Objective: To examine the impact of continuous plasma perfusion on plasma PQ concentration (PPQ) in acute PQ-poisoning patients for the estimation of its PQ clearance effect.
Methods: 21 PQ-poisoned patients admitted to our poisoning center within 24 hours after the ingestion were prospectively enrolled. Continuous plasma perfusion (flow rate 180 ml/min) was performed, with plasma/blood separation at 40 ml/min and routine cartridges change every 3 hours. Urinary PQ (UPQ), urine flow rate (UFR), and PPQ level at inlet/outlet of the cartridge were obtained right before, and 1.5 hours after the start of each perfusion session for calculation of renal and plasma PQ excretion.
Results: In all 8 rounds (108 sessions) of plasma perfusion on the 21 patients, PQ elimination rate (ml/min) by plasma perfusion was found always higher than the renal value: [1st (21 cases) 11.14±6.13 vs. 5.33±4.33; 2nd (21 cases) 18.36±11.32 vs. 4.85±3.15; 3rd (21 cases) 16.13±10.05 vs. 0.84±0.80; 4th (17 cases) 12.86 (6.72, 17.47) vs. 0.28 (0.09, 0.60); 5th (11 cases) 14.12 (10.48, 35.20) vs. 0.10 (0.03, 0.73); 6th (7 cases) 16.47 (11.82; 20.69) vs. 0.13 (0.03, 0.40); 7th (5 cases) 13.33 (9.71, 18.75) vs. 0.33 (0.24, 0.47); 8th (5 cases) 11.27 (9.21, 16.02) vs. 0.32 (0.10, 1.22), P< 0.05 or P< 0.01]. In the study, PPQ was found negatively correlated to PQ elimination by plasma perfusion (r = - 0.4799, P< 0.0001), and positively correlated to the renal elimination ( r = 0.5060, P< 0.0001). The survivors (10 cases) showed a higher PPQ reduction rate (mg×L(-1)×h(-1)) than the non-survivors (11 cases, 0.57± 0.03 vs. 0.47±0.06,P< 0.05).
Conclusion: Continuous plasma perfusion may be a promising therapeutic tool for its significant PPQ reduction effect, and plasma perfusion should be made available early for patients with acute PQ intoxication.