Successful Treatment of Severe Digitoxin Intoxication with CytoSorb® Hemoadsorption

2020 ◽  
pp. 1-4
Author(s):  
Thomas Georg Karl Breuer ◽  
Daniel Robert Quast ◽  
Stephan Wiciok ◽  
Adnan Labedi ◽  
Gisa Ellrichmann
Keyword(s):  
Renal Failure ◽  
Intensive Therapy ◽  
Plasma Concentrations ◽  
Clinical Signs ◽  
Stable Condition ◽  
Drug Level ◽  
Steroid Glycoside ◽  
Elimination Kinetics ◽  
Fab Fragment ◽  
Digitoxin Intoxication

While several intoxications can be successfully treated with specific antidotes, intoxications with the steroid glycoside digitoxin still represent a major challenge. Besides conventional approaches, CytoSorb® hemoadsorption might be another treatment option. We report on an 81-year-old female patient treated in our intensive care unit (ICU) with severe digitoxin intoxication, acute renal failure, and urinary tract infection (UTI). As physiological digitoxin elimination kinetics are known to appear slow, and also in regard to the renal failure, the decision was made to initiate continuous renal replacement therapy combined with CytoSorb hemoadsorption. The patient was hemodynamically stabilized within the first 4 h of treatment and initially required catecholamines to be stopped within 24 h of treatment. Pre- and post-adsorber drug level measurements showed a rapid elimination of digitoxin. Antibiotic treatment with piperacillin/tazobactam was initiated, and despite CytoSorb hemoadsorption therapy and its known potential to reduce plasma concentrations of several drugs, the UTI was successfully treated. After 3 days of CytoSorb treatment, digitoxin plasma levels were stable and almost normalized, and no clinical signs of intoxication were present. Five days after presentation, the patient was transferred from the ICU in a stable condition. CytoSorb hemoadsorption may be an easily available, efficient, and less cost-intensive therapy option than treatment with the Fab fragment, which is the currently recommended therapy for digitalis intoxications. Therefore, the use of CytoSorb might represent an alternative treatment for life-threatening complications of digitoxin intoxications.

Successful Treatment of Severe Lamotrigine Intoxication with CytoSorb Hemoadsorption

2021 ◽  
pp. 1-4
Author(s):  
Caterina Reuchsel ◽  
Falk Alexander Gonnert
Keyword(s):  
Therapeutic Option ◽  
Combined Treatment ◽  
Clinical Signs ◽  
Stable Condition ◽  
Drug Level ◽  
Short Term ◽  
Intractable Seizures ◽  
Anti Epileptic Drug ◽  
Severe Intoxication ◽  
Extracorporeal Removal

Severe intoxication with the anti-epileptic drug, lamotrigine can cause cardiovascular collapse, neurotoxicity – expressed as intractable seizures, and even death. As there is currently no known specific antidote, extracorporeal removal therapies such as CytoSorb hemoadsorption might represent a promising therapeutic option. We report on a deeply comatosed 60-year-old woman who was treated in our intensive care unit with severe lamotrigine intoxication. To support removal from the blood, combined treatment with continuous veno-venous hemodialysis and CytoSorb hemoadsorption was started. Pre- and post-adsorber drug level measurements showed the rapid elimination of lamotrigine accompanied by an impressive clinical improvement in the patient. Two days after treatment discontinuation, there were no more clinical signs of intoxication and the patient could be extubated, followed by transfer to the stroke unit in a stable condition the following day. In the absence of a viable antidote, for the efficient short-term removal of lamotrigine, hemoadsorption with the CytoSorb device could represent a feasible treatment option for patients with severe lamotrigine intoxication.

Plasma D Dimer: A Useful Marker of Fibrin Breakdown in Renal Failure

1989 ◽  
Vol 61 (03) ◽  
pp. 522-525 ◽  
Author(s):  
M P Gordge ◽  
R W Faint ◽  
P B Rylance ◽  
H Ireland ◽  
D A Lane ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Monoclonal Antibodies ◽  
Diabetic Nephropathy ◽  
Renal Disease ◽  
Plasma Concentrations ◽  
Significant Negative Correlation ◽  
Healthy Controls ◽  
D Dimer

SummaryD dimer and other large fragments produced during the breakdown of crosslinked fibrin may be measured by enzyme immunoassay using monoclonal antibodies. In 91 patients with renal disease and varying degrees of renal dysfunction, plasma D dimer showed no correlation with renal function, whereas FgE antigen, a fibrinogen derivative which is known to be cleared in part by the kidney, showed a significant negative correlation with creatinine clearance. Plasma concentrations of D dimer were, however, increased in patients with chronic renal failure (244 ± 3l ng/ml) (mean ± SEM) and diabetic nephropathy (308 ± 74 ng/ml), when compared with healthy controls (96 ± 13 ng/ml), and grossly elevated in patients with acute renal failure (2,451 ± 1,007 ng/ml). The results indicate an increase in fibrin formation and lysis, and not simply reduced elimination of D dimer by the kidneys, and are further evidence of activated coagulation in renal disease. D dimer appears to be a useful marker of fibrin breakdown in renal failure.

Dyslipidemia of chronic renal failure: the nature, mechanisms, and potential consequences

2006 ◽  
Vol 290 (2) ◽  
pp. F262-F272 ◽  
Author(s):  
N. D. Vaziri
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Hepatic Lipase ◽  
Low Density Lipoprotein ◽  
Plasma Concentrations ◽  
Cholesterol Acyltransferase ◽  
Lipoprotein Metabolism ◽  
Density Lipoprotein ◽  
Triglyceride Rich Lipoprotein ◽  
Density Lipoprotein Receptor

Chronic renal failure (CRF) results in profound lipid disorders, which stem largely from dysregulation of high-density lipoprotein (HDL) and triglyceride-rich lipoprotein metabolism. Specifically, maturation of HDL is impaired and its composition is altered in CRF. In addition, clearance of triglyceride-rich lipoproteins and their atherogenic remnants is impaired, their composition is altered, and their plasma concentrations are elevated in CRF. Impaired maturation of HDL in CRF is primarily due to downregulation of lecithin-cholesterol acyltransferase (LCAT) and, to a lesser extent, increased plasma cholesteryl ester transfer protein (CETP). Triglyceride enrichment of HDL in CRF is primarily due to hepatic lipase deficiency and elevated CETP activity. The CRF-induced hypertriglyceridemia, abnormal composition, and impaired clearance of triglyceride-rich lipoproteins and their remnants are primarily due to downregulation of lipoprotein lipase, hepatic lipase, and the very-low-density lipoprotein receptor, as well as, upregulation of hepatic acyl-CoA cholesterol acyltransferase (ACAT). In addition, impaired HDL metabolism contributes to the disturbances of triglyceride-rich lipoprotein metabolism. These abnormalities are compounded by downregulation of apolipoproteins apoA-I, apoA-II, and apoC-II in CRF. Together, these abnormalities may contribute to the risk of arteriosclerotic cardiovascular disease and may adversely affect progression of renal disease and energy metabolism in CRF.

scholarly journals ГІСТОЛОГІЧНА ДІАГНОСТИКА ХРОНІЧНОЇ НИРКОВОЇ НЕДОСТАТНОСТІ В КОТІВ

2016 ◽  
Vol 18 (3(70)) ◽  
pp. 17-21
Author(s):  
B.V. Borysevich ◽  
V. Sviridenko ◽  
V.V. Hunich
Keyword(s):  
Renal Failure ◽  
Kidney Failure ◽  
Clinical Signs ◽  
Chronic Kidney Failure ◽  
Glomerular Sclerosis ◽  
Kidney Cells ◽  
Paraffin Sections ◽  
Blood Capillaries ◽  
Histological Studies ◽  
Laboratory Results

The objective of the study is to set the criteria of histological diagnosis of chronic renal insufficiency in cats. Lifetime diagnosis of chronic renal failure in a complex was set in complex, basing on anamnesis, clinical signs and laboratory results of blood and urine. For histological studies 29 cats corpses of different breeds and ages were used, who died from chronic kidney failure. Paraffin sections of 7 – 10 mm thickness from the different segments of kidney were stained with Carazzi's hematoxylin and eosin.It was established that during the histological studies in the kidney of cats who died from chronic kidney failure the microscopic changes diversity is characteristic. A characteristic feature of chronic kidney failure cats is complex of changes, which includes: 1) expand and overflow of blood capillaries of the glomeruli; 2) sludge–phenomenon in the capillaries of the glomerulus; 3) lack of blood in the capillaries of the glomerulus; 4) an increased amount of leachate in the cavity of Boumen–Shumlyanskiy capsule; 5) thickening (in some casescrescent–like) of parietal layer of Boumen–Shumlyanskiy capsule due to the hypertrophy and hyperplasia of its cells in the part of kidney cells; 6) glomerular sclerosis of the renal corpuscles and total necrosis of the renal corpuscles; 7) microcysts formation, mainly in the cortex. Other microscopic changes in different animals vary. 

scholarly journals Early continuous dialysis in acute glyphosate-surfactant poisoning

2012 ◽  
Vol 140 (9-10) ◽  
pp. 648-652 ◽  
Author(s):  
Violeta Knezevic ◽  
Dusan Bozic ◽  
Ivana Budosan ◽  
Dejan Celic ◽  
Aleksandra Milosevic ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Positive Response ◽  
Intensive Therapy ◽  
Supportive Therapy ◽  
Complete Recovery ◽  
Patient Treatment ◽  
Early Introduction ◽  
Acid Base Status ◽  
Oliguric Acute Renal Failure

Introduction. Treating severe acute glyphosate-surfactant poisoning requires intensive therapy including dialysis. Cases of hemoperfusion and hemodialysis use in renal failure induced by herbicide ingestion have been reported in the current medical literature. We present a case report of successful patient treatment with continuous venovenous hemodiafiltration in acute glyphosate-surfactant poisoning. Case Outline. A 36-year-old male patient attempted suicide by drinking approximately 300 ml of glyphosate-surfactant about an hour before coming to our Clinic. On admittance the patient was somnolent, normotensive, acidotic and hyperkalemic. Six hours after poison ingestion there was no positive response to symptomatic and supportive therapy measures. The patient became hypotensive, hypoxic with oliguric acute renal failure, so that post-dilution continuous veno-venous hemodiafiltration was started. During the treatment the patient became hemodinamically stabile, diuresis was established along with electrolyte and acid-base status correction and a gradual decrease of blood urea nitrogen and creatinine levels. After a single 27.5-hour treatment, clinical condition and renal function parameters did not require further dialysis. Complete recovery of renal function was achieved on the fifth day. Conclusion. Early introduction of continuous veno-venous hemodiafiltration with other intensive therapy measures led to complete recovery in a hemodinamically instable patient.

scholarly journals Experience of treatment with Berodual-N in industrial workers with COPD

2005 ◽  
pp. 103-106
Author(s):  
L. A. Stepanishcheva ◽  
G. L. Ignatova ◽  
E. V. Nikolaeva
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Outpatient Treatment ◽  
Clinical Signs ◽  
Stable Condition ◽  
Chronic Obstructive ◽  
Symptomatic Therapy ◽  
Industrial Workers ◽  
Obstructive Pulmonary Disease ◽  
Stage 1 ◽  
Progressive Course

Chronic obstructive pulmonary disease (COPD) is an actual healthcare problem due to its widespread, progressive course and mortality. A great deal of the patients’ treatment takes a symptomatic therapy. Results of outpatient treatment with Berodual-N of patients with COPD stage 1 to 2 in stable condition are shown in the article. A significant improvement in clinical signs, lung function parameters (FEV1) and physical tolerance were noted.

Dietary Management of Feline Chronic Renal Failure: Where are We Now? In What Direction are We Headed?

2000 ◽  
Vol 2 (2) ◽  
pp. 75-82 ◽  
Author(s):  
D J Polzin ◽  
C A Osborne ◽  
S Ross ◽  
F Jacob
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Clinical Signs ◽  
Dietary Therapy ◽  
Dietary Management ◽  
Dietary Intakes ◽  
Normal Range ◽  
Limited Ability ◽  
Diet Formulation ◽  
Therapeutic Value

Dietary modification is of primary importance in managing cats with chronic renal failure. Diets designed for cats with chronic renal failure are typically formulated to be pH neutral and contain reduced quantities of protein, phosphorus and sodium and an increased quantity of potassium. These changes in diet formulation are designed to ameliorate clinical signs of renal failure by adapting dietary intakes to meet the limited ability of failing kidneys to adapt to the normal range of dietary intakes. Important recent clinical trials support the therapeutic value of dietary therapy in cats with chronic renal failure.

Influence of parasitism on plasma concentrations of growth hormone, somatomedin-C and somatomedin-binding proteins in calves

1988 ◽  
Vol 116 (2) ◽  
pp. 191-200 ◽  
Author(s):  
T. H. Elsasser ◽  
T. S. Rumsey ◽  
A. C. Hammond ◽  
R. Fayer
Keyword(s):  
Feed Intake ◽  
Binding Proteins ◽  
Binding Protein ◽  
Plasma Concentrations ◽  
Clinical Signs ◽  
Nitrogen Retention ◽  
Protein Patterns ◽  
Somatomedin C ◽  
Treatment Groups ◽  
Ad Libitum

ABSTRACT A parasitic disease model (sarcocystosis) was used to study the effects of infection and associated plane of nutrition on GH and somatomedin-C (SM-C) patterns in plasma, and SM-C binding protein patterns in plasma from 4-month-old male Holstein calves. Calves, matched by age and rate of growth before the experiment, were divided into three treatment groups (n = 7). In the first (control), animals were uninfected and food was available ad libitum; in the second, animals were infected with Sarcocystis cruzi and food was available ad libitum. The third group consisted of uninfected animals pair-fed to the level of feed intake of the infected animals. Blood samples were obtained at various times after infection for analysis of the secretory patterns of GH (day 27 after infection, samples every 10 min for 6 h), SM-C (days 27, 35 and 58 after infection) or binding protein (day 42 after infection). Samples were analysed for GH and SM-C by radioimmunoassay. Relative molecular weights of binding proteins were assessed by elution patterns from gel permeation columns. Clinical signs of infection were manifest abruptly on day 26 after infection. Voluntary feed intakes of infected calves as a per cent of control calves were 18, 46 and 78 on days 27, 35 and 58 after infection respectively. Plasma GH concentrations were lower in infected and pair-fed than in control calves (P < 0·05). Plasma SM-C concentrations were reduced in calves with diminished feed intakes and lower still in infected calves (P < 0·05). Plasma SM-C was positively correlated with nitrogen retention across treatment groups (r = 0·81). Two classes of binding proteins differing in molecular weight were identified. The relative amounts of each binding protein in plasma were reduced during low feed intake with some differences in the endogenous saturation affected by infection. These data suggest that altered growth and metabolism in parasitized calves may arise in part from both nutritional and infection-mediated effects on the regulation of GH, SM-C and SM-C binding proteins. J. Endocr. (1988) 116, 191–200

Sign in / Sign up

Export Citation Format

Share Document