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Plasma exchange parameter selection and safety observation of children with severe ricinism
1Department of Pediatrics, Fuzhou General Hospital of Nanjing Military Command, PLA, Clinical Medical College of Fujian Medical University, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China guangmingchencn@163.com.
Insights
Plasma exchange (PE) is a safe and effective treatment for children with severe ricin poisoning. This study details optimal PE parameters and heparin dosage, showing stable vital signs and no bleeding complications.
Area of Science:
- Pediatric Nephrology
- Toxicology
- Critical Care Medicine
Background:
- Severe ricinism presents a significant challenge in pediatric critical care.
- Plasma exchange (PE) is a potential therapeutic option for toxin removal.
Observation:
- This study monitored 7 children with severe ricinism undergoing PE.
- PE parameters including blood flow, exchange flow, plasma separation rate, and pressures were recorded.
- Heparin dosage was carefully managed throughout the procedure.
Findings:
- PE parameters were established: blood flow (50-80 mL/min), exchange flow (600-800 mL/h), plasma separation rate (12.5-19.05%).
- Transmembrane and venous pressures remained stable (approx. 100 mmHg and 95 mmHg, respectively).
- Initial heparin dose was 0.39 ± 0.04 mg/kg, with maintenance doses ranging from 0.40 ± 0.05 to 0.22 ± 0.03 mg·kg(-1)·h(-1).
- Vital signs (MAP, HR, RR, SpO2) remained steady during PE.
- Coagulation tests (aPTT, TT) prolonged post-PE, but no bleeding complications occurred.
Implications:
- PE is a safe and effective method for eliminating ricin toxin from circulation and tissues in children.
- The established PE parameters and heparinization protocols can guide clinical management of severe ricinism.
- This study provides crucial data for optimizing supportive care in pediatric poisoning cases.
Abstract:
The aim of this study was to investigate the selection of plasma exchange (PE) parameters and the safety of children with severe ricinism. The PE parameters and heparin dosage in 7 children with severe ricinism were recorded, and changes in the patients' vital signs and coagulation function were monitored before and after PE. All patients successfully completed PE. The speed of blood flow was 50-80 mL/min, speed of exchange flow was 600-800 mL/h, and isolating rate of blood plasma was 12.5-19.05%. Transmembrane pressure was stable at approximately 100 mmHg, and venous pressure was stable at approximately 95 mmHg. The first dose of heparin was 0.39 ± 0.04 mg/kg, and the maintaining heparin dose was 0.40 ± 0.05 to 0.22 ± 0.03 mg·kg(-1)·h(-1). During the PE process, mean arterial pressure, heart rate, respiratory rate, and pulse oxygen saturation were steady. After PE, the activated partial thromboplastin time and thrombin time prolonged to 2-3 times greater than that before PE. However, no bleeding tendency was seen. For children with severe ricinism, the choice of PE to eliminate the toxin from blood, tissues, and organs was safe and effective.
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