Dialysis and hemoperfusion for poisoning

  • S. Watkins

Abstract

Clinical toxicology is a rapidly growing and changing field in medicine today. Common substances, over the counter medications, prescription drugs and illicit drugs can all be responsible for poisonings and overdoses leading to clinical symptoms. Poisonings most commonly occur in children and the elderly, while intentional overdoses are becoming an increasing problem in adolescents. Thus, pediatric nephrologists are often confronted by a patient requiring medical intervention for poisonings and overdoses. When the American Academy of Pediatrics established an Accident Prevention committee in 1952 they found that 50% of all accidents involved poisoning and that 25% of these poisonings were caused by flavored children’s aspirin. Although the advent of safety closures for drug containers has reduced this number, poisonings remain a significant problem. The work of George Schreiner at Georgetown University led to the use of dialysis and other extracorporeal modalities as therapeutic regimens available to the practitioner for the treatment of poisoning and overdose.

Keywords

Peritoneal Dialysis Continuous Renal Replacement Therapy Blood Flow Rate Active Removal Poison Control Center 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Shannon M, Haddad LM. The Emergency Management of Poisoning, and Winchester JE Active methods for detoxification. In: Haddad LM, Shannon MW, Winchester JF, editors. Clinical Management of Poisoning and Drug Overdose, 3rd edn. Philadelphia: WB. Saunders, 1998: pp. 2–31 (Chapter 1), pp. 175-88 (Chapter 10).Google Scholar
  2. 2.
    Katona BG, Siegel EG, Cluxton RJ Jr. The new black magic: activated charcoal and new therapeutic uses. J Emerg Med. 1987;5(1):9–18.PubMedCrossRefGoogle Scholar
  3. 3.
    Garrettson LK, Geller RJ. Acid and alkaline diuresis. When are they of value in the treatment of poisoning? Drug Saf. 1990;5(3):220–32.PubMedCrossRefGoogle Scholar
  4. 4.
    Herrington AM, Clifton GD. Toxicology and management of acute drug ingestions in adults. Pharmacotherapy. 1995;15(2):182–200.PubMedGoogle Scholar
  5. 5.
    Litovitz TL, Felberg L, White S, Klein-Schwartz W. 1995 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 1996;14(5):487–537.PubMedCrossRefGoogle Scholar
  6. 6.
    Peterson RG, Peterson LN. Cleansing the blood. Hemodialysis, peritoneal dialysis, exchange transfusion, charcoal hemoperfusion, forced diuresis. Pediatr Clin N Am. 1986;33(3):675–89.Google Scholar
  7. 7.
    Pond SM. Diuresis, dialysis, and hemoperfusion. Indications and benefits. Emerg Med Clin N Am. 1984;2(l):29–45.Google Scholar
  8. 8.
    Aronoff G, Berns J, Brier M et al. Drug Prescribing in Renal Failure. 4th edn. Dosing Guidelines for Adults. Pennsylvania: American College of Physicians-American Society of Internal Medicine, 1999.Google Scholar
  9. 9.
    Gibson T, Atkinson A, Loo J, Rowland M. Effect of changes in intercompartment rate constants on drug removal during hemoperfusion. J Pharm Sci. 1978;67:1178–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Hirsch DJ, Jindal KK, Wong P, Fraser AD. A simple method to estimate the required dialysis time for cases of alcohol poisoning. Kidney Int. 2001;60(5):202–4.CrossRefGoogle Scholar
  11. 11.
    Gonda A, Gault H, Churchill D, Hollomby D. Hemodialysis for methanol intoxication. Am J Med. 1978;64(5):749–58.PubMedCrossRefGoogle Scholar
  12. 12.
    Jacobsen D, Jansen H, Wiik-Larsen E, Bredesen JE, Halvorsen S. Studies on methanol poisoning. Acta Med Scand. 1982;212(l-2):5–10.PubMedGoogle Scholar
  13. 13.
    Pappas SC, Silverman M. Treatment of methanol poisoning with ethanol and hemodialysis. Can Med Assoc J. 1982;126(12):1391–4.PubMedGoogle Scholar
  14. 14.
    Garella S, Jonathan L. Hemodialysis and hemoperfusion for poisoning. In: William H, editor. Principles and Practice of Dialysis. Dallas, TX: Williams and Wilkins, 1994;pp. 375–92.Google Scholar
  15. 15.
    Temple A. Acute and chronic effects of aspirin toxicity and their treatment. Arch Intern Med. 1981;141:364–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Okusa MD, Crystal LJ. Clinical manifestations and management of acute lithium intoxication. Am J Med. 1994;97(4):383–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Blye E, Lorch J, Cortell S. Extracorporeal therapy in the treatment of intoxication. Am J Kidney Dis. 1984;3(5):321–38.PubMedGoogle Scholar
  18. 18.
    Leblanc M, Raymond M, Bonnardeaux A, Isenring P, Pichette V, Geadah D, Quimet D, Ethier J, Cardinal J. Lithium poisoning treated by high-performance continuous arteriovenous and venovenous hemodiafiltration. Am J Kidney Dis. 1996;27(3):365–72.PubMedCrossRefGoogle Scholar
  19. 19.
    van Bommel EF, Kalmeijer MD, Ponssen HH. Treatment of life-threatening lithium toxicity with high-volume continuous venovenous hemofiltration. Am J Nephrol. 2000;20(5):408–11.PubMedCrossRefGoogle Scholar
  20. 20.
    Riegel W. Use of continuous renal replacement therapy for detoxification? Int J Artif Organs. 1996;19(2):111–12.PubMedGoogle Scholar
  21. 21.
    Chang TMS. Coated charcoal haemoperfusion. Life Support Syst. 1984;2:99–106.PubMedGoogle Scholar
  22. 22.
    De Broe ME, Bismuth C, De Groot G, Heath A, Okonek S, Ritz DR, Verpooten GA, Volans GN, Widdop B. Haemoperfusion: a useful therapy for a severely poisoned patient? Hum Toxicol. 1986;5(1):11–14.PubMedCrossRefGoogle Scholar
  23. 23.
    Ahlmen J, Heath A, Herlitz H, Kvist L, Meilstrand T. Treatment of oral theophylline poisoning. Acta Med Scand. 1984;216(4):423–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Hendeles L, Weinberger M. Theophylline. A “state of the art” review. Pharmacotherapy. 1983;3(1):2–44.PubMedGoogle Scholar
  25. 25.
    Volans G, Vale J, Crome P. The role of charcoal hemoperfusion in the management of acute poisoning by drugs. In: Kenedi RM, Courteny J, Gaylor JDS et al, editors. Artif Organs. Baltimore: University Park Press, 1976;pp. 178–87.Google Scholar
  26. 26.
    Hampel G, Widdop B. Experience with hemoperfusion in the treatment of acute drug intoxication. Proc Eur Soc Artif Organs. 1978;5:202–5.Google Scholar
  27. 27.
    Lund ME, Banner W Jr, Clarkson TW, Berlin M. Treatment of acute methylmercury ingestion by hemodialysis with N-acetylcysteine (Mucomyst) infusion and 2,3-dimercaptopropane sulfonate. J Toxicol Clin Toxicol. 1984;22(l):31–49.PubMedCrossRefGoogle Scholar
  28. 28.
    Helliwell M, Vale A, Goulding R. Haemoperfusion in “late” paracetamol poisoning. Hum Toxicol. 1981;1(1):25–30.PubMedCrossRefGoogle Scholar
  29. 29.
    Heath A, Ahlmen J, Mellstrand T, Wickstrom I. Resin hemoperfusion in chloroquine poisoning. J Toxicol Clin Toxicol. 1982;19(10):1067–71.PubMedCrossRefGoogle Scholar
  30. 30.
    Marcus L, Margel S, Savin H, Offarim M, Ravid M. Therapy of digoxin intoxication in dogs by specific hemoperfusion through agarose poly acrolein microsphere beads-antidigoxin antibodies. Am Heart J. 1985;110(1 Pt 1):30–9.PubMedCrossRefGoogle Scholar
  31. 31.
    de Groot G, van Heijst AN, van Kesteren RG, Maes RA. An evaluation of the efficacy of charcoal haemoperfusion in the treatment of three cases of acute thallium poisoning. Arch Toxicol. 1985;57(1):61–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Monhart V, Fusek J, Brndiar M, Tlustakova M. Use of hemoperfusion in experimental intoxication with nerve agents. Artif Organs. 1994;18(10):770–2.PubMedCrossRefGoogle Scholar
  33. 33.
    Palmer BF. Effectiveness of hemodialysis in the extracorporeal therapy of phenobarbital overdose. Am J Kidney Dis. 2000;36(3):640–3.PubMedCrossRefGoogle Scholar
  34. 34.
    Splendiani G, Zazzaro D, Di Pietrantonio P, Delfino L. Continuous renal replacement therapy and charcoal plasmaperfusion in treatment of amanita mushroom poisoning. Artif Organs. 2000;24(4):305–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Vesconi S, Langer M, Iapichino G, Costantino D, Busi C, Fiume L. Therapy of cytotoxic mushroom intoxication. Crit Care Med. 1985;13(5):402–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Goldberg MJ, Spector R, Park GD, Roberts RJ. An approach to the management of the poisoned patient. Arch Intern Med. 1986;146(7):1381–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2004

Authors and Affiliations

  • S. Watkins

There are no affiliations available

Personalised recommendations