Activated Carbon Hemoperfusion and Plasma Adsorption

Barnes, Jeff; Cowgill, Larry D; Auñon, Jose Diaz

doi:10.1016/j.yasa.2021.07.010

Cited by 11 publications

(6 citation statements)

References 7 publications

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“…The synthetic carbon adsorbent used in this case can remove a wide range of molecules with molecular weights between 150 and 50,000 Da. 8 Given that little is known about the alteration of the pharmacokinetic/pharmacodynamic profile in context of intoxication, in addition to the lack of caninespecific pharmacokinetics of 5-HTP, the authors decided to add cHP to HDF to maximize the elimination of 5-HTP and thus bring the best outcome for the dog presented in this study. Overall, the combination of cHP/HDF shortened the half-life of 5-HTP by nearly one-third compared with the dog's endogenous half-life (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Extracorporeal therapies such as carbon hemoperfusion (cHP), hemodialysis, or hemodiafiltration (HDF) may be considered to remove toxins. 8,9 Mechanistically, HDF allows for the diffusive and convective removal of substances, whereas hemoperfusion uses adsorption to effectively remove substances that have a large molecular weight (up to 40,000 Da) and are highly protein bound (>90%), regardless of lipid and water solubility. 8,9 At present, the use of extracorporeal techniques for the removal of 5-HTP has not been described, and the ability of the drug to be removed by cHP and HDF is undetermined.…”

Section: Introductionmentioning

confidence: 99%

“…8,9 Mechanistically, HDF allows for the diffusive and convective removal of substances, whereas hemoperfusion uses adsorption to effectively remove substances that have a large molecular weight (up to 40,000 Da) and are highly protein bound (>90%), regardless of lipid and water solubility. 8,9 At present, the use of extracorporeal techniques for the removal of 5-HTP has not been described, and the ability of the drug to be removed by cHP and HDF is undetermined. In the current report, we present a dog treated with a single session of simultaneous cHP/HDF after 5-HTP intoxication severe enough to require mechanical ventilation (MV).…”

Section: Introductionmentioning

confidence: 99%

“…Treatment of serotonin syndrome consists of cessation of serotonergic agents, supportive measures, and administration of benzodiazepines and serotonin antagonists, such as cyproheptadine 4,5 . Extracorporeal therapies such as carbon hemoperfusion (cHP), hemodialysis, or hemodiafiltration (HDF) may be considered to remove toxins 8,9 . Mechanistically, HDF allows for the diffusive and convective removal of substances, whereas hemoperfusion uses adsorption to effectively remove substances that have a large molecular weight (up to 40,000 Da) and are highly protein bound (>90%), regardless of lipid and water solubility 8,9 .…”

Section: Introductionmentioning

confidence: 99%

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Successful treatment of a severe 5‐hydroxytrytophan intoxication using carbon hemoperfusion, hemodiafiltration, and mechanical ventilation in a dog

Her,

Gordon,

Riggs

et al. 2024

J Vet Emergen Crit Care

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ObjectiveTo describe the successful use of carbon hemoperfusion and hemodiafiltration in combination with mechanical ventilation (MV) to treat a severe intoxication of 5‐hydroxytryptophan (5‐HTP) in a dog.Case SummaryA dog ingested a minimum of 550 mg/kg of extended‐release 5‐HTP, resulting in serotonin syndrome that progressed to a comatose state and severe hypoventilation requiring MV. Extracorporeal carbon hemoperfusion coupled with hemodiafiltration was performed to remove 5‐HTP from this patient. A carbon hemoperfusion cartridge was placed in series upstream in the extracorporeal circuit from the hemodialyzer. A total of 46.5 L of blood (4.89 L/kg) was processed during a 4.85‐hour treatment. Serial plasma samples were obtained at 0, 60, 90, and 150 minutes during the session and 14 hours after the session. These samples were later analyzed for 5‐HTP and serotonin concentrations. The extraction ratio of 5‐HTP was 93.6%–98.9% through the carbon filter. The dog was weaned from MV within 8 hours after extracorporeal therapy and, after a full recovery, was successfully discharged.New or Unique Information ProvidedDespite an extensive review of the available literature, this appears to be the first reported case of using a carbon hemoperfusion, hemodiafiltration, and MV to treat severe serotonin syndrome secondary to 5‐HTP intoxication in a dog. The combination of carbon hemoperfusion and hemodiafiltration can significantly reduce plasma 5‐HTP concentrations after acute intoxication and may serve to decrease morbidity and mortality in patients with severe intoxication.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Successful treatment of a severe 5‐hydroxytrytophan intoxication using carbon hemoperfusion, hemodiafiltration, and mechanical ventilation in a dog

Her,

Gordon,

Riggs

et al. 2024

J Vet Emergen Crit Care

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“…Charcoal hemoperfusion often used to treat toxicities with an appropriate pharmacokinetic profile. [37][38][39][40][41][42][43][44] The first veterinary-specific extracorporeal platform is a hemoperfusion machine (Aimalojic); it may be used by many emergency hospitals that do not have an extracorporeal therapies service, thus increasing the availability of ECTR throughout the United States.…”

Section: Specialty Procedures Extracorporeal Therapies-renal Replacem...mentioning

confidence: 99%

Nephrology in Veterinary Medicine

Foster

2023

Kidney360

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Veterinary nephrology is a specialized field of veterinary medicine providing a high level of care for animals with all types of kidney disease. Veterinarians complete extensive training to become board certified in veterinary nephrology-urology. Companion animal nephrology is the most advanced field; however, all species are afflicted by a variety of renal disorders. Most naturally occurring animal renal diseases have similar disorders found in people; where veterinary research is lacking clinical management is often modified from standard of care in people. Veterinarians have become adept at scaling down procedures to safely perform them on dogs and cats weighing only a few kilograms. Advanced diagnostics (renal biopsy, cystoscopy, fluoroscopic studies, etc.) and therapeutics (renal replacement therapy, interventional endourology, etc.) are commonly performed within the practice of veterinary nephrology-urology. Collaboration between veterinary and human nephrologists may advance both disciplines and improve care for people and animals alike.

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