
                96473 Blood Purif 2006;24:524–530
                10.1159/000096473
                17077625
                © 2006 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 5, Tables: 7, References: 17, Pages: 7
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/96473
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