Removal of inhibitors of brain Na+, K+-ATPase by hemoperfusion in fulminant hepatic failure.

Serum from patients with fulminant hepatic failure inhibits rat brain Na+, K+-ATPase activity in vitro. The effect of hemoperfusion on the level of inhibition was investigated with both resin and charcoal columns in clinical use. In the patient perfusions, the mean inhibitory activity of serum fell from 34.7 +/- 1.6 (SE) to 20.9 +/- 1.5% compared with pooled control serum when a resin column was used for the first time and from 26.9 +/- 2.2 to 20.4 +/- 1.7% with charcoal hemoperfusion, a statistically significant (p less than 0.01) removal in both groups. Column chromatography on Sephadex G-25 of material eluted from the resin column post-hemoperfusion and of serum ultrafiltrates before and after in vitro adsorption with charcoal showed considerable overlap in the profile of the substances removed, but with some peaks removed by only one adsorbent. Combinations of resin and charcoal in one hemoperfusion should remove a wider range of potentially toxic substances.