Acute intoxication with diisopyramide: clinical and experimental study by hemoperfusion an 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 micrograms/mL before epuration, 1.9 micrograms/mL after epuration, and a mean plasma clearance of 107.8 mL/min (61% of the plasmatic flow). Hemoperfusion of resin (Amberlite XAD 4) is more efficient than hemodialysis (cuprophan) and hemofiltration (polyacrylonitrile). The system that we have used is well tolerated and of low cost.