Poisoning peritoneal dialysis

For patients who have ingested more than 30 ml of (pure) methanol or ethylene glycol, dialysis is recommended, and haemodialysis is more effective than peritoneal dialysis. Dialysis both removes the alcohols and their metabolites, and corrects the renal and metabolic disturbances and so is the preferred treatment in severe poisoning. The maintenance dose of ethanol required may be tripled during haemodialysis as ethanol is also removed. Early treatment is indicated if ethylene glycol concentrations are above 20 mg/100 ml (200 mg/1), if the arterial pH is below 7.3, if serum bicarbonate concentrations are less than 20 mM/1, and when there are oxalate crystals in the urine. 

The supportive treatment of aspirin poisoning may include gastric lavage (to prevent the further absorption of salicylate), fluid replenishment (to offset the dehydration and oliguria), alcohol and water sponging (to combat the hyperthermia), the administration of vitamin K (to prevent possible hemorrhage), sodium bicarbonate administration (to combat acidosis) and, in extreme cases, peritoneal dialysis and exchange transfusion. 

Acute poisoning is treated with gastric aspiration and lavage combined with intensive supportive therapy, including thorough assessment of the patient plus measures to prevent respiratory failure. In cases of very severe poisoning, peritoneal dialysis or hemodialysis may be necessary. 

Hemodialysis is more efficient than peritoneal dialysis and has been well studied. It assists in correction of fluid and electrolyte imbalance and may also enhance removal of toxic metabolites (eg, formate in methanol poisoning, oxalate and glycolate in ethylene glycol poisoning). The efficiency of both peritoneal dialysis and hemodialysis is a function of the molecular weight, water solubility, protein binding, endogenous clearance, and distribution in the body of the specific toxin. 

Phenobarbitone Sodium Phenobarbitone sodium decomposes in aqueous solutions. Barbiturate poisoning may be treated with stomach wash and administration of activated charcoal. Monitoring respiratory, cardiovascular, and renal functions, hemodialysis, charcoal administration, forced diuresis, symptomatic and supportive therapy, and peritoneal dialysis may be performed. 

Kaufman DB, DiNicola W, McIntosh R. 1970. Acute potassium dichromate poisoning Treated by peritoneal dialysis. Am J Dis Child 119 374-376. 

Hemodialysis (383,552,553), sometimes with additional continuous venovenous hemofiltration dialysis (554,555), continues to be described as a successful intervention for lithium poisoning. Peritoneal dialysis is a far less efficient way to clear lithium from the body. One patient treated in this way had permanent neurological abnormalities and another died a third toxic patient who also had diabetic ketoacidosis died after treatment with hydration and insulin (556). On the other hand, a 51-year-old woman who took 50 slow-release lithium carbonate tablets (450 mg) had a serum lithium concentration of 10.6 mmol/1 13 hours later, but no evidence of neurotoxicity or nephrotoxicity. She was treated conservatively with intravenous fluids and recovered fully (557). Acute lithium overdose is often better tolerated than chronic intoxication. 

Peritoneal dialysis involves instilling appropriate fluid into the peritoneal cavity. Poison in the blood diffuses into the dialysis fluid down the concentration gradient. The fluid is then drained and replaced. The technique requires little equipment but is one-half to one-third as effective as haemodialysis it may be worth using for lithium and methanol poisoning. 

Baliah T, MacLeish H, Drummond KN. Acute boric acid poisoning report of an infant successfully treated by peritoneal dialysis. Can Med Assoc J 1969 101(3) 166-8. 

Lead poisoning in a six-week-old child was treated by adding disodium calcitetracemate to the peritoneal dialysis fluid (2). 

Severe poisoning in a hypoalbuminemic neonate responded unusually to peritoneal dialysis, possibly because of reduced phenytoin binding to plasma proteins (SEDA-16, 73). 

Since the first peritoneal dialysis for chlorate poisoning and the earliest hemodialysis for barbiturate intoxication in the early 1950 s [2, 3], the indications for dialysis in intoxication have expanded. With the development of high-flux [4] and high-efficiency mem-... 

Linquette,Goudemande,Warot,etal. Acute poisoning by sodium chlorate anuria exchange transfusions and peritoneal dialysis. Echo Med Nord. 1950 21 269-276. 

Vale JA, Prior JG, O Hare JP, et al. Treatment of ethylene glycol poisoning with peritoneal dialysis. Br Med J (Clin Res Ed). 1982 284 557... 

KobayashI T, UnIshI G, MatsuzakI S, et al. A survival case of acute chromic acid poisoning treated by peritoneal dialysis. Nippon Jinzo Gakkai Shi. 1984 26 1259-1261... 

Acute poisoning with metformin calls for intensive supportive therapy. Lactacidosis may require treatment with sodium bicarbonate or furosemide, a combination of insulin and glucose or peritoneal dialysis or haemodialysis (Lalau et al., 1989). 

It is controversial as to whether hemoperfusion, hemodialysis, peritoneal dialysis, or forced diuresis is most effective and as to whether any treatment measures are effective in massive thallium poisonings [20,21]. The combination of forced diuresis, hemoperfusion, and hemodialysis can remove up to 40% of absorbed thallium. Aggressive treatment is recommended based on a patient s... 

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