Mathieu D, Mathieu-Nolf M, Germain-Alonso M, Neviere R, Furon D, Wattel F
Service d'Urgence Respiratoire et de Réanimation Médicale, Hôpital A. Calmette, Lille, France.
Intensive Care Med. 1992;18(1):47-50. doi: 10.1007/BF01706427.
In massive arsenic poisoning, the use of hemodialysis and dimercaprol (BAL) therapy is still controversial. Hemodialysis is thought of value only for supportive care. BAL therapy has been criticized because of its delayed action, its own toxicity and its possible influence on arsenic clearance during hemodialysis. We studied arsenic kinetics during an acute suicidal intoxication (10 g of sodium arsenate). Treatment included gastric lavage, oral charcoal and supportive measures. Hemodialysis was performed immediately and repeated the next day. BAL therapy was prescribed only on the second day. Cardiovascular collapse, anuria and hepatic disturbance recovered in a few days and the patient could be discharged on the 15th day. Instantaneous serum arsenic hemodialysis clearance was 85 +/- 75 ml/min without previous BAL injection and 87.5 +/- 75 ml/min with a previous 250 mg BAL injection (difference not significant) indicating that BAL did not impede arsenic dialysis. The calculated total hemodialysis clearance of arsenic was higher than mean serum hemodialysis clearance indicating that erythrocyte bound arsenic is also eliminated during dialysis. We propose to consider early hemodialysis as an elimination measure in massive arsenic poisoning and to choose BAL as a chelator when dialysis is required.
在大规模砷中毒中，血液透析和二巯丙醇（BAL）疗法的使用仍存在争议。血液透析被认为仅对支持性治疗有价值。BAL疗法受到批评，因为其作用延迟、自身毒性以及在血液透析期间对砷清除的可能影响。我们研究了急性自杀性中毒（10克砷酸钠）期间的砷动力学。治疗包括洗胃、口服活性炭和支持性措施。立即进行血液透析并在第二天重复。仅在第二天开了BAL疗法。心血管衰竭、无尿和肝脏紊乱在几天内恢复，患者于第15天出院。在未预先注射BAL的情况下，即时血清砷血液透析清除率为85±75毫升/分钟，在预先注射250毫克BAL的情况下为87.5±75毫升/分钟（差异不显著），表明BAL并未阻碍砷的透析。计算得出的砷的总血液透析清除率高于平均血清血液透析清除率，表明透析期间红细胞结合的砷也被清除。我们建议将早期血液透析视为大规模砷中毒的清除措施，并在需要透析时选择BAL作为螯合剂。
