Extracorporeal Therapy of Patients with Drug Toxicity

Extracorporeal Therapy of Patients with Drug Toxicity 

Intensive supportive therapy is all that is required for most patients suffering from dose-related drug toxicity/ and drug removal by extracorporeal methods generally is indicated only for those patients whose condition deteriorates despite institution of these more conservative measures (49). However/ a decision to intervene with extracorporeal therapy may be prompted by other clinical and pharmacologic considerations that are listed in Table 6.6. For example/ most intoxications with phenobarbital can be managed by a combination of supportive care and minimization 

TABLE 6.6 Considerations for Extracorporeal Treatment of Drug Intoxications 

Although hemodialysis is effective in removing phenobarbital/ methanol/ and other low molecular weight compounds that have a relatively small distribution volume and are not extensively 

Complications of hemoperfusion include platelet and leukocyte depletion, hypocalcemia, and a mild reduction in body temperature (50). In many cases, these complications are outweighed by the fact that intoxicants are removed more rapidly by hemoperfusion than by hemodialysis. However, an additional consideration is that hemoperfusion clearance tends to decline during therapy as column efficiency declines, presumably reflecting saturation of adsorbent sites (53). In addition, intercompartmen-tal clearance from skeletal muscle and other slowly equilibrating tissues can limit the extent of drug removal by hemoperfusion and result in a rebound of blood levels and possible toxicity at the conclusion of this procedure (54). In some instances, alternative therapies have been developed that are even more efficient than hemoperfusion. For example. 

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