Extracorporeal Removal of Drugs and Toxins

Monaghan, Kelly; Acierno, Mark J.

doi:10.1016/j.cvsm.2010.09.005

Cited by 18 publications

(13 citation statements)

References 28 publications

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“…When treating intoxication due to agents that do not meet those criteria, the drug clearance by HD is low 6 . Hemoperfusion (HP) works by direct molecular adsorption by activated charcoal, and can remove any drug or toxin with affinity to charcoal, independent of molecular weight and plasma protein binding, until saturation of the filter is reached 7,8 . In‐series hemoperfusion and hemodialysis (HP/HD) is a combination therapy in which blood is first filtered with HP and then processed through an HD filter before returning to the patient.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of a single session in‐series hemoperfusion and hemodialysis in the management of carprofen overdose in two dogs

Fick

Messenger

Vigani

2020

J Vet Emergen Crit Care

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Objective To describe the efficacy of in‐series hemoperfusion and hemodialysis in 2 dogs with carprofen overdose. Case Summary This report describes the treatment of 2 dogs following accidental carprofen overdoses who underwent a single in‐series hemoperfusion and hemodialysis session. Serial serum carprofen concentrations were measured before, during, and after the session. The first patient's session lasted 5 hours, with the largest decrease in serum carprofen concentrations occurring during the first hour of treatment. The carprofen clearance during the following 4 hours of treatment decreased substantially compared to the first hour and was not different from the patient's intrinsic clearance of carprofen after the session was completed. Based on the findings from the first case, the second patient was treated with a 1 hour single hemoperfusion and hemodialysis session. Our results support the hypothesis that carprofen is not effectively removed by conventional hemodialysis and the efficacy of hemoperfusion is short lived due to rapid saturation of the charcoal filter. Once filter saturation occurs, the extracorporeal session is no longer efficacious. Using in‐series hemoperfusion and hemodialysis is of benefit to correct the side effects seen with hemoperfusion alone, and hourly charcoal filter replacement may extend the efficacy of treatment in removing carprofen. New or Unique Information Provided This is the first published report of in‐series hemoperfusion and hemodialysis being used to treat carprofen overdose in a dog. In these 2 cases, the intrinsic clearances of the patients were shown to be equivalent to that of standard hemodialysis alone, indicating that hemodialysis does not produce any advantage in carprofen clearance. In this limited report, we suggest that the efficacy of hemoperfusion in removing carprofen is short‐lived, and extending the treatment beyond the first hour does not produce any therapeutic benefit. In order to extend the efficacy of hemoperfusion, hourly replacement of the charcoal filter should be considered.

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Section: Introductionmentioning

confidence: 99%

Efficacy of a single session in‐series hemoperfusion and hemodialysis in the management of carprofen overdose in two dogs

Fick

Messenger

Vigani

2020

J Vet Emergen Crit Care

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“…The pharmacology of baclofen shows low molecular weight (214 Da), low-to-moderate volume of distribution (0.8–2.5 l/kg) and relatively low protein binding (30%). 6,7 For these reasons, hemodialysis with or without hemoperfusion are alternative therapeutic options for the management of severe baclofen toxicity. Hemodialysis has been successfully used to treat baclofen intoxication in people and dogs.…”

Section: Discussionmentioning

confidence: 99%

“…5 Baclofen has a small molecular weight (214 Da), lowto-moderate volume of distribution (0.8-2.5 l/kg), and relatively low protein binding (30%) in circulation, making it suitable for clearance by hemodialysis. 6,7 Two case reports of dogs with severe baclofen toxicity have shown successful treatment using hemodialysis: 8,9 one of the dogs was treated with hemodialysis in conjunction with hemoperfusion, and one required support with mechanical ventilation. To our knowledge this is the first report of a cat with severe signs of baclofen toxicity treated with hemodialysis and mechanical ventilation.…”

Section: Introductionmentioning

confidence: 99%

Management of severe baclofen toxicosis using hemodialysis in conjunction with mechanical ventilation in a cat with chronic kidney disease

Hoffman

Londoño

Martinez

2021

Journal of Feline Medicine and Surgery Open Reports

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Case summary A 2-year-old castrated male domestic shorthair cat was presented for evaluation of acute and progressive neurologic signs 2–4 h after exposure to baclofen. The suspected ingested dose was 2.1 mg/kg. On admission, the cat was tetraplegic with stuporous mentation, and venous blood gas analysis showed mild hypercapnia (PvCO2 43.4 mmHg) raising concern for hypoventilation. Owing to the acute nature of the ingestion, severity of the clinical signs and reported history of chronic kidney disease, hemodialysis was recommended to remove the toxin. A 5 h hemodialysis session was performed using an intermittent platform without hemoperfusion. At the beginning of hemodialysis, worsening hypoventilation and hypercapnia (PvCO2 88.6 mmHg) required endotracheal intubation and manual ventilation initially, followed by mechanical ventilation. At the end of the dialysis session, the cat was breathing spontaneously and disconnected from the ventilator. The cat was ambulatory and alert 1 h after the end of dialysis. After an additional 12 h of monitoring, the cat had full return of neurologic function and was discharged from hospital. Serum baclofen concentration measured prior to, during and after hemodialysis showed a 77.7% reduction in baclofen levels immediately after hemodialysis. Relevance and novel information This is the first report of baclofen toxicity in a cat successfully treated with hemodialysis and mechanical ventilation simultaneously. Treatment with hemodialysis therapy and mechanical ventilation could be considered in cases of acute baclofen toxicosis to improve outcome and reduce the length of the hospital stay.

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“…Protein serum anti bisa ular mempunyai berat molekul yang jauh lebih besar dari berat molekul venom dan volum distribusi yang lebih rendah dari venom. Perbedaan-pebedaan tersebut mempengaruhi potensi terafi dan efektifitas kerja serum anti bisa ular (Yanuartono, 2008 (Holubek, 2008;Monaghan, 2011 Kebanyakan obat mempunyai berat molekul < 500 Da, ada beberapa mempunyai berat molekul yang lebih besar seperti vancomycin sampai 1485 Da. CRRT telah digunakan sebagai terafi keracunan litium, carbamazepin, asam valproic, metformin, salisilat, teopilin, metotreksat dan racun-racun lainnya (Graffit, 1011;Chih, 2015;Goodman, 2006;Dargon, 2003).…”

Section: Pembahasanunclassified

Peranan Plasmafaresis pada Keracunan Bisa Ular Tipe Neurotoksik

Sumedi

2018

JPKM

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Female 19-year old with severe general neuroparalytic, admitted in intensive care unit with respiratory failure. He suffer from snake bite during night sleeping 2 hours before arrived in emergency unit of RSCM hospital. In early after snake bite, patient complained nausea, dizziness, limb parasthesia then felt uncomfortable eyesight. During observation in emergency unit anti venom serum (AVS) was given immediately 2 vial (10 ml) in 250 ml normal saline for an hour and then 2 vials in 250 normal saline in 3 hours ,but about 3 hours post bitten, patient suffer from ptosis, opthalmoplegia and quadriplegia, respiratory shortness followed by respiratory arrest. We diagnosed it as respiratory failure and neuromotoric paralytic ec. snake venom intoxication. After intubation and second dose AVS, patient moved to ICU for mechanical ventilation support and further treatment. We did CVVHDF for three days, AVS shcedulles 6 vials in 24 hours for 6 days. Until 7 days stay in ICU there were neuroparalytic improvement but not progressively and patient still on ventilator. Pasmapharesis then performed at 8thand 12th day in ICU. Weaning process going on smoothly and patient extubated at 14th day. Patient discharged from ICU at 16th day with fully aware, normal heart rate and blood pressureand score muscle strength is 4 until 5. We concluded that the neurotoxin venom in this case destructed vesicles presynaptic of nerve terminalmake resistant to AVS and neostigmin. We suspect this patient was exposedto high dose and more toxic venom where released continuously from bite site tissue or lymph circulation to blood and threaten recovery process. Plasmapharesis improve neuroparalytic and sympathetic overactivity significantlyand decrease lenght of stay in ICU.

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Extracorporeal Removal of Drugs and Toxins

Cited by 18 publications

References 28 publications

Efficacy of a single session in‐series hemoperfusion and hemodialysis in the management of carprofen overdose in two dogs

Efficacy of a single session in‐series hemoperfusion and hemodialysis in the management of carprofen overdose in two dogs

Management of severe baclofen toxicosis using hemodialysis in conjunction with mechanical ventilation in a cat with chronic kidney disease

Peranan Plasmafaresis pada Keracunan Bisa Ular Tipe Neurotoksik

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