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      Management of toxic ingestions with the use of renal replacement therapy

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          Abstract

          Although rare, renal replacement therapy (RRT) for the treatment of the metabolic, respiratory and hemodynamic complications of intoxications may be required. Understanding the natural clearance of the medications along with their volume of distribution, protein binding and molecular weight will help in understanding the benefit of commencing RRT. This information will aid in choosing the optimal forms of RRT in an urgent setting. Overdose of common pediatric medications are discussed with suggestions on the type of RRT within this educational review.

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          2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System.

          Frank Rodgers, T Litovitz, Cherith N Reid … (2005)
          Article 0 comments Cited 63 times – based on 0 reviews     Review now
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            Fomepizole for the treatment of ethylene glycol poisoning. Methylpyrazole for Toxic Alcohols Study Group.

            Robert J Donovan, K McMartin, K W Kulig … (1999)
            Ethylene glycol poisoning causes metabolic acidosis and renal failure and may cause death. The standard treatment is inhibition of alcohol dehydrogenase with ethanol, given in intoxicating doses, and adjunctive hemodialysis. We studied the efficacy of fomepizole, a new inhibitor of alcohol dehydrogenase, in the treatment of ethylene glycol poisoning. We administered intravenous fomepizole to 19 patients with ethylene glycol poisoning (plasma ethylene glycol concentration, > or =20 mg per deciliter [3.2 mmol per liter]). Patients who met specific criteria also underwent hemodialysis. Treatment was continued until plasma ethylene glycol concentrations were less than 20 mg per deciliter. Acid-base status, renal function, the kinetics of fomepizole, and ethylene glycol metabolism were assessed at predetermined intervals. Fifteen of the patients initially had acidosis (mean serum bicarbonate concentration, 12.9 mmol per liter). Acid-base status tended to normalize within hours after the initiation of treatment with fomepizole. One patient with extreme acidosis died. In nine patients, renal function decreased during therapy; at enrollment, all nine had high serum creatinine concentrations and markedly elevated plasma glycolate concentrations (> or =97.7 mg per deciliter [12.9 mmol per liter]). None of the 10 patients with normal serum creatinine concentrations at enrollment had renal injury during treatment; all 10 had plasma glycolate concentrations at or below 76.8 mg per deciliter (10.1 mmol per liter). Renal injury was independent of the initial plasma ethylene glycol concentration. The plasma concentration of glycolate and the urinary excretion of oxalate, the major metabolites of ethylene glycol, uniformly fell after the initiation of fomepizole therapy. Few adverse effects were attributable to fomepizole. In patients with ethylene glycol poisoning, fomepizole administered early in the course of intoxication prevents renal injury by inhibiting the formation of toxic metabolites.
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              Clinical manifestations and management of acute lithium intoxication.

              Mark Okusa, George J Crystal (1994)
              Acute lithium intoxication is a frequent complication of chronic lithium therapy for manic depressive disorders. Because of lithium's narrow therapeutic index and widespread use, lithium intoxication remains prevalent in 1994. This review summarizes information on the renal handling of lithium and the physiologic basis for toxicity. Recent reports that describe previously unrecognized side effects of lithium intoxication are discussed. We also present management guidelines based upon our understanding of the renal handling of lithium. In this review we compare the effectiveness of lithium removal by various dialysis methods, including bicarbonate dialysis, peritoneal dialysis and continuous arteriovenous hemofiltration. Hemodialysis remains the cornerstone for the treatment of acute lithium toxicity.
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                Author and article information

                Contributors
                : +1-616-822-8037 , pcrrt@aol.com
                Journal
                Journal ID (nlm-ta): Pediatr Nephrol
                Title: Pediatric Nephrology (Berlin, Germany)
                Publisher: Springer-Verlag (Berlin/Heidelberg )
                ISSN (Print): 0931-041X
                ISSN (Electronic): 1432-198X
                Publication date (Electronic): 12 October 2010
                Publication date PMC-release: 12 October 2010
                Publication date (Print): April 2011
                Volume: 26
                Issue: 4
                Pages: 535-541
                Affiliations
                [1 ]Pediatric Nephrology and Transplantation, Michigan State University, Grand Rapids, MI 49503 USA
                [2 ]Pediatric Nephrology, UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
                Article
                Publisher ID: 1654
                DOI: 10.1007/s00467-010-1654-3
                PMC ID: 3043241
                PubMed ID: 20938691
                SO-VID: 35b71bba-cf0d-4536-b43c-5e5ef47cdaae
                Copyright © © IPNA 2010
                History
                Date received : 29 June 2010
                Date revision received : 9 August 2010
                Date accepted : 27 August 2010
                Categories
                Subject: Educational Review
                Custom metadata
                issue-copyright-statement © IPNA 2011

                ScienceOpen disciplines: Nephrology
                Keywords: molecular adsorbents recirculating system (mars),overdose,intoxications,renal replacement therapy,single-pass albumin dialysis (spad),dialysis,pediatrics
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: molecular adsorbents recirculating system (mars), overdose, intoxications, renal replacement therapy, single-pass albumin dialysis (spad), dialysis, pediatrics

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