The effects of therapeutic plasma exchange in organophosphate poisoning cases with intermediate syndrome

The Effects of Therapeutic Plasma Exchange in Organophosphate Poisoning Cases With Intermediate SyndromeObjective: Organophosphate poisoning is encountered worldwide and particularly in developing countries where agricultural activities are commonplace, as cases involving its accidental or suicidal use. Respiratory failure is the most common cause of death especially in patients who developed intermediate syndrome. In this study, we aimed to apply therapeutic plasma exchange on patients with intermediate syndrome in order to remove the toxic substance from the body. Thus, we targeted accelerating the recovery, and reducing the mechanic ventilation and hospital stay in those patients.Method: Seventeen patients (4 female and 13 male) who presented to the Emergency Department between October 2008 - December 2010 and diagnosed with intermediate syndrome were included. The mean age of the patients was 50,59±20,162 years. Organic phosphate and pseudocholinesterase levels were determined from blood samples collected before and after the therapeutic plasma exchange. Moreover, organic phosphate level was also evaluated in the removed plasma.Results: Preplasmapheresis mean values of pseudocholinesterase and organophosphate were 219,40±463,820 (5-2583) U/L and 0,7210±1,83780 (0,00-9,05) mg/L, respectively. Postplasmapheresis mean values of pseudocholinesterase and organophosphate were 607,30±1148,870 (13-5046) U/L and 0,3753±0,82636 (0-3,24) mg/L, respectively. Moreover, organophosphate level in the removed plasma was 0,4835±1,11905 (0,00-4,55) mg/L. While there was a statistically significant increase in the pseudocholinesterase levels of the patients (p=0.014), organophosphate levels demonstrated a significant reduction (p=0.012).Conclusion: Plasmapheresis is a useful method in removing the toxic substance and increasing the pseudocholinesterase level in patients with intermediate syndrome. Although its benefits are limited by delayed application, inadequate number of sessions, and accumulation of organophosphate in the fat tissue, there is a need for further studies including larger series and controls in order to compare plasmapheresis with other therapeutic approaches.Key Words: Intermediate syndrome, Organophosphate poisoning, Therapeutic plasma exchange