Hemoperfusion paraquat

Pond, S.M., S.C. Johnston, D.D. Schoof, E.C. Hampson, M. Bowles, D.M. Wright, and JJ. Petrie. 1987. Repeated hemoperfusion and continuous arteriovenous hemofiltration in a paraquat poisoned patient. Clin. Toxicol. 25 305-316. 

Hemoperfusion is like hemodialysis except that blood is circulated extracorporeally through a column with adsorbent material like resin or charcoal, which binds molecules electrostatically. The molecules likely to be removed are characterized as poorly dialyzable, lipid-soluble, protein bound. Among the indications for hemoperfusion in the management of poisoning include the presence of a poison in a patient with impairment of excretory system (i.e. damaged kidneys), intoxication of a drug known to produce delayed toxicity or metabolized to a more toxic metabolite (i.e. paraquat or methotrexate), deterioration of the clinical state of the poisoned patient despite conservative therapy (i.e. convulsions or cardiac arrhythmias following theophylline intoxication), or development of coma as a complication. 

Whilst hemodialysis does remove paraquat, it is far less efficient than charcoal hemoperfusion, which... 

The policy at our institution is to start hemoperfusion and administer Fuller s earth as soon as the patient arrives in the hospital and not to wait for the results of paraquat blood levels. This practice followed from the knowledge that prognosis is related to the plasma paraquat level and the duration of such levels [40]. 

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