Combined hemoperfusion-hemodialysis in organophosphate poisoning

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.