Use of Continuous Vein-Venous Hemodiafiltration and On-Line Hemodiafiltration in Four Cases of Acute Arsine Gas Poisoning

Introduction: Extensive hemolysis resulting in anuric renal failure is the main clinical sign of acute arsine poisoning. Plasmapheresis and exchange transfusion are recommended for patients with massive hemolysis. We report four cases of arsine exposure which demonstrate the effectiveness of continuous vein-venous hemodiafiltration and on-line hemodiafiltration for arsenic removal. Method: Blood samples were obtained from four males admitted to Poisoning Treatment Centre during 2014–2015. The arsenic concentration was measured by a hydride atomic absorption analysis using ZeeNit 600 atomic absorption analyzer. Results: Three of the patients developed acute renal failure and underwent dialysis over 35 to 38 days. In two cases of on-line hemodiafiltration(on-line HDF) arsenic blood concentration decreased for 57 and 16%, total amount of arsenic removed was 98.7 mg and 43.3 mg, average arsenic clearance was 79.8 ± 30.0 ml/min. During continuous vein-venous hemodiafiltration (CVVHDF) arsenic blood concentration decreased for 99% arsenic clearance was 121.6 and 200 ml/min. Renal arsenic clearance was 75.6 ml/min. Arsenic half-life noticeably reduced during both reported procedures. Conclusion: Both on-line HDF and CVVHDF were effective for arsenic removal in cases reported in this study. The reducing of arsenic blood concentration did not prevent acute renal failure.