The use of sustained low efficiency dialysis (SLED) in massive paracetamol overdose

Wong, Anselm; Tong, Roger Lien-Kien; Ryan, Liam; Crozier, Tim M.; Graudins, Andis

doi:10.1080/15563650.2017.1358366

Cited by 5 publications

(6 citation statements)

References 12 publications

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“…[41][42][43][44] Hemodialysis is reported as an effective treatment in the severe acetaminophen exposure. 45,46 However, hemodialysis is generally not recommended to treat acetaminophen-poisoned patients. 47 Altogether, these studies showed a possible association between treatment with fomepizole and hemodialysis in severe acetaminophen-poisoned patients.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors of acetaminophen exposure in the United States: An analysis of 39,000 patients

et al. 2021

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Acetaminophen is a frequently used over-the-counter or prescribed medication in the United States. Exposure to acetaminophen can lead to acute liver cytolysis, acute liver failure, acute kidney injury, encephalopathy, and coagulopathy. This retrospective cohort study (1/1/2012 to 12/31/2017) investigated the clinical outcomes of intentional and unintentional acetaminophen exposure using the National Poison Data System data. The frequency of outcomes, chronicity, gender, route of exposure, the reasons for exposure, and treatments as described. Binary logistic regression was used to estimate the prognostic factors and odds ratios (OR) with 95% confidence intervals (CI) for outcomes. This study included 39,022 patients with acetaminophen exposure. Our study demonstrated that the likelihood of developing severe outcomes increased by aging (OR = 1.12, 95% CI: 1.08–1.015) and was lower in females (OR = 0.88, 95% CI: 0.78–0.99). Drowsiness/lethargy (OR = 1.48, 95% CI: 1.22–1.82), agitation (OR = 1.66, 95% CI: 1.11–2.50), coma (OR = 23.95, 95% CI: 17.05–33.64), bradycardia (OR = 2.29, 95% CI: 1.22–4.32), rhabdomyolysis (OR = 8.84, 95% CI: 3.71–21.03), hypothermia (OR = 4.1, 95% CI: 1.77–9.51), and hyperthermia 2.10 (OR = 2.10, 95% CI: 1.04–4.22) were likely associated with major outcomes or death. Treatments included intravenous N-acetylcysteine (61%), oral N-acetylcysteine (10%), vasopressor (1%), hemodialysis (0.7%), fomepizole (0.1%), hemoperfusion (0.03%), and liver transplant (0.1%). In conclusion, it is important to consider clinical presentations of patients with acetaminophen toxicity that result in major outcomes and mortality to treat them effectively.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors of acetaminophen exposure in the United States: An analysis of 39,000 patients

et al. 2021

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“…The suggested strategies in such scenarios are to increase the dose and duration of NAC, removal of acetaminophen from blood by an extracorporeal therapy (SLED, CVVH, PLEX, or MARS), and in dire circumstances, liver transplantation. [3][4][5][6][7][8][9][10][11]13 The Extracorporeal Treatments in Poisoning workgroup recommends extracorporeal therapies such as intermittent HD, CVVH, or PLEX in acetaminophen poisoning, where there is evidence of mitochondrial dysfunction and exceedingly high drug levels. 7 The Pediatric Continuous Renal Replacement Therapy workgroup recommended to startrenal replacement therapy (RRT) with HD for severe acetaminophen toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…2 If there is no improvement, extracorporeal therapies such as hemodialysis (HD), sustained low efficiency dialysis (SLED), continuous venovenous hemofiltration (CVVH), high-volume plasma exchange (PLEX), and molecular adsorbent recirculating system (MARS) can be used as rescue measures. [3][4][5][6][7][8][9][10][11][12] Here, we present an 18-month-old male infant who had presented with fulminant liver failure following accidental ingestion of acetaminophen. CVVH was used as a rescue therapy, which led to complete recovery.…”

Section: Introductionmentioning

confidence: 99%

Continuous Venovenous Hemofiltration as a Rescue Therapy for Severe Acetaminophen Toxicity in a Toddler

Awasthi

Jindal

Sharma

et al. 2020

J Pediatr Intensive Care

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Acetaminophen poisoning is one of the common accidental poisoning in children. Accidental administration of mismatched doses of drops for syrups can lead to life-threatening overdose. N-acetylcysteine (NAC) is the specific antidote; however, extracorporeal therapy such as continuous venovenous hemofiltration (CVVH) can be used as a rescue measure when there is no improvement despite adequate NAC therapy and can be lifesaving. We reported an 18-month-old male infant who presented with acetaminophen poisoning following accidental ingestion of acetaminophen drops in place of syrup and developed fulminant hepatic failure. Treatment with NAC did not lead to improvement and CVVH was used as a rescue therapy for 24 hours which led to dramatic clinical and biochemical improvement with intact neurological outcome.

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“…Usual settings for a patient with acute renal insufficiency would be blood and dialysate flows of 200 ml/min with a substitution fluid rate of 100 ml/min. There are case reports of its use in various toxicities, involving similar flow rate parameters, however, trial data are lacking [95][96][97][98]. SLED likely achieves outcomes which balance the advantages and disadvantages of intermittent and continuous modalities, similar to its place in the management spectrum for kidney failure.…”

Section: Continuous Renal Replacement Therapymentioning

confidence: 99%

Dialysis and extracorporeal therapies for enhanced elimination of toxic ingestions and poisoning

Yaxley

Scott

2022

Ther Apher Dial

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Poisoning and toxic ingestions cause significant morbidity and mortality worldwide. Extracorporeal therapies such as dialysis, hemoperfusion, and plasma exchange are selectively applied to patients with severe intoxications unresponsive to standard interventions and can be lifesaving. Extracorporeal therapies are a complex but fundamental aspect of the practice of nephrology.Without high-quality evidence to guide implementation, an understanding of toxicokinetics and the physiochemical principles of the enhanced elimination techniques is especially important. This review provides a comphrensive, userfriendly outline of the application of extracorporeal therapy in the poisoned patient.

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The use of sustained low efficiency dialysis (SLED) in massive paracetamol overdose

Abstract: SLED improved acidaemia with only moderate overall increase in paracetamol plasma clearance. Lack of development of hepatotoxicity was likely the result of early administration of acetylcysteine rather than any effect of SLED on paracetamol elimination.

Cited by 5 publications

References 12 publications

Prognostic factors of acetaminophen exposure in the United States: An analysis of 39,000 patients

Prognostic factors of acetaminophen exposure in the United States: An analysis of 39,000 patients

Continuous Venovenous Hemofiltration as a Rescue Therapy for Severe Acetaminophen Toxicity in a Toddler

Dialysis and extracorporeal therapies for enhanced elimination of toxic ingestions and poisoning

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