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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