Poisoning enhanced elimination

There is no specific antidote and no currently recognized way to enhance elimination. Conventional treatment is entirely supportive. Cholestyramine has been shown to enhance elimination of chlordane and kepone (HSDB 1994), and may enhance elimination after ingestion of endrin. However, its effectiveness in endrin poisoning has not been tested. 

D. Enhanced elimination. There is no role for dialysis or hemoperfusion in acute azide poisoning. 

D. Enhanced elimination. There is no role for hemodialysis or hemoperfusion in cyanide poisoning treatment. Hemodialysis may be indicated in patients with renal insufficiency who develop high thiocyanate levels while on extended ni-troprusside therapy. 

D. Enhanced elimination. There is no role for enhanced elimination procedures. Although hyperbaric oxygen therapy has been promoted for treatment of hydrogen sulfide poisoning, this is based on anecdotal cases and there is no convincing rationale or scientific evidence for its effectiveness. 

D. Enhanced elimination. Hemodialysis rapidly removes both methanol (half-life reduced to 3-6 hours) and formate. The indications for dialysis are suspected methanol poisoning with significant metabolic acidosis, visual abnormalities, an osmolar gap greater than 10 mOsm/L, or a measured serum methanol concentration greater than 50 mg/dL. Dialysis should be continued until the methanol concentration is less than 20 mg/dL. 

D. Enhanced elimination. There is no documented efficacy for repeat-dose activated charcoai, hemodiaiysis, or hemoperfusion. Whiie treatment with hyperbaric oxygen (HBO) may enhance eiimination of DCM, its efficacy for patients with acute poisoning remains unproven. 

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. 

D. Enhanced elimination. Consider hyperbaric oxygen (see p 482) for oarbon monoxide poisoning. 

The kidneys eliminate polar, water-soluble compounds and polar, water-soluble metabolites into the urine. Haemodialysis is used in clinical toxicology if the patient has kidney (renal) failure or to enhance elimination of toxic metabolites of poisons. 

Activated charcoal adsorbs salicylate effectively, and has been given in repeated oral doses (50 g 4 hourly) to enhance clearance, although its effect on outcome is unknown. Fluid and electrolyte replacement are important and special care should be taken to maintain normal potassium concentrations. Patients with signs of poisoning, especially when plasma salicylate concentration exceeds 500 mg/1, should receive specitic elimination therapy. 

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."... 

Guerra (187) reported shifts in the M—CO bond to lower frequencies due to poisoning of Ir and Os by H2S. Exposure of Rh to H2S enhanced the bond attributed to two CO molecules per metal site and eliminated bridged Rh2-CO species. Thus sulfur appears to affect the adsorption states for CO on some group VIII metals in a manner similar to nickel. 

Acute poisoning is manifested by excitement and peripheral sympathomimetic effects convulsiorrs may occur also, in acute or chronic overuse, a state resembling hyperactive paranoid schizophrenia with hallucinations develops. Hyperthermia occurs with cardiac arrhythmias, vascular collapse and death. Treatment is chlorpromazine with added antihypertensive, e.g. labetalol, if necessary these provide sedation and a- and P-adrenoceptor blockade (not a P-blocker alone), rendering unnecessary the enhancement of elimination by urinary acidification. 

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