Poisoning dialysis

Wills, M.R. and Savory, J. (1983). Aluminium poisoning dialysis encephalopathy, osteo-malasia, and anaemia. Lancet, 29. 

In most situations, adequate, usuaHy forced, ventilation is necessary to prevent excessive exposure. Persons who drink alcohol excessively or have Hver, kidney, or heart diseases should be excluded from any exposure to carbon tetrachloride. AH individuals regularly exposed to carbon tetrachloride should receive periodic examinations by a physician acquainted with the occupational hazard involved. These examinations should include special attention to the kidneys and the Hver. There is no known specific antidote for carbon tetrachloride poisoning. Treatment is symptomatic and supportive. Alcohol, oHs, fats, and epinephrine should not be given to any person who has been exposed to carbon tetrachloride. FoHowing exposure, the individual should be kept under observation long enough to permit the physician to determine whether Hver or kidney injury has occurred. Artificial dialysis may be necessary in cases of severe renal faHure. 

Antiflatulents are used for die relief of painful symptoms of excess gas in the digestive tract. These drugs are useful as adjunctive treatment of any condition in which gas retention may be a problem (ie, postoperative gaseous distention, air swallowing, dyspepsia, peptic ulcer, irritable colon, or diverticulosis). In addition to its use for tiie relief of intestinal gas, charcoal may be used in the prevention of nonspecific pruritus associated with kidney dialysis treatment and as an antidote in poisoning. Simethicone is in some antacid products, such as Mylanta liquid and Di-Gel liquid. 

Reversibility. It is known that the effect of eserine on cholinesterase can be completely reversed by prolonged dialysis against water. On the other hand, it proved impossible to obtain any reversal of the poisoning by the phosphorofluoridate esters (see table below). The enzyme solution (5 ml.) was treated with the inhibitor for 15 min. at 38° 1 ml. was used at once for activity estimation, and the remainder dialysed against running water for 24 hr. in the case of the eserine experiment, 36 hr. in the others. It was clear that the combination between the phosphorofluoridate esters and the enzyme is much firmer than that between eserine and the enzyme. 

Effect of dialysis against water on activity of cholinesterase poisoned with eserine and phosphorofluoridate... 

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. 

Diazinon is rapidly metabolized, with an estimated mammalian biological half-life of 12-15 hours (Iverson et al. 1975 Mucke et al. 1970). Consequently, efforts at reducing body burdens of poisoned persons may not be critical to the outcome. Dialysis and hemoperfusion are not indicated in organophosphate poisonings because of the extensive tissue distribution of the absorbed doses (Mucke et al. 1970 Poklis et al. 1980). 

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. 

There are three specific modalities of treatment for severe methanol poisoning suppression of metabolism by alcohol dehydrogenase to toxic products, dialysis to enhance removal of methanol and its toxic products, and alkalinization to counteract metabolic acidosis. 

Charcoal does not bind iron, lithium, or potassium, and it binds alcohols and cyanide only poorly. It does not appear to be useful in poisoning due to corrosive mineral acids and alkali. Recent studies suggest that oral activated charcoal given alone may be just as effective as gut emptying followed by charcoal. Also, other studies have shown that repeated doses of oral activated charcoal may enhance systemic elimination of some drugs (including carbamazepine, dapsone, and theophylline) by a mechanism referred to as "gut dialysis."... 

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. 

Kolf s early devices were used for patients who had suffered acute kidney failure as a result of trauma or poisoning and needed dialysis only a few times. Such emergency treatment was the main application of hemodialysis until the early 1960s, because patients suffering from chronic kidney disease require dialysis two to three times per week for several years, which was not practical with these early devices. However, application of hemodialysis to this class of patient was made possible by improvements in the dialyzer design in the 1960s. The development of a plastic shunt that could be permanently fitted to the patient to allow easy access to their blood supply was also important. This shunt, developed by Scribner et al. [6], allowed dialysis without the need for surgery to connect the patient s blood vessels to the dialysis machine for each treatment. 

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. 

Hemodialysis The process by which a drug is removed from the blood of a poisoned patient by allowing it to diffuse across a semipermeable membrane while the blood is pumped through a dialysis machine. 

Iserson KV, Banner W, Froede RC, et al. 1983. Failure of dialysis therapy in potassium dichromate poisoning. J Emerg Med 1 143-149. 

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

Activated carbon is commonly administered as an antidote to reduce poisoning by the adsorption mechanism. In addition, because drug adsorbs on activated carbon, a concentration gradient between the tissue and gastrointestinal fluids exists, and thus unwanted toxic substances diffuse out of the tissues (i.e., gastrointestinal dialysis). Ionic adsorbates adsorb much less to activated carbon due to the presence of electrostatic repulsion and polarity than their neutral counterpart molecules do. 

Cyanobacterial toxins produced and released by cyanobacteria in freshwater around the world are well documented [158,159]. Microcystins are the most common of the cyanobacterial toxins found in water, as well as being the ones most often responsible for poisoning animals and humans who come into contact with toxic blooms and contaminated water [ 160]. Acute exposure results in hepatic injury, which can in extreme cases prove fatal. One such incident occurred that resulted in the death of over 50 dialysis patients due to the use of microcystin-contaminated water in the treatment [161]. Chronic exposure due to the presence of microcystin in drinking water is thought to be a contributing factor in primary fiver cancer (PLC) through the known tumour-promoting activities of these compounds [162],... 

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. 

Bailey B, McGuigan M. Comparison of patients hemodia-lyzed for hthium poisoning and those for whom dialysis was recommended by PCC but not done what lesson can we learn Clin Nephrol 2000 54(5) 388-92. 

A method for the isolation of toxic anions by dialysis, and procedures for identification and quantification are given under Metals and Anions In non-fatal poisoning cases/the sample of food, vomit, etc. may be very limited. If this is the case, the sequential method described under Examination of Food and Drink, below, should be used. 

Clinical signs of microcystin or nodularin intoxication in mammals are diarrhea, vomiting, piloerection, weakness, and pallor (EUeman et al, 1978 Falconer et al, 1981). Acute episodes of gastroenteritis due to oral contamination by microcystins have been observed in Australia and Brazil (Rao et al, 2002). Moreover, in one case, 76 human deaths were recorded in Brazil after dialysis patients had been exposed to water contaminated by microcystins and cyUn-drospermopsin (Azevedo et al, 2002 Carmichael et al, 2001 Jochimsen et al, 1998). We are not aware of any case of human poisoning attributable to nodularins. 

Adsorbents are used in medicine mainly for the treatment of acute poisoning, whereas other extracorporeal techniques based on physico-chemical principles, such as dialysis and ultrafiltration, currently have much wider clinical applications [1]. Nevertheless, there are medical conditions, such as acute inflammation, hepatic and multi-organ failure and sepsis, for which mortality rates have not improved in the last forty years. These conditions are usually associated with the presence of endotoxin - lipopolysaccharide (LPS) or inflammatory cytokines - molecules of peptide/protein nature [2]. Advantages of adsorption over other extracorporeal techniques include ability to adsorb high molecular mass (HMM) metabolites and toxins. Conventional adsorbents, however, have poor biocompatibility. They are used coated with a semipermeable membrane of a more biocompatible material to allow for a direct contact with blood. Respectively, ability of coated adsorbents to remove HMM solutes is dramatically reduced. In this paper, preliminary results on adsorption of LPS and one of the most common inflammatory cytokines, TNF-a, on uncoated porous polymers and activated carbons, are presented. The aim of this work is to estimate the potential of extracorporeal adsorption technique to remove these substances and to relate it to the porous structure of adsorbents. 

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