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The efficacy of hemoperfusion for ediphenphos poisoning in dogs
International Notes
International Abstracts A retrospective study of 23 patients who suffered from acute carbon-monoxide poisoning. Yamaya K, Hagiwara T, Sumita S, et al. Jpn J Acute Med 1987; 11(8):995-999. A retrospective study of patients who suffered from acute carbon-monoxide poisoning was undertaken. The blood levels of carboxyhemoglobin (COHb) in 8 of 12 patients with relatively good consciousness and 6 of 9 with a comatose state were 25.0 to 57.0% and 13.6 to 65.3%, respectively. There were no significant differences in the blood COHb concentrations between these two groups. In 6 patients with a comatose state, there were no signiticant differences in blood COHb concentrations before hyperbaric oxygenation between those who recovered their conciousness after this procedure and those who did not. One of the 6 patients had convulsive attacks during hyperbaric oxygenation and showed cerebral edema afterward. He underwent barbiturate therapy and thereafter recovered. Severe cerebral edema due to hypoxia may be responsible for the lack of recovery in conciousness even after hyperbaric oxygenation. We consider that the combined therapy of hyperbaric oxygenation and barbiturates may be effective for cerebral edema. Osmolality gap as an index gauging the severity of emergency and critically ill patients: comparison to other scoring systems. Inaba H, Hirasawa H, Sugai T, et al. Jpn J Acute Med 1987;11(8):1001-1006. Osmolality gap is defined as the difference between the measured value and the predicted value of serum osmolality. The increase in the osmolality gap implies the presence of unmeasurable solute in serum. To evaluate the value of the osmolality gap as an index expressing the severity of illness, we studied the correlation between the osmolality gap and two scoring systems, the APACHE proposed by Knaus et al, and SSS proposed by Stevens, in 64 emergency and critically ill patients managed in the intensive care unit. None of these patients had received any chemical or drug known to increase osmolality. The osmolality gap significantly correlated with APACHE and SSS scores, and particularly with consciousness disturbance expressed by the Glasgow coma scale. These results indicate that the osmolality gap is a reliable index to express the severity of illness in emergency and critically ill patients and suggest the possible con-
tribution of unmeasurable solutes to the development of consciousness disturbance. The efficacy of hemoperfusion for ediphenphos poisoning in dogs. Takeda M, Yoshino K, Yamashita M, et al. Jpn J Acute Med 1987;11(8):1007-1012. The effectiveness of hemoperfusion for ediphenphos (EDDP) poisoning in dogs was evaluated. Eighteen mongrel dogs were anesthetized with ketamine HCl and ventilated mechanically. One group received a single intravenous injection and another group received continuous infusion of EDDP. In the single injection group, 4 controls dogs were not hemoperfused, 3 test dogs were treated for 2 hours hemoperfusion 2.5 hours after receiving 20 m&kg of EDDP. With continuous infusion of 10 mg/kg/h of EDDP, 4 control dogs were not hemoperfused and the 7 test dogs were hemoperfused for 2 hours from the beginning of the study. The blood concentrations of EDDP were measured at various times up to 7 hours, and comparisons made between the groups treated by hemoperfusion with the nontreated groups. The blood concentration of EDDP was not decreased significantly in the dogs treated by hemoperfusion in the single intravenous injection group. However, in the continuous infusion group, the blood concentration of EDDP at 100 to 150 minutes after treatment by hemoperfusion was decreased significantly. The volume of distribution of EDDP was 8 L/kg. Therefore, even if the volume of distribution is relatively high, as with EDDP, hemoperfusion may be effective for poisoning following organophosphorous absorption from the intestine, which can be considered equivalent to the infusion study. Systemic effects of esophageal sclerotherapy with ethanolamine oleate. Omote K, Namiki A, Hagiwara T, et al. Jpn J Acute Med 1987;11(8):1015-1020. The systemic effects of 5% ethanolamine oleate used as the sclerosing agent were investigated in 12 patients treated by injection sclerotherapy. Statistically significant changes were demonstrated (p < 0.05) after the injection of 5% ethanolamine oleate. The following results were obtained: decreased arterial PO,, activation of coagulotibrinolytic system, hemolysis, and increased values of blood urea nitrogen and serum creatinine. Sclerotherapy may cause serious systemic complications, including acute respiratory failure, 185
International Abstracts A retrospective study of 23 patients who suffered from acute carbon-monoxide poisoning. Yamaya K, Hagiwara T, Sumita S, et al. Jpn J Acute Med 1987; 11(8):995-999. A retrospective study of patients who suffered from acute carbon-monoxide poisoning was undertaken. The blood levels of carboxyhemoglobin (COHb) in 8 of 12 patients with relatively good consciousness and 6 of 9 with a comatose state were 25.0 to 57.0% and 13.6 to 65.3%, respectively. There were no significant differences in the blood COHb concentrations between these two groups. In 6 patients with a comatose state, there were no signiticant differences in blood COHb concentrations before hyperbaric oxygenation between those who recovered their conciousness after this procedure and those who did not. One of the 6 patients had convulsive attacks during hyperbaric oxygenation and showed cerebral edema afterward. He underwent barbiturate therapy and thereafter recovered. Severe cerebral edema due to hypoxia may be responsible for the lack of recovery in conciousness even after hyperbaric oxygenation. We consider that the combined therapy of hyperbaric oxygenation and barbiturates may be effective for cerebral edema. Osmolality gap as an index gauging the severity of emergency and critically ill patients: comparison to other scoring systems. Inaba H, Hirasawa H, Sugai T, et al. Jpn J Acute Med 1987;11(8):1001-1006. Osmolality gap is defined as the difference between the measured value and the predicted value of serum osmolality. The increase in the osmolality gap implies the presence of unmeasurable solute in serum. To evaluate the value of the osmolality gap as an index expressing the severity of illness, we studied the correlation between the osmolality gap and two scoring systems, the APACHE proposed by Knaus et al, and SSS proposed by Stevens, in 64 emergency and critically ill patients managed in the intensive care unit. None of these patients had received any chemical or drug known to increase osmolality. The osmolality gap significantly correlated with APACHE and SSS scores, and particularly with consciousness disturbance expressed by the Glasgow coma scale. These results indicate that the osmolality gap is a reliable index to express the severity of illness in emergency and critically ill patients and suggest the possible con-
tribution of unmeasurable solutes to the development of consciousness disturbance. The efficacy of hemoperfusion for ediphenphos poisoning in dogs. Takeda M, Yoshino K, Yamashita M, et al. Jpn J Acute Med 1987;11(8):1007-1012. The effectiveness of hemoperfusion for ediphenphos (EDDP) poisoning in dogs was evaluated. Eighteen mongrel dogs were anesthetized with ketamine HCl and ventilated mechanically. One group received a single intravenous injection and another group received continuous infusion of EDDP. In the single injection group, 4 controls dogs were not hemoperfused, 3 test dogs were treated for 2 hours hemoperfusion 2.5 hours after receiving 20 m&kg of EDDP. With continuous infusion of 10 mg/kg/h of EDDP, 4 control dogs were not hemoperfused and the 7 test dogs were hemoperfused for 2 hours from the beginning of the study. The blood concentrations of EDDP were measured at various times up to 7 hours, and comparisons made between the groups treated by hemoperfusion with the nontreated groups. The blood concentration of EDDP was not decreased significantly in the dogs treated by hemoperfusion in the single intravenous injection group. However, in the continuous infusion group, the blood concentration of EDDP at 100 to 150 minutes after treatment by hemoperfusion was decreased significantly. The volume of distribution of EDDP was 8 L/kg. Therefore, even if the volume of distribution is relatively high, as with EDDP, hemoperfusion may be effective for poisoning following organophosphorous absorption from the intestine, which can be considered equivalent to the infusion study. Systemic effects of esophageal sclerotherapy with ethanolamine oleate. Omote K, Namiki A, Hagiwara T, et al. Jpn J Acute Med 1987;11(8):1015-1020. The systemic effects of 5% ethanolamine oleate used as the sclerosing agent were investigated in 12 patients treated by injection sclerotherapy. Statistically significant changes were demonstrated (p < 0.05) after the injection of 5% ethanolamine oleate. The following results were obtained: decreased arterial PO,, activation of coagulotibrinolytic system, hemolysis, and increased values of blood urea nitrogen and serum creatinine. Sclerotherapy may cause serious systemic complications, including acute respiratory failure, 185