This document discusses various methods for eliminating poisons from the body, including forced diuresis and extracorporeal techniques like hemodialysis, hemoperfusion, and peritoneal dialysis. It also covers indications for hemodialysis, procedures for different extracorporeal techniques, complications, and administration of antidotes to treat poisonings. Nursing care for poisoned patients focuses on preventing pressure ulcers, inhalation of gastric contents, and infection, while psychiatric care involves counseling to prevent suicidal ideation from reoccurring.
Extracorporeal drugs overdose &toxin removal in icuMahmod Almahjob
1. Extracorporeal toxin removal (ECTR) involves removing drugs and toxins from the bloodstream using dialysis or other artificial methods. Over 142 dialyzable toxins have been identified.
2. The document discusses the indications for ECTR, factors that determine if a toxin is dialyzable like molecular weight and protein binding, and different ECTR modalities like hemodialysis, hemoperfusion, hemofiltration, and continuous renal replacement therapy.
3. Hemodialysis is generally preferred over hemoperfusion due to lower costs and ability to correct electrolyte and acid-base imbalances, though hemoperfusion can be better for highly protein-bound toxins. Close monitoring
RٌRT for poisoning Dr. Osama El ShahatFarragBahbah
This document discusses renal replacement therapy for poisoning. It begins by outlining criteria for considering RRT for poisoning, including progressive deterioration despite support, severe intoxication impairing ventilation/circulation, and impaired drug excretion with organ dysfunction. Modalities for RRT are then evaluated based on factors like solubility, molecular weight, and protein binding of the poison. Specific poisons like methanol, lithium, and theophylline are discussed. The conclusion states that RRT should be considered according to special criteria accounting for drug distribution and toxicity.
The document is a seminar report on diuretics presented by Shoriful Islam. It discusses the introduction, definitions, classification, mechanisms of action, pharmacokinetics, therapeutic uses, adverse effects and treatment of various types of diuretic drugs. The report classifies diuretics as high, medium and low efficacy and describes how different diuretics such as loop diuretics, thiazide diuretics, potassium-sparing diuretics and osmotic diuretics work to increase urine output. It also outlines the therapeutic uses and potential side effects of these important drugs used to treat conditions like hypertension, heart failure and edema.
This document discusses hemodialysis techniques. It defines hemodialysis as the extracorporeal removal of waste products from the blood of patients with poorly functioning kidneys, replacing some deficient materials. It describes the main principles of diffusion, osmosis, filtration, and convection that underlie hemodialysis. It also discusses various hemodialysis techniques including conventional hemodialysis, online hemodiafiltration, SLEDD, CRRT, and hemoadsorption.
This document discusses various methods for enhancing the elimination of toxins and poisons from the body. It describes the five main elimination systems in the body - the bowels, kidneys, lungs, skin, and liver. When these systems are overloaded or blocked, toxins can accumulate. Therapies to enhance elimination include activated charcoal, saline diuresis, dialysis, hemoperfusion, hemofiltration, plasmapheresis, exchange transfusion, hyperbaric oxygen, chelation therapy, cerebrospinal fluid removal, and immunological therapy using specific antibodies. Many of these therapies aim to remove toxins through the kidneys, intestines, blood, or cerebrospinal fluid.
This document discusses various extracorporeal methods for removing drugs from the body, including dialysis, hemoperfusion, and hemofiltration. It provides details on hemodialysis, peritoneal dialysis, continuous ambulatory peritoneal dialysis, hemoperfusion, hemofiltration, and continuous renal replacement therapy. The objective of these extracorporeal removal methods is to rapidly remove undesirable drugs and metabolites from the body without disturbing fluid and electrolyte balance.
This document discusses drug excretion and elimination from the body. It covers the major organs and processes involved, including the kidneys, lungs, bile/intestinal systems. Kidneys are the primary route of elimination for water-soluble drugs through glomerular filtration, tubular secretion, and reabsorption. Other topics covered include enterohepatic recirculation, factors influencing renal excretion, first vs zero order elimination kinetics, half-life, clearance, volume of distribution, and factors necessary for therapeutic drug monitoring.
This document discusses blood substitutes and their development. It covers:
- The functions of blood and the challenges in meeting demand for blood transfusions.
- The types of blood substitutes including plasma expanders and red blood cell substitutes like hemoglobin-based oxygen carriers.
- The ideal properties of blood substitutes and examples of products in development or approved, including challenges faced.
- Perfluorocarbon-based products and hemoglobin-based products, discussing sources, modifications made and examples of some products.
Extracorporeal drugs overdose &toxin removal in icuMahmod Almahjob
1. Extracorporeal toxin removal (ECTR) involves removing drugs and toxins from the bloodstream using dialysis or other artificial methods. Over 142 dialyzable toxins have been identified.
2. The document discusses the indications for ECTR, factors that determine if a toxin is dialyzable like molecular weight and protein binding, and different ECTR modalities like hemodialysis, hemoperfusion, hemofiltration, and continuous renal replacement therapy.
3. Hemodialysis is generally preferred over hemoperfusion due to lower costs and ability to correct electrolyte and acid-base imbalances, though hemoperfusion can be better for highly protein-bound toxins. Close monitoring
RٌRT for poisoning Dr. Osama El ShahatFarragBahbah
This document discusses renal replacement therapy for poisoning. It begins by outlining criteria for considering RRT for poisoning, including progressive deterioration despite support, severe intoxication impairing ventilation/circulation, and impaired drug excretion with organ dysfunction. Modalities for RRT are then evaluated based on factors like solubility, molecular weight, and protein binding of the poison. Specific poisons like methanol, lithium, and theophylline are discussed. The conclusion states that RRT should be considered according to special criteria accounting for drug distribution and toxicity.
The document is a seminar report on diuretics presented by Shoriful Islam. It discusses the introduction, definitions, classification, mechanisms of action, pharmacokinetics, therapeutic uses, adverse effects and treatment of various types of diuretic drugs. The report classifies diuretics as high, medium and low efficacy and describes how different diuretics such as loop diuretics, thiazide diuretics, potassium-sparing diuretics and osmotic diuretics work to increase urine output. It also outlines the therapeutic uses and potential side effects of these important drugs used to treat conditions like hypertension, heart failure and edema.
This document discusses hemodialysis techniques. It defines hemodialysis as the extracorporeal removal of waste products from the blood of patients with poorly functioning kidneys, replacing some deficient materials. It describes the main principles of diffusion, osmosis, filtration, and convection that underlie hemodialysis. It also discusses various hemodialysis techniques including conventional hemodialysis, online hemodiafiltration, SLEDD, CRRT, and hemoadsorption.
This document discusses various methods for enhancing the elimination of toxins and poisons from the body. It describes the five main elimination systems in the body - the bowels, kidneys, lungs, skin, and liver. When these systems are overloaded or blocked, toxins can accumulate. Therapies to enhance elimination include activated charcoal, saline diuresis, dialysis, hemoperfusion, hemofiltration, plasmapheresis, exchange transfusion, hyperbaric oxygen, chelation therapy, cerebrospinal fluid removal, and immunological therapy using specific antibodies. Many of these therapies aim to remove toxins through the kidneys, intestines, blood, or cerebrospinal fluid.
This document discusses various extracorporeal methods for removing drugs from the body, including dialysis, hemoperfusion, and hemofiltration. It provides details on hemodialysis, peritoneal dialysis, continuous ambulatory peritoneal dialysis, hemoperfusion, hemofiltration, and continuous renal replacement therapy. The objective of these extracorporeal removal methods is to rapidly remove undesirable drugs and metabolites from the body without disturbing fluid and electrolyte balance.
This document discusses drug excretion and elimination from the body. It covers the major organs and processes involved, including the kidneys, lungs, bile/intestinal systems. Kidneys are the primary route of elimination for water-soluble drugs through glomerular filtration, tubular secretion, and reabsorption. Other topics covered include enterohepatic recirculation, factors influencing renal excretion, first vs zero order elimination kinetics, half-life, clearance, volume of distribution, and factors necessary for therapeutic drug monitoring.
This document discusses blood substitutes and their development. It covers:
- The functions of blood and the challenges in meeting demand for blood transfusions.
- The types of blood substitutes including plasma expanders and red blood cell substitutes like hemoglobin-based oxygen carriers.
- The ideal properties of blood substitutes and examples of products in development or approved, including challenges faced.
- Perfluorocarbon-based products and hemoglobin-based products, discussing sources, modifications made and examples of some products.
This document discusses the basics of hemodialysis, including the main principles of diffusion, osmosis, filtration, and convection that hemodialysis is based on. It also describes the technique of hemodialysis, varieties of hemodialysis methods like conventional hemodialysis and online hemodiafiltration, and provides details on assessing hemodialysis treatment adequacy using Kt/V.
Plasmapheresis is a medical procedure that separates blood components to remove plasma. There are three main types: autologous, therapeutic exchange, and donation. Autologous plasmapheresis removes a patient's own plasma, treats it, and returns it to remove antibodies, immune complexes, or toxins. It is used to treat various neurological, hematological, metabolic, dermatological, and renal diseases. Complications can include hypotension, allergic reactions, hemorrhage, hypocalcemia, and infections from replacement fluids. Plasmapheresis removes drugs and proteins from plasma like IVIG and monoclonal antibodies but not drugs like steroids that are widely distributed in tissues. It is used pre- and
This document provides an overview of plasmapheresis, a therapeutic procedure that involves removing macromolecules from a patient's plasma. It discusses the history of plasmapheresis and how it works to separate plasma from blood cells. Common indications for plasmapheresis include renal and non-renal diseases. Technical aspects such as plasma separation techniques, anticoagulants, replacement fluids, and venous access are also summarized.
The document discusses drug excretion pathways and mechanisms. The major organs involved in excretion are the kidneys, liver, lungs, saliva, milk, and skin. The kidneys are the primary route of excretion and remove drugs via glomerular filtration, tubular secretion, and tubular reabsorption. The liver excretes drugs into bile via transporters like OATPs. Lungs, saliva, milk, and skin remove some drugs via passive diffusion depending on their solubility. Factors like molecular size, charge, and transporters influence which excretion pathway a given drug utilizes.
This document discusses various extracorporeal methods for removing drugs from the body, including dialysis, hemoperfusion, and hemofiltration. Dialysis works by diffusion across a membrane to filter waste and drugs from the blood or fluid. Hemoperfusion directly contacts blood with absorbent materials like charcoal to remove drugs. Hemofiltration slowly filters fluids and small molecules from the blood through convection. Continuous renal replacement therapy like CVVH and CAVH provide ongoing toxin removal without concentration effects of intermittent methods.
Erythrocytes, or red blood cells, have potential as carriers for drug delivery. They are biocompatible, biodegradable, have long circulation times, and can be loaded with drugs using various chemical and physical methods. Resealed erythrocytes are prepared by breaking open erythrocytes, loading them with drugs from solution, and resealing the cells. Various methods exist for drug loading, including hypotonic lysis, electroporation, and endocytosis. Loaded erythrocytes have applications in targeting drugs to tissues like the liver and spleen, and treating conditions like cancer, parasites, and iron overload. Further research continues to improve drug loading efficiency and stability of resealed
Management of poisoning by extracorporeal treatmentsDr. Lalit Agarwal
This document discusses extracorporeal treatments for poisonings, including hemodialysis, hemoperfusion, and plasma exchange. It covers criteria for using extracorporeal treatments, factors that influence toxin removal like molecular weight and protein binding, complications of different treatments, and technical considerations. The EXTRIP group developed recommendations for managing common poisonings with extracorporeal methods.
This document discusses plasmapheresis, which is a therapeutic apheresis procedure that removes plasma from the blood. There are two main techniques used: membrane apheresis, which is fast but limited in substance removal, and centrifugal devices, which are more expensive but efficient. Complications can include hypotension, bleeding, and allergic reactions. Plasmapheresis is used to treat autoimmune disorders by removing autoantibodies, and other conditions involving abnormal circulating factors. Care must be taken with anticoagulation and replacement fluids during the procedure.
Basic plasmapheresis prof. dr. montasser zeidFarragBahbah
1. Plasmapheresis involves removing plasma from a patient and replacing it with either fresh frozen or stored plasma. It can remove pathogenic factors like antibodies, immune complexes, and proteins.
2. There are two main techniques for plasmapheresis - centrifugal separation and membrane plasmafiltration. Complications can include hypotension, bleeding, and allergic reactions.
3. Plasmapheresis is used to treat various conditions and is categorized based on evidence. It may be used as an adjunctive therapy for sepsis to remove harmful molecules.
Dialysis various modalities and indices usedAbhay Mange
Dialysis is a process used to remove waste and excess water from the blood of patients with kidney failure. There are various modalities of dialysis including intermittent hemodialysis, peritoneal dialysis, and continuous renal replacement therapy. Hemodialysis uses diffusion and ultrafiltration across a semi-permeable membrane in a dialyzer to clean the blood. Proper vascular access and anticoagulation are also important aspects of hemodialysis treatment.
Intravenous fluid therapy involves infusions of crystalloids such as normal saline, dextrose solutions, or Ringer's lactate, as well as colloids like albumin, gelatin, or hydroxyethyl starches. The choice of fluid depends on the indication, whether it be volume resuscitation, maintaining hydration or electrolyte balance, or as a vehicle for intravenous drugs. Care must be taken to avoid complications from large volumes or rapid administration like electrolyte imbalances, edema, or coagulopathies. Preoperative evaluation of a patient's fluid status helps guide appropriate fluid management in the perioperative period.
This document provides an overview of hemodialysis, including its basic principles and techniques. It discusses how diffusion, osmosis, filtration, and convection work to remove toxins and excess fluid from the blood during dialysis. It also describes different types of dialysis membranes and techniques, such as high flux dialysis and continuous renal replacement therapy. Key aspects of hemodialysis like treatment adequacy, dialysate composition, and avoiding complications are also summarized.
The document discusses drug excretion, which is the process by which drugs are transferred from the internal to external environment. The kidneys, lungs, liver, intestines and other organs are involved in excretion. Renal excretion is the primary route for water soluble drugs. Factors like glomerular filtration, tubular secretion and reabsorption determine renal clearance. Non-renal routes include biliary, pulmonary, salivary and dermal excretion. Physicochemical properties of drugs and physiological factors impact excretion routes and rates.
The document discusses the adrenal glands and their hormones. It covers:
1. The two parts of the adrenal glands - the inner medulla and outer cortex. The medulla produces epinephrine and norepinephrine. The cortex produces cortisol and aldosterone.
2. The hormones produced by the adrenal cortex - mineralocorticoids like aldosterone, glucocorticoids like cortisol, and sex hormones.
3. The synthesis and effects of catecholamines epinephrine and norepinephrine produced in the adrenal medulla, and diseases like pheochromocytoma associated with excess catecholamine production.
This document provides information on pharmacokinetics, including key terms and concepts. It discusses volume of distribution, clearance, half-life, steady state, and loading/maintenance doses. Volume of distribution relates the amount of drug in the body to its concentration in blood or plasma. Clearance is the rate of drug elimination. Half-life is the time for a drug amount to reduce by half. Steady state is reached when the dosing rate equals the elimination rate. Loading doses are used to quickly reach the target concentration for drugs with long half-lives, while maintenance doses are repeated to maintain steady state. Therapeutic drug monitoring measures drug levels to adjust doses for each patient.
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This document summarizes various aspects of pharmacokinetic drug interactions. It discusses how the absorption, distribution, metabolism, and excretion of one drug can be altered by another drug, leading to changes in effects. Specific examples are provided of drugs that interact by inhibiting or inducing metabolic enzymes, competing for transporters, or displacing protein binding, which can increase or decrease drug levels and potentially cause adverse effects. Close monitoring is recommended when drugs with a risk of these pharmacokinetic interactions are prescribed together.
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This document discusses the basics of hemodialysis, including the main principles of diffusion, osmosis, filtration, and convection that hemodialysis is based on. It also describes the technique of hemodialysis, varieties of hemodialysis methods like conventional hemodialysis and online hemodiafiltration, and provides details on assessing hemodialysis treatment adequacy using Kt/V.
Plasmapheresis is a medical procedure that separates blood components to remove plasma. There are three main types: autologous, therapeutic exchange, and donation. Autologous plasmapheresis removes a patient's own plasma, treats it, and returns it to remove antibodies, immune complexes, or toxins. It is used to treat various neurological, hematological, metabolic, dermatological, and renal diseases. Complications can include hypotension, allergic reactions, hemorrhage, hypocalcemia, and infections from replacement fluids. Plasmapheresis removes drugs and proteins from plasma like IVIG and monoclonal antibodies but not drugs like steroids that are widely distributed in tissues. It is used pre- and
This document provides an overview of plasmapheresis, a therapeutic procedure that involves removing macromolecules from a patient's plasma. It discusses the history of plasmapheresis and how it works to separate plasma from blood cells. Common indications for plasmapheresis include renal and non-renal diseases. Technical aspects such as plasma separation techniques, anticoagulants, replacement fluids, and venous access are also summarized.
The document discusses drug excretion pathways and mechanisms. The major organs involved in excretion are the kidneys, liver, lungs, saliva, milk, and skin. The kidneys are the primary route of excretion and remove drugs via glomerular filtration, tubular secretion, and tubular reabsorption. The liver excretes drugs into bile via transporters like OATPs. Lungs, saliva, milk, and skin remove some drugs via passive diffusion depending on their solubility. Factors like molecular size, charge, and transporters influence which excretion pathway a given drug utilizes.
This document discusses various extracorporeal methods for removing drugs from the body, including dialysis, hemoperfusion, and hemofiltration. Dialysis works by diffusion across a membrane to filter waste and drugs from the blood or fluid. Hemoperfusion directly contacts blood with absorbent materials like charcoal to remove drugs. Hemofiltration slowly filters fluids and small molecules from the blood through convection. Continuous renal replacement therapy like CVVH and CAVH provide ongoing toxin removal without concentration effects of intermittent methods.
Erythrocytes, or red blood cells, have potential as carriers for drug delivery. They are biocompatible, biodegradable, have long circulation times, and can be loaded with drugs using various chemical and physical methods. Resealed erythrocytes are prepared by breaking open erythrocytes, loading them with drugs from solution, and resealing the cells. Various methods exist for drug loading, including hypotonic lysis, electroporation, and endocytosis. Loaded erythrocytes have applications in targeting drugs to tissues like the liver and spleen, and treating conditions like cancer, parasites, and iron overload. Further research continues to improve drug loading efficiency and stability of resealed
Management of poisoning by extracorporeal treatmentsDr. Lalit Agarwal
This document discusses extracorporeal treatments for poisonings, including hemodialysis, hemoperfusion, and plasma exchange. It covers criteria for using extracorporeal treatments, factors that influence toxin removal like molecular weight and protein binding, complications of different treatments, and technical considerations. The EXTRIP group developed recommendations for managing common poisonings with extracorporeal methods.
This document discusses plasmapheresis, which is a therapeutic apheresis procedure that removes plasma from the blood. There are two main techniques used: membrane apheresis, which is fast but limited in substance removal, and centrifugal devices, which are more expensive but efficient. Complications can include hypotension, bleeding, and allergic reactions. Plasmapheresis is used to treat autoimmune disorders by removing autoantibodies, and other conditions involving abnormal circulating factors. Care must be taken with anticoagulation and replacement fluids during the procedure.
Basic plasmapheresis prof. dr. montasser zeidFarragBahbah
1. Plasmapheresis involves removing plasma from a patient and replacing it with either fresh frozen or stored plasma. It can remove pathogenic factors like antibodies, immune complexes, and proteins.
2. There are two main techniques for plasmapheresis - centrifugal separation and membrane plasmafiltration. Complications can include hypotension, bleeding, and allergic reactions.
3. Plasmapheresis is used to treat various conditions and is categorized based on evidence. It may be used as an adjunctive therapy for sepsis to remove harmful molecules.
Dialysis various modalities and indices usedAbhay Mange
Dialysis is a process used to remove waste and excess water from the blood of patients with kidney failure. There are various modalities of dialysis including intermittent hemodialysis, peritoneal dialysis, and continuous renal replacement therapy. Hemodialysis uses diffusion and ultrafiltration across a semi-permeable membrane in a dialyzer to clean the blood. Proper vascular access and anticoagulation are also important aspects of hemodialysis treatment.
Intravenous fluid therapy involves infusions of crystalloids such as normal saline, dextrose solutions, or Ringer's lactate, as well as colloids like albumin, gelatin, or hydroxyethyl starches. The choice of fluid depends on the indication, whether it be volume resuscitation, maintaining hydration or electrolyte balance, or as a vehicle for intravenous drugs. Care must be taken to avoid complications from large volumes or rapid administration like electrolyte imbalances, edema, or coagulopathies. Preoperative evaluation of a patient's fluid status helps guide appropriate fluid management in the perioperative period.
This document provides an overview of hemodialysis, including its basic principles and techniques. It discusses how diffusion, osmosis, filtration, and convection work to remove toxins and excess fluid from the blood during dialysis. It also describes different types of dialysis membranes and techniques, such as high flux dialysis and continuous renal replacement therapy. Key aspects of hemodialysis like treatment adequacy, dialysate composition, and avoiding complications are also summarized.
The document discusses drug excretion, which is the process by which drugs are transferred from the internal to external environment. The kidneys, lungs, liver, intestines and other organs are involved in excretion. Renal excretion is the primary route for water soluble drugs. Factors like glomerular filtration, tubular secretion and reabsorption determine renal clearance. Non-renal routes include biliary, pulmonary, salivary and dermal excretion. Physicochemical properties of drugs and physiological factors impact excretion routes and rates.
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3. The synthesis and effects of catecholamines epinephrine and norepinephrine produced in the adrenal medulla, and diseases like pheochromocytoma associated with excess catecholamine production.
This document provides information on pharmacokinetics, including key terms and concepts. It discusses volume of distribution, clearance, half-life, steady state, and loading/maintenance doses. Volume of distribution relates the amount of drug in the body to its concentration in blood or plasma. Clearance is the rate of drug elimination. Half-life is the time for a drug amount to reduce by half. Steady state is reached when the dosing rate equals the elimination rate. Loading doses are used to quickly reach the target concentration for drugs with long half-lives, while maintenance doses are repeated to maintain steady state. Therapeutic drug monitoring measures drug levels to adjust doses for each patient.
Pharmacokinetics Drug drug interaction [Best one]abdelrahman_asar
This document summarizes various aspects of pharmacokinetic drug interactions. It discusses how the absorption, distribution, metabolism, and excretion of one drug can be altered by another drug, leading to changes in effects. Specific examples are provided of drugs that interact by inhibiting or inducing metabolic enzymes, competing for transporters, or displacing protein binding, which can increase or decrease drug levels and potentially cause adverse effects. Close monitoring is recommended when drugs with a risk of these pharmacokinetic interactions are prescribed together.
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Elimination of poisoning and antidote
1. Elimination of poisoning
and
Antidote administration
Dr.Sunanda Nandikol
Clinical Pharmacy Practice,
BLDEA’s SSM College of
Pharmacy & Research
Centre,Vijayapura
2. The various methods of Elimination of absorbed poisons from the body include
the following:
Forced Diuresis
Extracorporeal techniques:
1. Haemodialysis
2. Heamoperfusion
3. Peritoneal dialysis
4. Hemofiltration
5. Plasmaphersis
6. Plasma perfusion
7. Cardiopulmonary bypass.
3. Forced Diuresis
(Increased urine formation by diuretics and fluid) Forced Diuresis may
enhance the excretion of drugs in urine and is used to treat drug overdose or
Poisoning.
Most drugs taken in overdose are extensively detoxified by the liver to produce
inactive metabolites which are voided in the urine.
4. Principle: Most of the drugs are either weak acids or weak bases. When urine is
made alkaline, elimination of acidic drugs in the urine is increased. The converse applies
for alkaline drugs. This method is only of therapeutic significance where the drug is
excreted in active form in urine and where the pH of urine can be adjusted to levels above
or below the pK value of the active form of drug. For acidic drugs, urine pH should be
above the pK value of that drug, and converse for the basic drugs
Forced alkaline Diuresis:
This is most useful procedure in the case of Phenobarbitone,lithium,and salicylates.
Administer 1500ml of fluid IV, in the first hr as follows:
500ml of 5% Dextrose, 500ml of 1.2or 1.4% Sodium carbonate , 500ml of 5% Dextrose.
Forced Acidic Diuresis:
It is No longer recommended for any drug or poison.
5. EXTRACORPOREAL TECHNIQUES:
Haemodialysis: is a process of purifying the blood of a patient whose kidneys are not
functioning normally.Heamodialysis was first used in 1913 in experimental poisoning,
but was not applied clinically until 1950,when it was used for the treatment of
salicylate overdose.
All drugs are not dialyzable, so it must be ensured before embarking on this procedure
that the following conditions are satisfied.
The substance should be such that it can diffuse easily through a dialysis membrane.
A significance proportion of the substance should be present in plasma water or be
capable of rapid equilibration with it.
The Pharmacological effects should be directly related to the blood concentration.
COMPLICATIONS: Infections, Thrombosis, Hypotension, air embolism, bleeding
6. Procedure:
The 3 basic components of haemodialysis are:
Blood delivery system
The dialyser
The composition and method of delivery of the dialysate.
For Acute haemodialysis, Catheters are usually placed in the femoral vein and passed
into the inferior venacava. Blood from the one catheter is pumped to the dialyser
through lines that contains equipment to measure flow and pressure within the system.
Blood returns through the second catherter.Dialysis begins at a blood flow rate of 50 to
100ml/min, and is gradually increased to 250 to 300 ml/min to give maximal
clearance.
7.
8. Indications for Heamodialysis:
1. Best indications:
Dialysis should be initiated regardless of clinical conditions, in the following situations,
after heavy metal chelation in patients with renal failure patients, ethylene glycol or
methanol ingestion cases.
2.Very good indications:
usually effective in patients with severe intoxications with the following agent: Lithium,
Phenobarbitone, Salicylates, and Theophylline
3.Fairly good indication:
dialysis can be initiated based on the exposure of the following agents, if clinical
condition deems the procedure is necessary e.g. Alcohols, Amphetamine, Anilines,
Antibiotics, Barbiturates, chlorates, iodides, INH, Quinidine, Fluorides.
Poor indications:
Dialysis can be considered as a supportive measure in the presence of renal failure e.g.
PCT, Antidepressants, antihistamines, Benzodiazepines, Digitalis, opiates, etc.
9. 2. HEAMOPERFUSION:
This technique is increasingly becoming popular since it is capable of removing many
of the toxins that are not removed well by Haemodialysis.
PROCEDURE: An arteriovenous shunt or a double-lumen venous catheter is inserted
into the patient’s vascular tree. The Heamoperfusion saline in accordance with the
manufacture’s instructions are connected to the shunt or catheter. On commencement of
perfusion, a bolus of heparin is injected, into the arterial line and heparinisation is
continued by administrating an infusion of heparinised saline.
Toxins removed by Heamoperfusion are: Barbiturates, carbon tetrachloride's,
chlorpromazine, Dapsone, Diazepam, Digoxin, Organophosphate, phenols,
promethazine, quinidine, anti depressants, etc..
Complications: Bleeding, Air embolism ,Infection, Thrombocytopenia, Hypocalcaemia,
Hypotension.
10. 3. PERITONEAL DIALYSIS:
Although is widely available, this type of dialysis today is almost never recommended,
for detoxification. In general, it is only 10-25% as effective as haemodialysis and often
only slightly more effective than forced diuresis. It is also time consuming, requiring
24hrs for successful completion as compared to 2 to 4 hr cycles of haemodialysis and
Heamoperfusion. The only advantages are that it doesn’t require anticoagulation and uses
minimal equipment .
PROCEDURE: Peritoneal dialysis works on the same principle as haemodialysis,
allowing the diffusion of toxins from mesenteric capillaries across the peritoneal
membrane into the dialysate dwelling in the peritoneal cavity.
COMPLICATION: Pain, Haemorrhage , perforation of viscus, Bacterial peritonitis,
Volume depletion, Pneumonia, Pleural effusion, Hyperglycaemia, Electrolyte imbalance
11. HAEMOFILTRATION:
Hemofiltration is performed similar to haemodialysis except that the
blood is pumped through a haemofilter.This procedure allows a
substantial flow of plasma water, and a high permeability to
compounds with molecular weight less than 40,000.The procedure can
be done intermittently at high ultra-filtrate rates of upto 6 litres/hr. or
continuously at rate of 100ml/hr.
The main advantage of hemofiltration is that it can remove compounds
of large relative molecular weight (4500-40,000) ,Such compounds
include aminoglycosides antibiotics and metal chelates. This can be
useful in treating the lithium, ethanol, methanol, ethylene glycol
poisoning.
12. Haemodiafiltration:
This is a combination of hemofiltration with haemodialysis. It has
been undertaken very rarely.
13. Plasmaphersis:
It is technique of separating cellular blood components from plasma. The cells are re-suspended in either
colloids, albumin or fresh frozen plasma, and then re-infused .It is very effective in eliminating toxic
substances but exacts a heavy toll: a part of the patient’s plasma proteins are scarified in the process.
Plasmaphersis has been used in cases of overdose with theophylline, carbamazepine, amanita, mercury,
hemlock, etc.. But serious complications greatly limits its utility:
COMPLICATIONS:
Bleeding disorders: Thrombocytopenia
Hyper coagulation: Cerebral thrombosis, pulmonary embolism, myocardial infiltration.
Anaphylaxis
Fluid overload: Hypertension,CCF
Infection
Vessels perfusion. Air embolism
Disequilibrium syndrome: Vomiting,tetany(muscle spasm ), chills, arrhythmias,
Convulsions
Metabolic alkalosis.
14. PLASMA PERFUSION:
This is a combination of Plasmaphersis and
Heamoperfusion and has rarely been used in poisoning
15. 8.CARDIOPULMANRY BYPASS:
This is another rarely used experimental procedure in the treatment
of poisoning and has been shown to be useful in certain cases, of
overdose involving cardiac depressants such as verapamil and
lidocaine.
17. ANTIDOTE ADMINISTRATION
In majority of cases of acute poisoning ,all that is required is intensive supportive
therapy with attention.
Antidotes can change the chemical nature of a poison by rendering it less toxic or
preventing its absorption.
Antidotes work in any one of the following common modes of action are:
1. Insert complex formation
2. Accelerated detoxification
3. Reduced toxic conversion
4. Receptor site competition
5. Receptor site blockade
6. Toxic effect by pass
18. Inert Complex Formation
Some antidotes interact with the poison to form an inert complex which is
then excreted from the body , eg: chelating agents for heavy metals .
Prussian blue for thallium, specific antibody fragments for digoxin,
Dicobalt edeate for cyanide etc.
19. Accelerated detoxification
Some antidotes accelerate the detoxification of a poison,
eg; thiosulfate the conversion of cyanide to non-toxic , acetyl cysteine acts as a
glutathione substitute which combines with hepatotoxic paracetamol metabolites and
detoxifies.
20. Reduced toxic conversion
The best examples of this mode of action is provided by
ethanol which inhibits the metabolism of methanol to toxic
metabolites by competing for the same enzyme.
21. Receptor site competition
Some antidotes displace the poison from specific receptor sites there by
antagonising the effects completely .The best example is provided by
Naloxone, which antagonises the effect of opiates at stereo-specific opioid
receptor sites.
22. Receptor site blockade
This mode of action is best exemplified by atropine which blocks the effects of
anticholinesterase agents such as organophosphates at muscarinic receptor
sites.
23. Toxic effect bypass
An example of this type of antidotal action is provided by the use of 100%
oxygen in cyanide poisoning.
24. Examples
Acetylcysteine for Acetaminophen poisoning
Oxygen for Carbon monoxide poisoning
Atropine for Anticholinesterases, organophosphates, carbamates
sodium Bicarbonate for Membrane-depressant cardiotoxic drugs (tricyclic
antidepressants, quinidine, etc
Calcium for Fluoride; calcium channel blockers
Deferoxamine for Iron salts
Digoxin antibodies for Digoxin and related cardiac glycosides
Esmolol for Theophylline, caffeine, metaproterenol
Ethanol for Methanol, ethylene glycol posioning
25. NURSING CARE AND PSYCHIATRIC CARE
Nursing care:
This is especially imp in comatose patients and involves the following
measures:
Attention to pressure points to prevent development of decubitus ulcer (injury
to skin and underlying tissue resulting from prolonged pressure on the skin)
In the absence of spontaneous blinking of eye , avoid exposure keratitis
(inflammation of cornea) by methyl cellulose eye drops
Inhalation of gastric contents is a frequent problem which can lead to
pneumonitis, it should be treated.
Passive physiotherapy may be advisable to prevent stiffness and muscle
atrophy.
Prophylactic antibiotics keratitis is caused because of infection by viruses,
bacterial etc…if necessary.
26. PSYCHIATRIC CARE
A significant proportion of overdose cases comprise suicide attempts. After
medical stabilization, the most imp aspect of management consists of
psychiatric counselling in order to prevent reoccurrence of suicidal ideation
once the patients has been discharged.
Careful analysing the patients psychological state will allow for a realistic
appraisal of the psychosocial alternatives w.r.t immediate and long term
treatment ,disposition, and continued follow-up or outpatient care.
Today psychosocial assessment has become an important component in the
comprehensive evaluation of toxicological emergencies.