Hemoperfusion agents

Extracorporeal blood purification therapies do not efficiently remove heavy metals or their salts. Chelating agents can be combined with dialysis modalities and hemoperfusion to improve the clearance of aluminum, iron, and other metals. 

Quinine The antimalarial agent quinine is derived from the bark of the cinchona tree along with several other alkaloids and salicylate (aspirin). Many of these agents produce similar toxic features (cinchon-ism) in patients with excessive intake, but only quinine produces blindness. Cinchonism consists of abdominal pain and vomiting, ringing in the ears (tinnitus), and confusion. Visual loss after quinine overdose is due to direct retinal toxicity, although until recently it was believed to be due to spasm of the arterial blood supply to the retina. Treatment is difficult, but limited evidence suggests charcoal hemoperfusion may be beneficial (hemoperfusion is similar to hemodialysis, except in place of a semi-permeable membrane to filter the toxin from the blood, charcoal is used to bind the toxin). 

D. Enhanced elimination. Hemodialysis, hemoperfusion, peritoneal dialysis, and repeat-dose charcoal are not effective in removing anticholinergic agents. 

D. Enhanced elimination. Dialysis and hemoperfusion are not generally indicated because of the large volume of distribution of organophosphates and the effectiveness of the specific therapy described above. Repeat-dose activated charcoal (see p 57) is theoretically applicable to aldicarb poisoning, because the agent undergoes significant enterohepatic recirculation. 

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