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INTRODUCTION

Enhancing the elimination of a xenobiotic from a poisoned patient is a logical step after initial stabilization of the airway, breathing, and circulation; supportive measures; and techniques to inhibit absorption. Table 6–1 lists methods that might be used to enhance elimination. In this chapter, hemodialysis, hemoperfusion, and hemofiltration are considered extracorporeal treatments (ECTRs) because xenobiotic removal occurs in a blood circuit outside the body. Extracorporeal treatments are used infrequently because most poisonings are not amenable to removal by these methods. In addition, because these elimination techniques have associated adverse effects, costs, and complications, the risk-to-benefit analysis suggests they are only indicated in a relatively small proportion of patients and situations.

TABLE 6–1Potential Methods of Enhancing Elimination of Xenobiotics

EPIDEMIOLOGY

Although undoubtedly an underestimate of true use, enhanced elimination techniques were performed relatively infrequently in the cohorts of millions of patients reported by the American Association of Poison Control Centers (AAPCC) National Poison Data System (NPDS) (Chap. 130). Alkalinization of the urine was reportedly used 11,651 times, multiple-dose activated charcoal (MDAC) 1,104 times, hemodialysis 2,663 times, and hemoperfusion 49 times. As in the past, there continue to be many instances of inappropriate use of ECTRs, such as in the treatment of overdoses of cyclic antidepressants (CAs).35

The AAPCC data reveal that there is a continued increase in the reported use of hemodialysis, paralleling a decline in reports of charcoal hemoperfusion (Chap. 130) (Table 6–2). Lithium and ethylene glycol were the most common xenobiotics for which hemodialysis was used between 1985 and 2014 (Fig. 6–1).18 Possible reasons for the decline in use of charcoal and resin hemoperfusion are described in the section on hemoperfusion in this chapter. Peritoneal dialysis (PD), a slower modality that should have little or no role in any poisoning, is no longer reported separately. “Other extracorporeal procedures” in past AAPCC reports include continuous modalities (discussed later in the section Continuous Hemofiltration and Hemodiafiltration), plasmapheresis, and PD.

TABLE 6–2Changes in AAPCC Annual Reported Use of Extracorporeal Therapiesa

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