What enhanced elimination techniques are useful in critical toxicology patients?

February 16, 2013, 9:13 pm

★★★☆☆

Enhanced Poison Elimination in Critical Care. Ghannoum M, Gosselin S. Adv Chronic Kidney Dis 2013 Jan;20:94-101.

Abstract

This survey of methods available for enhanced elimination in toxicology cases gives a good overview, but unnecessarily wastes time discussing modalities that now are never used (e.g., forced diuresis and urine acidification). The information would have been more accessible if it had been streamlined to reflect current practice. For instance, the authors list 20 poisons “amenable” to multidose activated charcoal, but in fact the indications for this treatment are limited and can be remembered by using the mnemonic ABCDQ: aminophylline /theophylline, barbiturates (phenobarbital), carbamazepine, dapsone, and quinine.

The authors don’t delve into specific indications for these modalities, deferring to the EXtracorporeal Treatments In Poisoning (EXTRIP) workgroup which is expected to publish consensus guidelines in the near future. Actually, this project has become somewhat controversial, since some toxicologists and other clinicians do not believe there is enough evidence to make firm recommendations in many types of poisoning. My own feeling is that the lack of evidence makes the availability of consensus guidelines even more important, as long as the document clearly states that the suggestions are not mandates and in no way constitute a standard of care.

Related posts:

Superb review of hemodialysis and other enhanced elimination techniques

Management of poisonings from a nephrologist’s point of view

Another must-read article on hemodialysis and other enhanced-elimination techniques

Hemodialysis and other extracorporeal modalities in toxicology cases

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