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Abstract: FR-PO240

Use of Molecular Adsorbent Recirculating System for the Management of Acute Poisoning Without Liver Failure

Session Information

  • Pharmacology
    November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

  • 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical

Authors

  • Serrano-Santiago, Victor E., Methodist Dallas Medical Center, Dallas, Texas, United States
  • Zhao, Yi, Methodist Dallas Medical Center, Dallas, Texas, United States
  • Collazo-Maldonado, Roberto L., Methodist Dallas Medical Center, Dallas, Texas, United States
Introduction

Molecular Adsorbent Recirculating System (MARS) is an extracorporeal liver assist device that removes endogenous substances based on the principle of albumin-based dialysis. In addition to its uses in liver failure patients, MARS can be used to remove albumin-bound toxins. We present a case of vasoplegic shock and coma caused by multiple medications that was treated successfully with MARS.

Case Description

A 30 y/o woman with significant psychiatric history was admitted for a suicide attempt by intentional overdose. Empty bottles of the following albumin-bound medications were found on the scene: guanfacine, hydroxyzine, lamotrigine, propranolol, sertraline, and ziprasidone. On presentation, she was hypotensive and had bradycardia, bradypnea, and a GCS of 7. The patient was intubated emergently and received activated charcoal, glucagon (2mg), and CaCl2 (2g). Her blood pressure was supported with norepinephrine infusion and aggressive volume expansion. Poison control recommended seizure precautions and serial electrocardiograms (EKG). Neurological examination without sedation showed a comatose female, pupils dilated and reactive, no motor response to noxious stimulation in all four limbs, weak cough, and no gag reflex. Labs on presentation revealed normal kidney function, acid-base balance, electrolyte levels, and liver function tests. An EKG showed sinus bradycardia (QTc = 432ms) and an electroencephalogram showed moderately severe generalized cerebral dysfunction. Nephrology was consulted, and it was determined that all the ingested medications, except for lamotrigine and hydroxyzine, are highly protein-bound and not dialyzable. MARS therapy was performed for life-threatening vasoplegic shock caused by multiple toxic ingestions. Three hours later, her neurological status and blood pressure improved, and norepinephrine was discontinued. She completed 12 hours of MARS therapy with no complications. The next day, she was successfully extubated, her mental status returned to baseline, and she was hemodynamically stable. The patient was discharged to an inpatient psychiatric unit on hospital day four.

Discussion

This case demonstrated MARS is a feasible treatment for patients without liver failure, and that it can be a promising therapy option for those with acute poisoning from protein-bound drugs.