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Table 3 Effectiveness of various modes of extracorporeal blood purification and different chelators in arsenic intoxication

From: Treatment of lead and arsenic poisoning in anuric patients – a case report and narrative review of the literature

Patients

Renal Function (Creatinine)

Pre-dialysis Ars Level

Post-dialysis Ars Level

Chelator

Mode of Dialytic Therapy

Dialytic Ars Clearance

Dialytic Ars Removal

Urinary Ars Clearance

Urinary Ars Removal

Outcome

Giberson [24]

288 μmol/L

Oliguric

300 μg/L

140 μg/L

BAL

HD 4 h

87 ml/min

3.36 mg over 4 h

n/a

2.03 mg/day

Resolved GI symptoms and renal function recovered

Vaziri [8]

707 μmol/L

411 μg/L

364 μg/L

BAL

HD 4 h

76 ml/min

4.68 mg over 4 h

n/a

3.12 mg/day

Resolved GI symptoms and renal function recovered

Smith [26]

Oliguric

26.7 μg/L

29.0 μg/L

BAL and Penicillamine

HP 2 h

n/a

n/a

  

Improved renal function and remained comatosed after 100 days

29.0 μg/L

36.2 μg/L

HD 2 h

  

21.7 μg/L

22.7 μg/L

HD 3 h

  

18.9 μg/L

21.5 μg/L

HP 3 h

  

Levin-Scherz [27]

495 μmol/L

Anuric

190 μg/L

62 μg/L

BAL

HD 4 h

n/a

2.9 mg over 4 h

n/a

n/a

Died

Mathieu [10]

238 μmol/L

Anurica

249 μg/L

133 μg/L

No chelator

HD 4 h

85 ml/min

8.2 mg over 4 h

n/a

10.7 mg

Renal function recovered

110 μg/L

91 μg/L

BAL

HD 4 h

87.5 ml/min

5.3 mg over 4 h

n/a

13.2 mg

1 – Blyth [25]

Oligurica

80 μg/L

n/a

BAL

HD

  

358 ml/min

94 mg/72 h

Renal function recovered

2

Oliguric

340 μg/L

n/a

BAL

CVVH

15 ml/min

23 mg over 90 h

3.83 ml/min

6 mg/99 h

Died

Fesmir [28]

Normal

444 μg/L

170 μg/L

BAL and Penicillamine

HD

n/a

n/a

n/a

24 mg/day

Developed PN and HT

Hanston [29]

459 μmol/L

Oliguric

n/a

n/a

BAL + DMSA IV 2 days →

DMSA IV 9 days

HD

37.5 ml/min

26 mg over 11 days

1.34 ml/min

15 mg over 11 days

Died

CVVH

0.64 ml/min

8 mg over 11 days

DMSA IP 11 days

PD

4.28 ml/min

17 mg over 11 days

Zilker [11]

Normal

245 μg/L

2.3 μg/Lb

DMPS

HD 5 h

n/a

0.168 mg

n/a

89.67 mg over 87 h

Recovered

CAVHDF

0.061 mg

HD 5 h

0.12 mg

Lai [14]

Anuric

730 μg/L at autopsy

n/a

BAL

DMPS

HD

n/a

2.04 mg

  

Died

1 – Adam [30]

406 μmol/L

Oliguric

558 μg/L

n/a

BAL

HD-HP

3.5 – 4 h

55.7 – 70.4 ml/min

3.8 – 5.2 mg per session

37.1 ml/min

156 mg over 20 days

Paraplegic

     

PD

 

2.83 mg over 6 days

2

247 μmol/L

Oliguric

540 μg/L

n/a

BAL

HD-HP

3.5 h

125.8 ml/min

11.62 mg per session

 

8.54 mg over 34 h

Died

3

274 μmol/L

Oliguric

620 μg/L

n/a

BAL

DMPS

HD-HP

3.5 h

47.3 – 54 ml/min

2.28 – 2.89

mg per session

68 ml/min

123.4 mg over 4 days

Died

4

Normal

245 μg/L

n/a

DMPS

HD 5 h

40 ml/min

0.24 mg

696 ml/min

86.25 mg over 3 days

Fully recovered

CAVHDF

32.1 – 54.7 ml/min

0.063 mg over 6 h and 0.051 mg over 12 h

5

Normal

2240 μg/L

n/a

DMPS

Nil

n/a

n/a

183 - 436 ml/min

134.6 mg over 4 days

Fully recovered

6

901 μmol/L

Anuric

4469 μg/L

n/a

DMPS

HDF 5 h

42.2 - 140.3 (average 98) ml/min

252 mg over 6 sessions

 

Anuric

Fully recovered

  1. Ars arsenic, PN peripheral neuropathy, HT hypertension, GI gastrointestinal, n/a not available, HD haemodialysis, CVVH continuous veno-venous haemofiltration, HDF haemodiafiltration, HD-HP haemodialysis-haemoperfusion, CAVHDF continuous arterio-venous haemodiafiltration, IV intravenous, IP intraperitoneal
  2. a: renal function recovered in hours after commencement of treatment; b: serum arsenic level after 7 days