Dialysis in the poisoned patient

Bayliss, George

doi:10.1111/j.1542-4758.2009.00427.x

Cited by 38 publications

(33 citation statements)

References 49 publications

(121 reference statements)

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“…From 1985 to 2005, cases of poisoning requiring HD increased to 707 per million calls to poison control centers from 231 per million, with lithium and EG being the most common toxins removed by HD over this period [7]. Fomepizole was approved by the FDA in 1997 for the treatment of ethylene glycol intoxication.…”

Section: Resultsmentioning

confidence: 99%

“…The acid-base status would need to be frequently monitored, as well as neurological, cardiac, and pulmonary status monitored. The indication for HD in EG poisoning appears to be mainly determined by the presence of acute kidney injury, electrolyte imbalances that do not respond to conventional therapy, as well as deteriorating vital signs despite intensive care [7].…”

Section: Resultsmentioning

confidence: 99%

“…Refractory serum hyperosmolality and a glycolic acid level greater than 10 mmol/l have also been described as indications [6]. Dialysis is undertaken with a bicarbonate dialysate bath until the toxic alcohol level is <20 mg/dL [7]. A peak serum concentration of 20 mg/dL or greater has been cited as potentially toxic, however, data from human studies regarding this is lacking.…”

Section: Hemodialysismentioning

confidence: 99%

“…The main determinates as to the appropriateness of fomepizole as monotherapy include: Time of presentation postingestion, degree of acidemia, and of renal function [11]. The highest serum EG concentration treated with fomepizole monotherapy was 706 mg/dL, in a patient with normal creatinine and arterial pH [7]. These case reports highlight the evidence that even in the presence of metabolic acidosis, patients with normal renal function would likely not require HD in EG poisoning, regardless of the EG concentration [12].…”

Section: Fomepizole As Monotherapymentioning

confidence: 99%

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The Role of Hemodialysis and Fomepizole in Ethylene Glycol Intoxication

Buller¹,

Moskowitz²

2011

J Nephrol Ther

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Ethylene glycol is one of the most common toxic alcohol ingestions requiring hemodialysis for treatment. With the FDA approval in 1997 of fomepizole (4-methylpyrazole), the indications for hemodialysis in addition to fomepizole for ethylene glycol poisoning have been examined in recent articles and case reports. Fomepizole, a competitive inhibitor of alcohol dehydrogenase, binds to the same site on the enzyme as ethanol, however the pharmacokinetics of fomepizole are more predictable, and with fewer side effects compared to ethanol. Current guidelines cited in the literature for the use of hemodialysis in ethylene glycol poisoning include patients with severe metabolic acidosis (pH 7.3), serum ethylene glycol level 50 mg/dL, acute kidney injury, and deteriorating vital signs despite intensive care. This article is a review of the current literature with regard to the use of fomepizole as monotherapy for ethylene glycol poisoning, as well as the indications for hemodialysis in ethylene glycol poisoning.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Hemodialysismentioning

confidence: 99%

Section: Fomepizole As Monotherapymentioning

confidence: 99%

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The Role of Hemodialysis and Fomepizole in Ethylene Glycol Intoxication

Buller¹,

Moskowitz²

2011

J Nephrol Ther

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“…As per hospital protocol, lithium levels were repeated every 2 -4 h [6]. It is a common phenomenon for lithium levels to rebound after HD secondary to its diffusion from intracellular space to extracellular space [7]. Similarly, this patient's serum lithium decreased after the first HD; however, it rebounded after a few hours, followed by decline after a second round of HD and colonic decontamination (Fig.…”

Section: Discussionmentioning

confidence: 99%

Lethal but Reversible Encephalopathy Secondary to Lithium Toxicity: A Case Report and Review of Literature

Shah¹,

Khalpada

Sangroula

et al. 2017

J Med Cases

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Lithium has been the first line of drug for bipolar disorder since the 1970s and is also efficient in treating acute mania and major depression. Due to its narrow therapeutic window, the risk of toxicity remains a concern. Clinical manifestations include gastrointestinal, cardiac, renal symptoms, and, in chronic intoxication, development of neurological symptoms. Here we report a rare case of a severe, life-threatening lithium intoxication in a 43-year-old male who was unresponsive with a very high serum lithium level of 5.0 mEq/L. Additionally, we discuss clinical profile, diagnostic examination, and management.

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Methanol Poisoning

Desai¹,

Sudhalkar²,

Vyas³

et al. 2013

JAMA Ophthalmol

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Objective: To determine whether laboratory markers of methanol ingestion and subsequent toxicity can serve as predictors of visual outcomes in patients. Methods: Retrospective medical record review of 122 patients in a cluster outbreak of methanol poisoning. Data collected included history, complete ocular and systemic examination details, time to presentation, amount of alcohol ingested, and results of laboratory investigations, such as hemogram, glucose levels, hematocrit level, arterial pH, methanol levels, potassium and bicarbonate levels, and anion and osmolar gap determination, as well as hepatic and renal function tests. Therapy administered consisted of ethyl alcohol, sodium bicarbonate, and nutritional supplements, with hemodialysis in severe cases. Visual acuity (VA), pupillary reaction, and optic disc findings were assessed at presentation and 3 months after discharge. Patients were classified according to their visual disturbance: transient (group 1) or permanent (group 2). Appropriate statistical analysis was performed. Outcome measures included determining the association between biochemical markers of methanol poisoning and final VA. Results: A total of 122 patients (1 female and 121 male) were admitted for treatment; of these, 10 died. Only 1 patient showed a 2-line drop in VA. pH was the strongest predictor of final VA and improvement in VA among all markers. The odds that a patient with an initial pH greater than 7.2 would have only transient visual disturbances were high (odds ratio, 31; 95% CI, 6-149). Conclusions: The degree of acidosis at presentation appears to determine final VA; early presentation and treatment did not seem to significantly alter the visual outcome, especially in severe poisoning.

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Dialysis in the poisoned patient

Cited by 38 publications

References 49 publications

The Role of Hemodialysis and Fomepizole in Ethylene Glycol Intoxication

The Role of Hemodialysis and Fomepizole in Ethylene Glycol Intoxication

Lethal but Reversible Encephalopathy Secondary to Lithium Toxicity: A Case Report and Review of Literature

Methanol Poisoning

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