Acute Intoxication with Diisopyramide: Clinical and Experimental Study by Hemoperfusion on Amberlite XAD 4 Resin

Abstract

Diisopyramide overdose induces an early and severe cardiogenic shock; hemoperfusion on resin (Amberlite XAD 4) is the most efficient treatment. In vitro, 92% of the drug is adsorbed in 240 min. In dog, the plasmatic epuration is 66% with a mean plasma clearance of 74% plasmatic flow. A woman who had absorbed 4.50 g diisopyramide showed an idioventricular rhythm. The cardiac electrical stimulation and positive inotrope drugs were inefficient. Hemoperfusion on resin Amberlite XAD 4 corrected hemodynamic and ECG disturbances in 4 h. The epuration was proved by the decrease of diisopyramide plasma level: 24.4 (Lig/mL before epuration, 1.9 jig/mL after epuration, and a mean plasma clearance of 107.8 mL/min (61% of the plasmatic flow). Hemoperfusion on resin (Amberlite XAD 4) is more efficient than hemodialysis (cuprophan) and hemofiltration (poly-acrylonitrile). The system that we have used is well tolerated and of low cost.