At least four controlled studies have proved the effectivness of chrysotherapy for the treatment of rheumatoid arthritis (14). The administration of gold can be followed by severe toxic side effects. The patient presented in this report developed two severe side effects of gold therapy: a) bone-marrow-induced thrombocytopenia (5-lo), and b) bilateral lower extremity neuropathy (1 1-14). In the course of his illness the patient also developed acute oliguric renal failure, which required peritoneal dialysis treatment.Upon review of the literature, no information was found on the peritoneal clearance of gold. Peritoneal clearance studies of gold were performed on this patient. This report is presented to reveal the large quantity of gold that was removed by peritoneal dialysis. Peritoneal dialysis offers a mode of gold removal if the usual chelating agents cannot be employed.
MATERIALS AND METHODSSerum, urine, and dialysate gold levels were determined by the atomic absorption spectrophotometry described by Lorber (15), using the methyl isobutyl ketone extraction technique described by Balazs (16).Peritoneal dialysis was performed using intermittent peritoneal puncture. Each course of dialysis employed 2-liter exchanges of commercial fluid with appropriate additions of potassium and heparin. The total time for each exchange was I hour with a 30-minute "dwell time" in the abdominal cavity. Ten-milliliter aliquots of dialysate were obtained from each exchange for gold determination. Serum gold levels were measured before and after each dialysis exchange. Control levels of gold from the dialysate showed no detectable level before the onset of dialysis.Peritoneal clearance was calculated with the formula previously described by Boen (1 7): c = V V / P where C = clearance in ml/minute V = concentration in outflow fluid P = blood concentration V = dialysate volume in ml/minute (volume passing through the three stages of dialysis-inflow, dwell, and outflow time)
CASE REPORTA 67-year-old male was admitted to University Hospital for acute renal failure complicating gold-induced throm-
937bocytopenia and severe bilateral lower extremity neuropathy. He had been considered well until 1.5 years before admission, when he developed the symptoms and signs of rheumatoid arthritis. Treatment with aspirin, indomethacin, and phenylbutazone did not relieve the symptoms. These medications were all discontinued. Nine weeks before admission the patient was started on gold sodium thiomalate (Myochrysinb). Progressively increasing weekly doses of 10 mg, 25 mg, and finally 50 mg were used. The weekly 50-mg dose was continued for 7 weeks. The patient received a total dose of 385 mg of gold. Four weeks before admission to University Hospital, the patient had developed petechiae on his lower extremities which he failed to report to his physician. He ignored the petechiae for 3 weeks until they involved the entire body. He was admitted to his local hospital with epistaxis, melena, hematuria, bilateral painful burning lower extremities, and a gen...
