Jerry L. Rosenbaum

Resin Hemoperfusion: A New Treatment for Acute Drug Intoxication

Abstract A resin-column hemoperfusion system was used to treat four patients with profound, life-threatening drug intoxication. The column contained 650 g of pyrogen-free resin, Amberlite XAD-2. The resin is uncharged and has a cross-linked, polystyrene macroreticular structure with particular surface attraction for high-molecular-weight, lipid-soluble molecules. Blood was pumped through the column at a flow rate of 300 ml per minute for three hours. Two patients had secobarbital, one a mixture of glutethimide-butabarbital-ethchlorvynol, and one amobarbital intoxication. In all patients the column clearances of these drugs were markedly superior to known clearances with hemodialysis. A transient, modest fall in blood platelet concentration followed hemoperfusion. No serious clinical toxic effects were noted. The resin-column hemoperfusion system was technically simpler, consistently more effective and clinically superior to hemodialysis.

Recirculation peritoneal dialysis with sorbent Redy cartridge.

Sorbent regeneration of peritoneal dialysate and use of small volume of dialysate for intermittent peritoneal dialysis (IPD) has been shown to be feasible. The present study compares the solute clearance (C) for urea (U) and creatinine (Cr) at varying flow rates in IPD and in recirculation peritoneal dialysis (RPD) utilizing Redy cartridge in ten dogs. Two silastic peritoneal catheters and one Sarns roller pump were used for RPD. CU was 12 +/- 2 ml/min (mean +/- 1SD),18 +/- 2 with IPD and 15 +/- 2,21 +/- 4 with RPD at flow rate of 66 and 100 ml/min, respectively, while CCr was 9 +/- 2,12 +/- 2 with IPD and 10 +/- 2, 13 +/- 3 with RPD. At increasing flow rates of 150,200 and 250 ml/min, CU was 27 +/- 3,31 +/- 4 and 32 +/- 6, and CCr was 17 +/- 2,20 +/- 3 and 22 +/- 3 with RPD. U and Cr were completely removed by the Redy. Glucose was not removed by the cartridge after initial saturation. Serum sodium concentration increased 2-3 mEq/l after 6 h of RPD. The data suggest that at comparable flow rates, RPD is relatively more efficient than IPD (p greater than 0.01). This may be due to continuous exchange across the peritoneal membrane in RPD. At high flow rate in RPD, solute removal is 2-3 times higher than the currently used IPD. RPD with Redy cartridge is mechanically simple, efficient, and may help reduce total peritoneal dialysis time.

Comparison of Subdavian Vein With Femoral Vein Catheterization for Hemodialysis

Subclavian vein catheterization (SVC) is not widely accepted for vascular access because it is considered more invasive than femoral vein catheterization (FVC). The use of FVC and SVC for acute vascular access was compared for 9 mo each. Complications were minimal with both, but access related hospitalizations were lower and the number of out-patient dialyses performed were higher with SVC than FVC. Complications with SVC might have been minimized by using an 18-gauge metallic needle for insertion, avoiding interdialytic infusions and using SVC for less than 4 wk.

Hyperosmotic Coma Complicating Peritoneal Dialysis with Sorbitol Dialysate

Abstract A uremic and severely edematous patient with diabetic nephropathy underwent peritoneal dialysis with hypertonic sorbitol dialysate. Although azotemia and edema improved, he became comatose...

Determination of Inulin and p-Aminohippurate Clearances without Urine Collection

Standard inulin and PAH clearances utilizing blood and urine collections were determined in 50 individuals with chronic kidney disease. Each of these patients, as well as 14 anephric patients, also ha

Evaluation of hypertonic peritoneal dialysis solutions with low sodium.

19 separate 3- to 5-day ultrafiltration peritoneal dialyses (UPD) were performed in 12 markedly edematous patients. A 7-percent dextrose dialysis solution with 120 mEq/l sodium (7–120) was used in 10

The use of resin hemoperfusion in the treatment of acute drug intoxication.

(1972). The Use of Resin Hemoperfusion in the Treatment of Acute Drug Intoxication. Clinical Toxicology: Vol. 5, No. 3, pp. 331-335.

Hemoperfusion with Uncoated Amberlite XE-336 Resin in Normal and Uremic Dogs

Amberlite XE-336 is a pyrolized polystyrene resin with an adsorptive spectrum similar to activated charcoal. 5 normal (group I) and 5 uremic (group II) dogs had 6 h of hemoperfusion with a 400-gram column of Amberlite XE-336 resin with a blood flow rate of 300 ml/min. In group II during 0, 0.5, 1, 3, and 6 h of hemoperfusion the mean column clearances of creatinine were 273 +/- 10, 224 +/- 7, 177 +/- 8, 125 +/- 30, and 64 +/- 17 ml/min and the serum creatinine concentration decreased from 10.4 +/- 1.3 to 3.2 +/- 0.9 mg/dl. In one of the uremic dogs the column clearance of middle molecules measured at 0, 0,5, 1, 3, and 6 h of hemoperfusion was 273,258,101,109, and 23 ml/min. The side reactions in group I and II hemoperfusion studies included transient hypotension, hypocalcemia, leukopenia and a reduction in platelet count.

Solute Transport in Comparable Surface Area Dialyzers

The present study compared clearance (K) for urea (U), uric acid (Ua), and BSP in relatively equal surface area dialyzers, EX-29 to dual EX-21 in parallel (DEX-21) at QB and QD 300 ml/min, and hollow fiber kidney model 5 (HFK-5) to dual HFK model 4 in series (DHFK-4) at QB 200, QD 500 ml/min. KU was 158 +/- 20 ml/min, 129 +/- 22; KUa was 106 +/- 10, 96 +/- 5, and KBSP was 80 +/- 11 and 67 +/- 12 (p less than 0.01) for EX-29 and DEX-21, respectively. KU was 173 +/- 8 ml/min, 159 +/- 6; KUa was 131 +/- 6, 117 +/- 8, and KBSP was 65 +/- 9 and 56 +/- 7 (p less than 0.01) for HFK-5 and DHFK-4, respectively. Comparable changes in outlet pressure had a varied effect on ultrafiltration and solute transport. 3-hour hemodialysis in the same patients showed that EX-29 was better tolerated than DEX-21. The data suggest that dialyzer designs with the same membrane of equal surface area may significant affect K for both small and middle molecular weight solutes. Comparable changes in outlet pressure may have a varied effect on K in different designs. Due to these variations, comparison of dialysis schedules with different dialyzers on the basis of the square meter hour dialysis to prove validity of middle molecule hypothesis should be interpreted cautiously.

Solute Transport in Reused Hollow Fiber Artificial Kidney

The present studies compare clearance (K) for varying molecular weight (MW) solutes, Urea (U), Uric acid (Ua), BSP and B12 in hollow fiber kidneys (HFK) before and in reused hollow fiber kidneys (RHFK) after five hemodialyses. In 10 RHFK, 3 % H2O2 was perfused in the dialysate compartment to clear residual blood. Five RHFK were cleaned with water (W) alone. Fiber bundle volume (FBV) before each use was > 75 ml. RHFK with H2O2 appeared cleaner than with W. KU was 168 ± 6,134 ± 12, and 152 ± 10 ml/min; KUa was 144 ± 11, 89 ± 12, and 101 ± 6 ml/min; KBSP was 50 ± 7, 29 ± 7, and 42 ± 6 ml/min, and KB12 was 15 ± 2,7 ± 2 and 11 ± 2 ml/min with HFK before, RHFK with H2O2, and RHFK with W, respectively. The percentage decrease in K was greater for higher MW solutes. HFK cleaning with H2O2 before dialysis did not change solute transport markedly. The data suggest: (1) there is relatively greater decrease in middle molecule clearance than small molecule in RHFK, and (2) with comparable FBV, clearance is better (p 2O2.