Enhanced poison elimination in critical care.

Marc Ghannoum, Sophie Gosselin

University of Montreal, Verdun Hospital, Montreal, Qc, Canada H4G2A3. marcghannoum@gmail.com

Advances in chronic kidney disease 2013 Jan

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Nephrologists and critical care physicians are commonly involved in the treatment of severely poisoned patients. Various techniques exist presently to enhance the elimination of poisons. Corporeal treatments occur inside of the body and include multiple-dose activated charcoal, resin binding, forced diuresis, and urinary pH alteration. Extracorporeal treatments include hemodialysis, hemoperfusion, peritoneal dialysis, continuous renal replacement therapy, exchange transfusion, and plasmapheresis. This review illustrates the potential indications and limitations in the application of these modalities as well as the pharmacological characteristics of poisons amenable to enhanced elimination. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.