Results of hemodialysis & hemoperfusion in the treatment of acute arsenic ingestion.

Hemodialysis and charcoal hemoperfusion have been used in the last few years for the treatment of acute toxin ingestion. We used these methods to treat a patient with a known ingestion of 1.3 grams of arsenic trioxide. We measured blood and urine levels of arsenic prior to and after dialytic therapy in addition to before and after conventional chelation therapy. The blood and urine levels showed no significant change with any therapy and clinically he lapsed into prolonged coma. In view of the lack of laboratory and clinical response, we feel that hemodialysis and hemoperfusion may not be indicated in acute massive ingestion. Supportive care to maintain blood pressure and urinary output may be all there is to offer. In recent years both hemodialysis and hemoperfusion have been introduced as treatment of accidental or deliberate drug or toxin ingestion. (1-4) There have been previous reports on the supposedly successful treatment of arsenic ingestion with hemodialysis. (5-6) We report our experience with a massive ingestion of arsenic trioxide. This patient received treatment with conventional chelating agents, standard hemodialysis, as well as hemoperfusion, without evidence of significant removal of arsenic or clinical benefit.