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Probable progress in the therapy of organophosphate poisoning

Extracorporeal hemodialysis and hemoperfusion

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Abstract

Whether or not extracorporeal hemodialysis or hemoperfusion with coated activated charcoal might be used in eliminating organophosphates following poisoning with nitrostigmine, demeton-S-methyl sulfoxide, or dimethoate was here examined. Nitrostigmine could not be hemodialysed. The other two organophosphates, on the other hand could be well eliminated from the blood by hemodialysis. The clearance rates for demeton-S-methyl sulfoxide and dimethoate were 52.98 ml/min and 59.07 ml/min respectively, at a blood flow rate of 100 ml/min. The clearance values for hemoperfusion with coated activated charcoal were higher under the same trial conditions, the values being 83.70 ml/min for demeton-S-methyl sulfoxide and 87.84 ml/min for dimethoate. Nitrostigmine, too, could be eliminated from the blood by hemoperfusion, its clearance being 59.20 ml/min.

These results from in vitro hemoperfusion were verified on a patient admitted with nitrostigmine intoxication following attempted suicide.

Zusammenfassung

Es wurde untersucht, ob extracorporale Hämodialyse oder Hämoperfusion mit beschichteter Aktivkohle bei Vergiftungen mit Nitrostigmin, Demeton-S-methylsulfoxid oder Dimethoat zur Elimination der Organophosphate eingesetzt werden können. Nitrostigmin war nicht hämodialysabel. Die beiden anderen Organophosphate dagegen ließen sich gut durch Hämodialyse aus dem Blut eliminieren. Bei einem Blutfluß von 100 ml/min betrug die Clearance für Demeton-S-methylsulfoxid 52,98 ml/min und für Dimethoat 59,07 ml/min. Die Clearancewerte durch Hämoperfusion mit beschichteter Aktivkohle waren unter gleichen Versuchsbedingungen höher. Sie betrugen für Demeton-S-methylsulfoxid 83,70 ml/min und für Dimethoat 87,84 ml/min. Auch Nitrostigmin konnte durch Hämoperfusion aus dem Blut entfernt werden; die Clearance betrug 59,20 ml/min.

Bei einem Patienten mit Nitrostigmin-Intoxikation in suicidaler Absicht ließen sich die o. g. Ergebnisse der in vitro-Hämoperfusion bestätigen.

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Authors and Affiliations

  1. Center for Detoxification and Poisons Information of the II. Med. Clinic, University of Mainz, Langenbeckstr. 1, D-6500, Mainz, Germany

    S. Okonek

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My thanks go to Miss I. Reininghaus of the II. Med. Clinic, Mainz for her technical cooperation.

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Okonek, S. Probable progress in the therapy of organophosphate poisoning. Arch. Toxicol. 35, 221–227 (1976). https://doi.org/10.1007/BF00293570

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