Combined hemoperfusion‐hemodialysis in organophosphate poisoning

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Abstract
We report on a patient treated with combined prolonged hemoperfusion (HP, Adsorba 300 C, Gambro, Sweden) and hemodialysis (HD, C‐DAK 1.2, Cordis Dow, USA) for severe dimethoate poisoning. This procedure was adopted since the combination of dialysis and adsorption may improve overall drug removal. Combined HP–HD was performed during 24 h using the same charcoal column and dialyser. Adequate heparinization was obtained by monitoring the whole blood activated partial thromboplastin time. The patient (a 34‐year‐old female) ingested approximately 10 g of dimethoate (Teletox 10) in a suicide attempt, 30 min before admission to the hospital. On admission, serum level of dimethoate (analysed by gas chromatography) was 2340 ng ml−1. She received conventional treatment and combined HP–HD was started within 2 h after admission. At this time serum levels had risen to 3110 ng ml−1. However, they declined constantly during the epuration and after 18 h no more dimethoate could be detected in the serum. She was discharged 3 days after treatment. During the 24 h of HP–HD treatment, 110.8 mg dimethoate entered the epuration system via the plasma. 55.3 mg were extracted by the charcoal column and 25.3 mg by hemodialysis.