Resin hemoperfusion in ethchlorvynol overdose

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Abstract
An 18-yr-old human male with a severe ethchlorvynol (ECV, a sedative that may be addictive) overdose was treated with Amberlite XAD-4 resin hemoperfusion. Plasma ECV concentrations declined 33% during a 3.5-h hemoperfusion, but rebounded substantially, peaking 6 h later. Apparently 16% of ECV in the body was removed. After hemoperfusion, plasma ECV concentrations declined linearly at a rate of 13 mg/l per day. Hemoperfusion clearance [Cl] was estimated by both the traditional method, using extraction ratios across the column and column blood flow (Cl = 270 ml/min), and an alternative method, using blood concentrations during hemoperfusion and recovery of drug from the resin (Cl = 184 ml/min). The latter may provide a better estimate of hemoperfusion clearance as it is not subject to error (which can be substantial) in measurement of column blood flow. The resin completely extracted ECV from plasma, causing a rate of elimination 10 times that expected from endogenous processes. To aid in kinetic analysis, blood:plasma partition and protein binding of ECV in 3 normal subjects were examined. Blood:plasma ratio averaged 0.88 .+-. 0.04 and fraction free in plasma, 0.38 .+-. 0.02; neither changed as a function of blood concentration between 27-108 mg/l. Apparently removal of ECV from the overdosed patient by hemoperfusion is limited by extensive distribution in and slow redistribution from body tissues, but due to the extremely slow rate of removal by the body and the severe nature of the ECV overdose, Amberlite XAD-4 hemoperfusion may be clinically useful.

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