digitoxin and Mushroom-Poisoning

Although the elimination of specific toxins by the removal of all plasma constituents is a crude approach, further refinements of the technique should permit safer and more selective detoxification in the future. Currently the mainstay of treatment of intoxicated patients remains careful, aggressive, supportive care. Plasmapheresis should be considered as yet an unproven, hazardous form of therapy for the treatment of intoxication. Its main role should be confined to a research setting in which investigators attempt to develop more advanced and potentially useful apheresis techniques. Membrane plasmapheresis with subsequent on-line treatment of the plasma by sorbent may remove specific plasma solutes. The plasma may be perfused back to the patient without the need to use replacement fluids, thus avoiding many of the side effects of conventional exchange. Bile acids have been removed by circulating plasma over charcoal-coated glass beads, and several toxic substances were shown to be absorbed by perfusion over amberlite resin columns. Another productive area for future research includes the use of plasma exchange therapy for the treatment of acute endogenous intoxications. Recent examples include the treatment of severe preeclampsia, extensive rhabdomyolysis, and life-threatening bleeding in a hemophiliac with inhibitors to clotting factors. Although plasmapheresis in the management of intoxications is still an experimental technique, it may open the door to the treatment of previously intractable syndromes, both medical and toxicologic.

Topics: Adult; Blood Proteins; Digitoxin; Evaluation Studies as Topic; Half-Life; Humans; Kinetics; Mushroom Poisoning; Paraquat; Plasma Exchange; Plasma Volume; Plasmapheresis; Poisoning; Toxicology

Topics: Albumins; Alkaloids; Atropine; Atropine Derivatives; Basidiomycota; Charcoal; Child; Digitalis; Gastroenteritis; Humans; Mouth; Mushroom Poisoning; Nicotine; Phenytoin; Physostigmine; Plant Poisoning; Plants; Plants, Medicinal; Plants, Toxic; Poisons; Potassium Chloride; Renal Dialysis; Seizures; Toxins, Biological; Vomiting; Water-Electrolyte Balance

This article focuses on some of the more common dangerous plant and mushroom ingestions, discussing toxic components, early symptoms, and treatment. Among the plants considered are oleander, foxglove, hemlock, dieffenbachia, and Amanita phalloides. Details concerning recognition of toxic species are intentionally omitted in an effort to avoid potentially dangerous errors in identification.

Topics: Coprinus; Digitalis; Emergencies; Emetics; Gastric Lavage; Humans; Mushroom Poisoning; Plant Poisoning; Plants, Medicinal; Plants, Toxic; Ricinus communis

Topics: Antidepressive Agents, Tricyclic; Charcoal; Chloral Hydrate; Digitoxin; Hemoperfusion; Humans; Mushroom Poisoning; Resins, Synthetic

Ten patients with various intoxications were treated with resin hemoperfusion. Three of four patients with grade IV coma due to tricyclic antidepressant (TCA) poisoning could be extubated during or on termination of hemoperfusion. Clearance values of 135--185 and 190--200 ml/min were obtained for amitriptyline and nortriptyline, respectively. One patient with severe chloral hydrate poisoning could be extubated after less than one hour's hemoperfusion. A clearance of 140 ml/min was obtained in a uremic patient with AV block II due to digitoxin intoxication. Four patients with mushroom poisoning were treated with combined hemoperfusion-hemodialysis. A transient fall in platelet count was seen in all patients. Resin hemoperfusion is of definite value in selected, severe cases of self-poisoning with psychotropic drugs such as TCA and possibly in cases of mushroom poisoning where the prognosis with hemodialysis and supportive therapy is doubtful.

Topics: Adult; Antidepressive Agents, Tricyclic; Chloral Hydrate; Digitoxin; Female; Hemoperfusion; Humans; Male; Metabolic Clearance Rate; Middle Aged; Mushroom Poisoning; Resins, Synthetic; Time Factors