CRRT and Extracorporeal Techniques in Exogenous Intoxications

Abstract

Exogenous intoxications in the form of intentional and unintentional poisonings can lead to a high degree of morbidity and potential mortality. In the United States, around 2 million human exposures were reported to poison control centers in 2016 alone. While accidental poisoning may occur and include household cleaning products and cosmetics among others, medications such as analgesics, antidepressant, and other psychiatric medications are among the most frequently purposefully ingested substances.

Strategies to treat exogenous intoxications involve symptomatic care and support, metabolite level monitoring (when available), detoxification strategies including antidote administration, activated charcoal administration, fluid administration and urinary pH modification and in severe cases, the use of extracorporeal techniques to enhance clearance of the specific intoxicant.

The mainstays of extracorporeal approaches include intermittent hemodialysis and continuous renal replacement therapies. The majority of poisonings/intoxications, if treatable with extracorporeal approaches, can be accomplished using these more common techniques. The overall success with specific therapies is dependent on the extracorporeal approach used and the physical and distributive properties of the intoxicant.

In this chapter, we review and describe some of the extracorporeal approaches to treat intoxications. We also provide some specific evidence-based approaches as outlined by the Extracorporeal Treatment in Poisoning workgroup.