HAEMOPERFUSION INEFFECTIVE FOR PARAQUAT REMOVAL IN LIFE-THREATENING POISONING
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173 scattered throughout the district during an outbreak and since the family doctor is the most likely to see the child during the acute phase, it would seem wise for paediatric and community medicine departments at teaching centres to recruit a panel of family doctors to report suspected cases during the first phase and arrange hospital admission to prevent cardiac damage. The evidence suggests a viral infection and the resemblance to acquired immunodeficiency syndrome in children is intriguing. T cell function should be investigated in affected children. Paediatric Dermatology Clinic, Guy’s Hospital London SEI 9RT E. J. MOYNAHAN HAEMOPERFUSION INEFFECTIVE FOR PARAQUAT REMOVAL IN LIFE-THREATENING POISONING SIR,—We agree with Dr Mascie-Taylor and his colleagues (June 18, p 1376) that haemoperfusion is ineffective in paraquat poisoning. A 33-year-old man was admitted after a suicidal ingestion of 250 g paraquat. Gastric lavage was done 1.5 5 h after ingestion. Fuller’s earth was administered and repeated 1 h later. 3.5 h after ingestion, a haemoperfusion-haemodialysis (HP-HD) procedure was started.’ i Paraquat levels were measured colorimetrically after isolation on cation exchange resin. The figure shows paraquat levels found in the serum, before the charcoal column, between the charcoal column and the artificial kidney, and after the artificial kidney. Clearances of paraquat were 160±40 ml/min (n = 5) for the charcoal column and 150±40 ml/min (n=4) for the artificial kidney. After 15 - 5 h of HP-HD treatment, paraquat was no longer detectable in the serum. 30 - 5 h after paraquat ingestion, the HP-HD procedure was stopped (after 27 h). The patient died 39 h after paraquat ingestion. After cation exchange resin isolation, paraquat concentrations in necropsy specimens were determined by thin layer chromatography.3 Tissue paraquat levels (µg/g wet tissue) were: 4. Centers for Disease Control. Unexplained immunodeficiency and opportunistic infections in infants in New York, Jersey and California. MMWR 1982; 31: 665-67. 1. de Broe ME, Verpooten GA, Christiaens MA, Rutsaert RJ, Holvoet J, Nagler J, Heyndrickx A. A clinical experience with prolonged combined hemoperfusion- hemodialysis treatment of severe poisoning. Artif Organs 1981; 5: 59-66. 2 van den Heede M, Heyndrickx A Toxicological screening analysis in case of paraquat intoxication in man. In: Heyndrickx A, ed. Human toxicology. Gent: European Press, 1978: 207-12. 3. van den Heede M, Heyndrickx A, Timperman J. Une intoxication mortelle par ingestion du paraquat sans aucun traitement spécifique subséquent. J Pharm Belg 1979; 34: 69-76. Serum paraquat concentrations (µg/ml) in fatal case of paraquat poisoning. ———— * before charcoal. ———— * ———— between charcoal and artifical kidney. - - - - after artificial kidney. kidney 34, pancreas 24, heart 9, liver 8, lung 6, prostate 5, cerebral cortex 4, testis 4, thyroid 2, adrenal 1, bone marrow 1. Spleen, skeletal muscle, and stomach showed concentrations of 0. 2 µg/g or lower. Measurements of serum paraquat levels in our patient confirmed that increased clearances of paraquat can be obtained by haemoperfusion4,5 and by haemodialysis. 6 However, the multicompartmental behaviour of paraquat is clearly shown by the discrepancy between the HP-HD clearance of the central (plasma) and peripheral (tissue) compartments. This case confirms that HP- HD is ineffective in the treatment of intoxications with agents showing a large distribution volume (more than 500 litres) and strongly bound to tissues. 8 Department of Nephrology-hypertension, University of Antwerp, B-2520 Edegem, Belgium Department of Toxicology, State University of Ghent FRANK L. VAN DE VYVER JAN VAN DE SANDE GERT A. VERPOOTEN MARC E. DE BROE MARC VAN DEN HEEDE AUBIN HEYNDRICKX LITERACY OF MENTAL PATIENTS FOR WHOM COMMUNITY CARE IS PLANNED SIR,—The United Nations Educational Scientific and Cultural Organisation (UNESCO) has suggested that a person must be able to read as well as a 13-year-old to function eftectively and independently. This is known as functional literacy. In the UK an adult whose reading ability is equivalent to that ofa 7-year-old is said to be illiterate, and people who lie between illiteracy and functional literacy are classified as semiliterate. As the BBC Adult Literacy Handbook (1975) points out, semiliterate people read hesitantly, but not fluently, and they can grasp the meaning of only the simplest material: they can cope with road signs or easy newspapers but not with advertisements for accommodation or official documents, for example and most jobs require more than just a basic ability in reading and writing. Literacy, in a society so dependent upon reading and writing, is thus relevant to plans for community rather than long-stay hospital care for mentally ill adults. A survey at a large psychiatric hospital in Wandsworth (south- west London) showed that 293 of the 803 inpatients were under 65 years of age (171 men and 122 women). A sample-78 of the 171 men and 44 of the 122 women under 65-were given a Schonell graded word recognition test. Severely psychotic patients were excluded and 6 patients did not wish to take part. In this sample roughly 1 in 7 of the patients were illiterate (reading age below 9), one-quarter were semiliterate (reading ages 10-12), and three-fifths could be described as functionally literate: No significant difference was found between men and women. The average number of words read by the men was 73±27 (SD) giving a mean reading age of 11 - 6 years; the corresponding figures were 71±28 (11 - 4 years) for women and 74±26 (11 - 7 years) for the whole 4. Okonek S, Tonnis HJ, Baldamus CA, Hofmann A. Hemoperfusion versus hemodialysis in the management of patients severely poisoned by organophosphorus insecticides and bipyridyl herbicides. Artif Organs 1979; 3: 341-45. 5. Tabei K, Asano Y, Hosada S. Efficacy of charcoal hemoperfusion in paraquat poisoning. Artif Organs 1982; 6: 37-42. 6. Fairshter RD, Dabir-Vazirj N, Smith WR, Glauser FL, Wilson AF. Paraquat poisoning: an analytical toxicologic study of three cases. Toxicology 1979; 12: 259-66. 7. Fréjaville JP, Bismuth C, Conso F. Toxicologie clinique. Paris: Flammarion, 1981: 349. 8. de Broe ME, Verpooten GA. Combined hemoperfusion-hemodialysis in severe poisoning: a four year experience (1978-1982). In: Piskin E, Chang TM, eds. The past, present and future of artificial organs. Ankara: Meteksan Publishing, 1983: 180-95.
Transcript of HAEMOPERFUSION INEFFECTIVE FOR PARAQUAT REMOVAL IN LIFE-THREATENING POISONING
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scattered throughout the district during an outbreak and since thefamily doctor is the most likely to see the child during the acutephase, it would seem wise for paediatric and community medicinedepartments at teaching centres to recruit a panel of family doctorsto report suspected cases during the first phase and arrange hospitaladmission to prevent cardiac damage.The evidence suggests a viral infection and the resemblance to
acquired immunodeficiency syndrome in children is intriguing. Tcell function should be investigated in affected children.
Paediatric Dermatology Clinic,Guy’s HospitalLondon SEI 9RT E. J. MOYNAHAN
HAEMOPERFUSION INEFFECTIVE FOR PARAQUATREMOVAL IN LIFE-THREATENING POISONING
SIR,—We agree with Dr Mascie-Taylor and his colleagues (June18, p 1376) that haemoperfusion is ineffective in paraquatpoisoning.A 33-year-old man was admitted after a suicidal ingestion of 250 g
paraquat. Gastric lavage was done 1.5 5 h after ingestion. Fuller’searth was administered and repeated 1 h later. 3.5 h after ingestion,a haemoperfusion-haemodialysis (HP-HD) procedure was started.’ i
Paraquat levels were measured colorimetrically after isolation oncation exchange resin. The figure shows paraquat levels found inthe serum, before the charcoal column, between the charcoalcolumn and the artificial kidney, and after the artificial kidney.Clearances of paraquat were 160±40 ml/min (n = 5) for the charcoalcolumn and 150±40 ml/min (n=4) for the artificial kidney. After15 - 5 h of HP-HD treatment, paraquat was no longer detectable inthe serum. 30 - 5 h after paraquat ingestion, the HP-HD procedurewas stopped (after 27 h). The patient died 39 h after paraquatingestion.After cation exchange resin isolation, paraquat concentrations in
necropsy specimens were determined by thin layerchromatography.3 Tissue paraquat levels (µg/g wet tissue) were:
4. Centers for Disease Control. Unexplained immunodeficiency and opportunisticinfections in infants in New York, Jersey and California. MMWR 1982; 31: 665-67.
1. de Broe ME, Verpooten GA, Christiaens MA, Rutsaert RJ, Holvoet J, Nagler J,Heyndrickx A. A clinical experience with prolonged combined hemoperfusion-hemodialysis treatment of severe poisoning. Artif Organs 1981; 5: 59-66.
2 van den Heede M, Heyndrickx A Toxicological screening analysis in case of paraquatintoxication in man. In: Heyndrickx A, ed. Human toxicology. Gent: EuropeanPress, 1978: 207-12.
3. van den Heede M, Heyndrickx A, Timperman J. Une intoxication mortelle paringestion du paraquat sans aucun traitement spécifique subséquent. J Pharm Belg1979; 34: 69-76.
Serum paraquat concentrations (µg/ml) in fatal case of paraquatpoisoning.———— * - before charcoal.———— * ———— between charcoal and artifical kidney.- - - - after artificial kidney.
kidney 34, pancreas 24, heart 9, liver 8, lung 6, prostate 5, cerebralcortex 4, testis 4, thyroid 2, adrenal 1, bone marrow 1. Spleen,skeletal muscle, and stomach showed concentrations of 0. 2 µg/g orlower.Measurements of serum paraquat levels in our patient confirmed
that increased clearances of paraquat can be obtained byhaemoperfusion4,5 and by haemodialysis.
6 However, the
multicompartmental behaviour of paraquat is clearly shown by thediscrepancy between the HP-HD clearance of the central (plasma)and peripheral (tissue) compartments. This case confirms that HP-HD is ineffective in the treatment of intoxications with agentsshowing a large distribution volume (more than 500 litres) andstrongly bound to tissues.8
Department of Nephrology-hypertension,University of Antwerp,B-2520 Edegem, Belgium
Department of Toxicology,State University of Ghent
FRANK L. VAN DE VYVER
JAN VAN DE SANDEGERT A. VERPOOTENMARC E. DE BROE
MARC VAN DEN HEEDEAUBIN HEYNDRICKX
LITERACY OF MENTAL PATIENTS FOR WHOMCOMMUNITY CARE IS PLANNED
SIR,—The United Nations Educational Scientific and CulturalOrganisation (UNESCO) has suggested that a person must be ableto read as well as a 13-year-old to function eftectively andindependently. This is known as functional literacy. In the UK anadult whose reading ability is equivalent to that ofa 7-year-old is saidto be illiterate, and people who lie between illiteracy and functionalliteracy are classified as semiliterate. As the BBC Adult LiteracyHandbook (1975) points out, semiliterate people read hesitantly, butnot fluently, and they can grasp the meaning of only the simplestmaterial: they can cope with road signs or easy newspapers but notwith advertisements for accommodation or official documents, forexample and most jobs require more than just a basic ability inreading and writing. Literacy, in a society so dependent uponreading and writing, is thus relevant to plans for community ratherthan long-stay hospital care for mentally ill adults.A survey at a large psychiatric hospital in Wandsworth (south-
west London) showed that 293 of the 803 inpatients were under 65years of age (171 men and 122 women). A sample-78 of the 171 menand 44 of the 122 women under 65-were given a Schonell gradedword recognition test. Severely psychotic patients were excludedand 6 patients did not wish to take part. In this sample roughly 1 in7 of the patients were illiterate (reading age below 9), one-quarterwere semiliterate (reading ages 10-12), and three-fifths could bedescribed as functionally literate:
No significant difference was found between men and women. Theaverage number of words read by the men was 73±27 (SD) giving amean reading age of 11 - 6 years; the corresponding figures were71±28 (11 - 4 years) for women and 74±26 (11 - 7 years) for the whole
4. Okonek S, Tonnis HJ, Baldamus CA, Hofmann A. Hemoperfusion versus
hemodialysis in the management of patients severely poisoned byorganophosphorus insecticides and bipyridyl herbicides. Artif Organs 1979; 3:341-45.
5. Tabei K, Asano Y, Hosada S. Efficacy of charcoal hemoperfusion in paraquatpoisoning. Artif Organs 1982; 6: 37-42.
6. Fairshter RD, Dabir-Vazirj N, Smith WR, Glauser FL, Wilson AF. Paraquatpoisoning: an analytical toxicologic study of three cases. Toxicology 1979; 12:259-66.
7. Fréjaville JP, Bismuth C, Conso F. Toxicologie clinique. Paris: Flammarion, 1981:349.
8. de Broe ME, Verpooten GA. Combined hemoperfusion-hemodialysis in severe
poisoning: a four year experience (1978-1982). In: Piskin E, Chang TM, eds. Thepast, present and future of artificial organs. Ankara: Meteksan Publishing, 1983:180-95.
