Fresh Frozen Plasma as a Successful Antidotal Supplement in Acute Organophosphate Poisoning

Autor: Slavica Vučinić, Milica Zlatković, Biljana Antonijević, Marijana Ćuričić, Bogdan Bošković
Jazyk: angličtina
Rok vydání: 2013
Předmět:
Zdroj: Arhiv za higijenu rada i toksikologiju
Volume 64
Issue 2
ISSN: 1848-6312
0004-1254
Popis: Despite improvements to intensive care management and specific pharmacological treatments (atropine, oxime, diazepam), the mortality associated with organophosphate (OP) poisoning has not substantially decreased. The objective of this examination was to describe the role of fresh frozen plasma (FFP) in acute OP poisoning. After a deliberate ingestion of malathion, a 55-year-old male suffering from miosis, somnolence, bradycardia, muscular fasciculations, rales on auscultation, respiratory insufficiency, as well as from an inhibition of red blood cell acetylcholinesterase (AChE) and plasma butyrylcholinesterase (BuChE), was admitted to hospital. Malathion was confirmed in a concentration of 18.01 mg L-1. Apart from supportive measures (including mechanical ventilation for four days), antidotal treatment with atropine, oxime - pralidoxime methylsulphate (Contrathion®), and diazepam was administered, along with FFP. The potentially beneficial effects of FFP therapy included a prompt increase of BuChE activity (from 926 IU L-1 to 3277 IU L-1; reference range from 7000 IU L-1 to 19000 IU L-1) and a reduction in the malathion concentration, followed by clinical recovery. Due to BuChE replacement, albumin content, and volume restitution, FFP treatment may be used as an alternative approach in patients with acute OP poisoning, especially when oximes are not available.
Unatoč napretku intenzivnog liječenja i specifične farmakološke terapije (atropin, oksim, diazepam), mortalitet u akutnim trovanjima organofosfatima (engl. Organophosphate, OP) nije se značajno smanjio. Cilj je bio upozoriti na ulogu svježe smrznute plazme (engl. Fresh frozen plasma, FFP) u liječenju akutnih otrovanja OP-ima. Nakon namjerne ingestije malationa, u bolnicu je primljen muškarac u dobi od 55 godina s miozom, somnolencijom, bradikardijom, mišićnim fascikulacijama, pukotima pri auskultaciji pluća i respiratornom insufi cijencijom kao karakterističnim znacima trovanja organofosfatom, kao i inihibicijom eritrocitne acetilkolinesteraze (AChE) i plazmatske butirilkolinesteraze (BuChE). U krvi je potvrđena prisutnost malationa u koncentraciji od 18,01 mg L-1. Pored pratećih mjera (uključujući mehaničku ventilaciju tijekom četiri dana), primijenjena je antidotska terapija atropinom, oksimom pralidoksim-metilsulfatom (Contrathion®) i diazepamom, zajedno s FFP-om. Naglo povećanje aktivnosti BuChE (od 926 IU L-1 do 3277 IU L-1; referentna vrijednost od 7000 IU L-1 do 19000 IU L-1), eliminacija otrova s promptnom redukcijom koncentracije malationa, uz klinički oporavak, mogu se pripisati povoljnim učincima terapije FFP-om kao adjuvansom. FFP osigurava BuChE, povećani sadržaj albumina i nadoknadu volumena, zbog čega se može koristiti kao alternativni način liječenja akutnih trovanja OP-ima, posebno kada nam nisu dostupni oksimi.
Databáze: OpenAIRE
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