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      Call for Papers: Green Renal Replacement Therapy: Caring for the Environment

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      About Blood Purification: 3.0 Impact Factor I 5.6 CiteScore I 0.83 Scimago Journal & Country Rank (SJR)

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      Continuous Renal Replacement Therapy Does Not Have a Clear Role in the Treatment of Poisoning

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          Abstract

          Extracorporeal removal of drugs and other poisons is occasionally indicated in the management of intoxications. The available modalities include hemodialysis and several methods of continuous renal replacement therapy (CRRT), including continuous venovenous hemofiltration with or without dialysis augmenting drug removal. A growing literature promoting CRRT for extracorporeal removal has been published and is reviewed here. Estimates of clearance achieved by these techniques uniformly demonstrate that hemodialysis achieves higher clearances. CRRT may be appropriate for more hypotensive and unstable patients, though these might be the patients most in need of a more rapidly effective technique. For the most part, these case reports have not demonstrated that CRRT was necessary because of hemodynamic instability. Hemodialysis remains the first choice among modalities of extracorporeal removal with CRRT reserved for patients who truly cannot tolerate hemodialysis.

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          Toxic alcohol ingestions: clinical features, diagnosis, and management.

          Ira Kurtz, Jeffrey A. Kraut (2007)
          Alcohol-related intoxications, including methanol, ethylene glycol, diethylene glycol, and propylene glycol, and alcoholic ketoacidosis can present with a high anion gap metabolic acidosis and increased serum osmolal gap, whereas isopropanol intoxication presents with hyperosmolality alone. The effects of these substances, except for isopropanol and possibly alcoholic ketoacidosis, are due to their metabolites, which can cause metabolic acidosis and cellular dysfunction. Accumulation of the alcohols in the blood can cause an increment in the osmolality, and accumulation of their metabolites can cause an increase in the anion gap and a decrease in serum bicarbonate concentration. The presence of both laboratory abnormalities concurrently is an important diagnostic clue, although either can be absent, depending on the time after exposure when blood is sampled. In addition to metabolic acidosis, acute renal failure and neurologic disease can occur in some of the intoxications. Dialysis to remove the unmetabolized alcohol and possibly the organic acid anion can be helpful in treatment of several of the alcohol-related intoxications. Administration of fomepizole or ethanol to inhibit alcohol dehydrogenase, a critical enzyme in metabolism of the alcohols, is beneficial in treatment of ethylene glycol and methanol intoxication and possibly diethylene glycol and propylene glycol intoxication. Given the potentially high morbidity and mortality of these intoxications, it is important for the clinician to have a high degree of suspicion for these disorders in cases of high anion gap metabolic acidosis, acute renal failure, or unexplained neurologic disease so that treatment can be initiated early.
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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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              Use of hemodialysis and hemoperfusion in poisoned patients.

              Andrew R. Hoffman, William Holubek, Kimberly J. Nelson … (2008)
              Extracorporeal removal techniques such as hemodialysis, charcoal hemoperfusion, and peritoneal dialysis have been used to remove toxins from the body. To define trends in the use of these techniques for toxin removal, we analyzed the 19,351 cases requiring extracorporeal removal reported to U.S. poison centers from 1985-2005. The number of such patients who received hemodialysis, excluding those with other medical indications, (normalized per million calls) increased from 231 to 707 whereas hemoperfusion decreased from 53 to 12 in the years 1985-2005. Peritoneal dialysis decreased from 2.2 in 1985 to 1.6 in 1991. The most common toxins removed by hemodialysis were lithium and ethylene glycol. There were more dialysis treatments for poisonings with valproate and acetaminophen in 2001-2005 than for methanol and theophylline, although hemodialysis for acetaminophen removal is generally not recommended. Theophylline was the most common toxin removed by hemoperfusion from 1985-2000, but carbamazepine became the most frequent toxin for removal during 2001-2005. Our study shows that the profile of toxins and the type of extracorporeal technique used to remove the toxins have changed over the years.
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                Author and article information

                Journal
                Journal ID (publisher-id): NEC
                Journal ID (nlm-ta): Nephron Clin Pract
                Journal ID (doi): 10.1159/issn.1660-2110
                Title: Nephron Clinical Practice
                Publisher: S. Karger AG
                ISSN (Electronic): 1660-2110
                Publication date Subscription-year: 2010
                Publication date (Print): April 2010
                Publication date (Electronic): 19 February 2010
                Volume: 115
                Issue: 1
                Pages: c1-c6
                Affiliations
                aDivision of Nephrology, Nassau University Medical Center, East Meadow, N.Y., and bDivision of Nephrology, NYU School of Medicine and cNephrology Section, NY Harbor VA Medical Center, New York, N.Y., USA
                Article
                Publisher ID: 286343 Other ID: Nephron Clin Pract 2010;115:c1–c6
                DOI: 10.1159/000286343
                PubMed ID: 20173343
                SO-VID: 3e760dfe-72e8-4ecd-8b95-da8bacb71b8b
                Copyright © © 2010 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Page count
                Tables: 2, References: 25, Pages: 1
                Categories
                Subject: Minireview

                ScienceOpen disciplines: Cardiovascular Medicine,Nephrology
                Keywords: Continuous venovenous hemofiltration,Intoxication management,Continuous renal replacement therapy,Extracorporeal removal,Xenobiotics
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine, Nephrology
                Keywords: Continuous venovenous hemofiltration, Intoxication management, Continuous renal replacement therapy, Extracorporeal removal, Xenobiotics

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