Principles and operational parameters to optimize poison removal with extracorporeal treatments.
A role for nephrologists in the management of a poisoned patient involves evaluating the indications for, and methods of, enhancing the elimination of a poison. Nephrologists are familiar with the various extracorporeal treatments (ECTRs) used in the management of impaired kidney function, and their respective advantages and disadvantages. However, these same skills and knowledge may not always be considered, or applicable, when prescribing ECTR for the treatment of a poisoned patient. Maximizing solute elimination is a key aim of such treatments, perhaps more so than in the treatment of uremia, because ECTR has the potential to reverse clinical toxicity and shorten the duration of poisoning. This manuscript reviews the various principles that govern poison elimination by ECTR (diffusion, convection, adsorption, and centrifugation) and how components of the ECTR can be adjusted to maximize clearance. Data supporting these recommendations will be presented, whenever available.
Division of Nephrology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada.
Josée
J
Bouchard
Darren M
DM
Roberts
Louise
L
Roy
Georges
G
Ouellet
Brian S
BS
Decker
Bruce A
BA
Mueller
Simon
S
Desmeules
Marc
M
Ghannoum
D006801:Humans; D009398:Nephrology / Q000379:methods*; D011041:Poisoning / Q000628:therapy*; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis / Q000592:standards*