Manikian Adriana, Stone Susan, Hamilton Richard, Foltin George, Howland Mary Ann, Hoffman Robert S
Department of Pediatrics, New York University School of Medicine, NY 10016, USA.
Vet Hum Toxicol. 2002 Aug;44(4):224-7.
We used exchange transfusion as an alternative to hemodialysis in an infant with severe salicylism. A 4-mo old, 5 kg male was presented to a local hospital with acute vomiting, tachypnea, hyperpnea and intermittent agitation and lethargy. Shortly after a generalized tonic-clonic seizure he passed several tablets in his stool. Salicylate (ASA) level was 85 mg/dL. He was transferred to our institution for further management: i.v. fluids, activated charcoal, whole bowel irrigation and supplementation with sodium bicarbonate, potassium and calcium. The patient's mental status and gas exchange deteriorated and he was intubated. Despite large amounts of sodium bicarbonate and potassium, severe hypokalemia, anion gap metabolic acidosis and aciduria persisted for 10 h. The small size of the infant precluded use of hemodialysis. An exchange transfusion using 180 mL/kg packed red blood cells reconstituted in fresh frozen plasma was performed. The pre-exchange transfusion ASA level was 70.1 mg/dL; the post-exchange transfusion ASA level was 34.4 mg/dL. There was rebound elevation of ASA to 35.2 mg/dL at 6 h post-exchange transfusion. The 18, 36 and 48 h post-exchange transfusion ASA levels were 20.2, 6.8 and < 2 mg/dL respectively. The ASA level dropped 17.6% before, 41.9% in 8.5 h during, and 40.5% by 48 h after the exchange transfusion. There were no complications. The patient recovered completely to his pre-morbid state. Double volume exchange transfusion was used safely as an effective alternative to hemodialysis in this case of severe infant salicylate poisoning.
我们对一名患有严重水杨酸中毒的婴儿采用换血疗法替代血液透析。一名4个月大、体重5千克的男婴因急性呕吐、呼吸急促、呼吸深快以及间歇性烦躁和嗜睡被送往当地医院。在一次全身性强直阵挛发作后不久，他排出了数片药片。水杨酸盐（阿司匹林）水平为85毫克/分升。他被转至我院进一步治疗：静脉输液、活性炭、全肠道灌洗以及补充碳酸氢钠、钾和钙。患者的精神状态和气体交换恶化，遂行气管插管。尽管给予了大量碳酸氢钠和钾，但严重低钾血症、阴离子间隙代谢性酸中毒和酸尿持续了10小时。婴儿体型小，无法进行血液透析。采用180毫升/千克悬浮红细胞在新鲜冰冻血浆中重构进行换血。换血前阿司匹林水平为70.1毫克/分升；换血后阿司匹林水平为34.4毫克/分升。换血后6小时阿司匹林水平反弹至35.2毫克/分升。换血后18、36和48小时阿司匹林水平分别为20.2、6.8和<2毫克/分升。换血前阿司匹林水平下降17.6%，换血期间8.5小时内下降41.9%，换血后48小时下降40.5%。无并发症发生。患者完全恢复至病前状态。在这例严重婴儿水杨酸盐中毒病例中，双倍容量换血疗法作为血液透析的有效替代方法被安全使用。
