Skip to main content
Erschienen in: Pediatric Nephrology 1/2024

29.03.2023 | Educational Review

Use of extracorporeal therapies to treat life-threatening intoxications

verfasst von: Kyle Deville, Nathan Charlton, David Askenazi

Erschienen in: Pediatric Nephrology | Ausgabe 1/2024

Einloggen, um Zugang zu erhalten

Abstract

Toxic ingestions are a significant cause of pediatric morbidity and mortality, with some requiring extracorporeal removal for therapy. Given the emergent and life-threatening nature of such scenarios, it is paramount that clinicians caring for intoxicated children be familiar with the subject. This review summarizes the following: (a) the properties of a substance which lend it amenable to removal; (b) the current extracorporeal treatment modalities available for such removal (of which hemodialysis is typically the ideal choice); (c) an introduction and framework to use a quick reference guide from the Extrip organization, which has a website available to guide clinicians’ rapid decisions; and (d) new membranes/approaches that may optimize clearance of certain intoxications.
Literatur
1.
Zurück zum Zitat Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Brooks DE, Dibert KW, Rivers LJ, Pham NPT, Ryan ML (2020) 2019 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 37th Annual Report. Clin Toxicol (Phila) 58:1360–1541CrossRefPubMed Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Brooks DE, Dibert KW, Rivers LJ, Pham NPT, Ryan ML (2020) 2019 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 37th Annual Report. Clin Toxicol (Phila) 58:1360–1541CrossRefPubMed
2.
Zurück zum Zitat Raina R, Grewal MK, Blackford M, Symons JM, Somers MJ, Licht C, Basu RK, Sethi SK, Chand D, Kapur G (2019) Renal replacement therapy in the management of intoxications in children: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) workgroup. Pediatr Nephrol 34:2427–2448CrossRefPubMed Raina R, Grewal MK, Blackford M, Symons JM, Somers MJ, Licht C, Basu RK, Sethi SK, Chand D, Kapur G (2019) Renal replacement therapy in the management of intoxications in children: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) workgroup. Pediatr Nephrol 34:2427–2448CrossRefPubMed
3.
Zurück zum Zitat Tyagi PK, Winchester JF, Feinfeld DA (2008) Extracorporeal removal of toxins. Kidney Int 74:1231–1233CrossRefPubMed Tyagi PK, Winchester JF, Feinfeld DA (2008) Extracorporeal removal of toxins. Kidney Int 74:1231–1233CrossRefPubMed
4.
Zurück zum Zitat Mirrakhimov AE, Barbaryan A, Gray A, Ayach T (2016) The role of renal replacement therapy in the management of pharmacologic poisonings. Int J Nephrol 2016 Mirrakhimov AE, Barbaryan A, Gray A, Ayach T (2016) The role of renal replacement therapy in the management of pharmacologic poisonings. Int J Nephrol 2016
5.
Zurück zum Zitat Levy G, Yaffe SJ (1974) Relationship between dose and apparent volume of distribution of salicyiate in children. Pediatr Res 8:365–365CrossRef Levy G, Yaffe SJ (1974) Relationship between dose and apparent volume of distribution of salicyiate in children. Pediatr Res 8:365–365CrossRef
8.
9.
Zurück zum Zitat Dudley MN, Shyu W, Nightingale C, Quintiliani R (1986) Effect of saturable serum protein binding on the pharmacokinetics of unbound cefonicid in humans. Antimicrob Agents Chemother 30:565–569CrossRefPubMedPubMedCentral Dudley MN, Shyu W, Nightingale C, Quintiliani R (1986) Effect of saturable serum protein binding on the pharmacokinetics of unbound cefonicid in humans. Antimicrob Agents Chemother 30:565–569CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Allawati H, Dallas L, Nair S, Palmer J, Thaikandy S, Hutchison C (2020) A pharmacokinetic study comparing the clearance of vancomycin during haemodialysis using medium cut-off membrane (theranova) and high-flux membranes (revaclear). Toxins 12:317CrossRefPubMedPubMedCentral Allawati H, Dallas L, Nair S, Palmer J, Thaikandy S, Hutchison C (2020) A pharmacokinetic study comparing the clearance of vancomycin during haemodialysis using medium cut-off membrane (theranova) and high-flux membranes (revaclear). Toxins 12:317CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Weidhase L, Haussig E, Haussig S, Kaiser T, de Fallois J, Petros S (2019) Middle molecule clearance with high cut-off dialyzer versus high-flux dialyzer using continuous veno-venous hemodialysis with regional citrate anticoagulation: a prospective randomized controlled trial. PLoS One 14:e0215823CrossRefPubMedPubMedCentral Weidhase L, Haussig E, Haussig S, Kaiser T, de Fallois J, Petros S (2019) Middle molecule clearance with high cut-off dialyzer versus high-flux dialyzer using continuous veno-venous hemodialysis with regional citrate anticoagulation: a prospective randomized controlled trial. PLoS One 14:e0215823CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Amyot S-L, Leblanc M, Thibeault Y, Geadah D, Cardinal J (1999) Myoglobin clearance and removal during continuous venovenous hemofiltration. Intensive Care Med 25:1169–1172CrossRefPubMed Amyot S-L, Leblanc M, Thibeault Y, Geadah D, Cardinal J (1999) Myoglobin clearance and removal during continuous venovenous hemofiltration. Intensive Care Med 25:1169–1172CrossRefPubMed
13.
Zurück zum Zitat Ghannoum M, Hoffman RS, Gosselin S, Nolin TD, Lavergne V, Roberts DM (2018) Use of extracorporeal treatments in the management of poisonings. Kidney Int 94:682–688CrossRefPubMed Ghannoum M, Hoffman RS, Gosselin S, Nolin TD, Lavergne V, Roberts DM (2018) Use of extracorporeal treatments in the management of poisonings. Kidney Int 94:682–688CrossRefPubMed
14.
Zurück zum Zitat De Pont AC (2007) Extracorporeal treatment of intoxications. Curr Opin Crit Care 13:668–673CrossRefPubMed De Pont AC (2007) Extracorporeal treatment of intoxications. Curr Opin Crit Care 13:668–673CrossRefPubMed
15.
16.
Zurück zum Zitat Warady BA, Schaefer F, Alexander SR (2011) Pediatric dialysis. Third edition. Springer Nature Switzerland, Cham Warady BA, Schaefer F, Alexander SR (2011) Pediatric dialysis. Third edition. Springer Nature Switzerland, Cham
17.
18.
Zurück zum Zitat Kane SL, Constantiner M, Staubus AE, Meinecke CD, Sedor JR (2000) High-flux hemodialysis without hemoperfusion is effective in acute valproic acid overdose. Ann Pharmacother 34:1146–1151CrossRefPubMed Kane SL, Constantiner M, Staubus AE, Meinecke CD, Sedor JR (2000) High-flux hemodialysis without hemoperfusion is effective in acute valproic acid overdose. Ann Pharmacother 34:1146–1151CrossRefPubMed
19.
Zurück zum Zitat Sikma M, Van den Broek M, Meulenbelt J (2012) Increased unbound drug fraction in acute carbamazepine intoxication: suitability and effectiveness of high-flux haemodialysis. Intensive Care Med 38:916–917CrossRefPubMedPubMedCentral Sikma M, Van den Broek M, Meulenbelt J (2012) Increased unbound drug fraction in acute carbamazepine intoxication: suitability and effectiveness of high-flux haemodialysis. Intensive Care Med 38:916–917CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Spinale JM, Laskin BL, Sondheimer N, Swartz SJ, Goldstein SL (2013) High-dose continuous renal replacement therapy for neonatal hyperammonemia. Pediatr Nephrol 28:983–986CrossRefPubMedPubMedCentral Spinale JM, Laskin BL, Sondheimer N, Swartz SJ, Goldstein SL (2013) High-dose continuous renal replacement therapy for neonatal hyperammonemia. Pediatr Nephrol 28:983–986CrossRefPubMedPubMedCentral
23.
24.
Zurück zum Zitat Szczepiorkowski ZM, Winters JL, Bandarenko N, Kim HC, Linenberger ML, Marques MB, Sarode R, Schwartz J, Weinstein R, Shaz BH (2010) Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher 25:83–177CrossRefPubMed Szczepiorkowski ZM, Winters JL, Bandarenko N, Kim HC, Linenberger ML, Marques MB, Sarode R, Schwartz J, Weinstein R, Shaz BH (2010) Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher 25:83–177CrossRefPubMed
25.
Zurück zum Zitat Schutt RC, Ronco C, Rosner MH (2012) The role of therapeutic plasma exchange in poisonings and intoxications. Semin Dial 25:201–206CrossRefPubMed Schutt RC, Ronco C, Rosner MH (2012) The role of therapeutic plasma exchange in poisonings and intoxications. Semin Dial 25:201–206CrossRefPubMed
26.
Zurück zum Zitat Peszynski P, Klammt S, Peters E, Mitzner S, Stange J, Schmidt R, Peszynski P, Klammt S, Peters E, Mitzner S (2002) Albumin dialysis: single pass vs. recirculation (MARS). Liver 22:40–42CrossRefPubMed Peszynski P, Klammt S, Peters E, Mitzner S, Stange J, Schmidt R, Peszynski P, Klammt S, Peters E, Mitzner S (2002) Albumin dialysis: single pass vs. recirculation (MARS). Liver 22:40–42CrossRefPubMed
27.
Zurück zum Zitat Vilay AM, Mueller BA, Haines H, Alten JA, Askenazi DJ (2010) Treatment of methotrexate intoxication with various modalities of continuous extracorporeal therapy and glucarpidase. Pharmacotherapy 30:111CrossRefPubMed Vilay AM, Mueller BA, Haines H, Alten JA, Askenazi DJ (2010) Treatment of methotrexate intoxication with various modalities of continuous extracorporeal therapy and glucarpidase. Pharmacotherapy 30:111CrossRefPubMed
28.
Zurück zum Zitat Kıhtır HS, Yıldırım HM, Yeşilbaş O, Duramaz BB, Şevketoğlu E (2016) Single-pass albumin dialysis in a child aged six months with phenobarbital poisoning. Turk Arch Pediatr 51:228CrossRef Kıhtır HS, Yıldırım HM, Yeşilbaş O, Duramaz BB, Şevketoğlu E (2016) Single-pass albumin dialysis in a child aged six months with phenobarbital poisoning. Turk Arch Pediatr 51:228CrossRef
29.
Zurück zum Zitat Chung YK, Chang KY, Park HS, Kim MH, Lee KM, Lim TS, Kim HW (2014) Severe carbamazepine intoxication unresponsive to albumin-enhanced continuous venovenous hemodiafiltration with low dialysate flow. Hemodial Int 18:551–555CrossRefPubMed Chung YK, Chang KY, Park HS, Kim MH, Lee KM, Lim TS, Kim HW (2014) Severe carbamazepine intoxication unresponsive to albumin-enhanced continuous venovenous hemodiafiltration with low dialysate flow. Hemodial Int 18:551–555CrossRefPubMed
30.
Zurück zum Zitat Koivusalo AM, Yildirim Y, Vakkuri A, Lindgren L, Höckerstedt K, Isoniemi H (2003) Experience with albumin dialysis in five patients with severe overdoses of paracetamol. Acta Anaesthesiol Scand 47:1145–1150CrossRefPubMed Koivusalo AM, Yildirim Y, Vakkuri A, Lindgren L, Höckerstedt K, Isoniemi H (2003) Experience with albumin dialysis in five patients with severe overdoses of paracetamol. Acta Anaesthesiol Scand 47:1145–1150CrossRefPubMed
31.
Zurück zum Zitat McIntyre CW, Fluck RJ, Freeman JG, Lambie SH (2002) Use of albumin dialysis in the treatment of hepatic and renal dysfunction due to paracetamol intoxication. Nephrol Dial Transplant 17:316–317CrossRefPubMed McIntyre CW, Fluck RJ, Freeman JG, Lambie SH (2002) Use of albumin dialysis in the treatment of hepatic and renal dysfunction due to paracetamol intoxication. Nephrol Dial Transplant 17:316–317CrossRefPubMed
32.
Zurück zum Zitat Pichon N, François B, Clavel M, Vignon P, Chevreuil C, Michel Gaulier J (2006) Albumin dialysis: a new therapeutic alternative for severe diltiazem intoxication. Clin Toxicol 44:195–196CrossRef Pichon N, François B, Clavel M, Vignon P, Chevreuil C, Michel Gaulier J (2006) Albumin dialysis: a new therapeutic alternative for severe diltiazem intoxication. Clin Toxicol 44:195–196CrossRef
33.
Zurück zum Zitat Dobisova A, Vavrinec P, Vavrincova-Yaghi D, Gebhardtova A, Henning RH, Yaghi A (2021) Case report: enhanced diazepam elimination with the molecular adsorbents recirculating system (MARS) in severe autointoxication: a survival case report. Front Med 8:189CrossRef Dobisova A, Vavrinec P, Vavrincova-Yaghi D, Gebhardtova A, Henning RH, Yaghi A (2021) Case report: enhanced diazepam elimination with the molecular adsorbents recirculating system (MARS) in severe autointoxication: a survival case report. Front Med 8:189CrossRef
34.
Zurück zum Zitat Covic A, Goldsmith DJ, Gusbeth-Tatomir P, Volovat C, Dimitriu AG, Cristogel F, Bizo A (2003) Successful use of molecular absorbent regenerating system (MARS) dialysis for the treatment of fulminant hepatic failure in children accidentally poisoned by toxic mushroom ingestion. Liver Int 23:21–27CrossRefPubMed Covic A, Goldsmith DJ, Gusbeth-Tatomir P, Volovat C, Dimitriu AG, Cristogel F, Bizo A (2003) Successful use of molecular absorbent regenerating system (MARS) dialysis for the treatment of fulminant hepatic failure in children accidentally poisoned by toxic mushroom ingestion. Liver Int 23:21–27CrossRefPubMed
35.
Zurück zum Zitat Prokurat S, Grenda R, Lipowski D, Kaliciński P, Migdal M, Prokurat S, Grenda R, Lipowski D, Kaliciński P, Migdal M (2002) MARS procedure as a bridge to combined liver–kidney transplantation in severe chromium–copper acute intoxication: a paediatric case report. Liver 22:76–77CrossRefPubMed Prokurat S, Grenda R, Lipowski D, Kaliciński P, Migdal M, Prokurat S, Grenda R, Lipowski D, Kaliciński P, Migdal M (2002) MARS procedure as a bridge to combined liver–kidney transplantation in severe chromium–copper acute intoxication: a paediatric case report. Liver 22:76–77CrossRefPubMed
36.
Zurück zum Zitat Sen S, Ratnaraj N, Davies NA, Mookerjee RP, Cooper CE, Patsalos PN, Williams R, Jalan R (2003) Treatment of phenytoin toxicity by the molecular adsorbents recirculating system (MARS). Epilepsia 44:265–267CrossRefPubMed Sen S, Ratnaraj N, Davies NA, Mookerjee RP, Cooper CE, Patsalos PN, Williams R, Jalan R (2003) Treatment of phenytoin toxicity by the molecular adsorbents recirculating system (MARS). Epilepsia 44:265–267CrossRefPubMed
37.
Zurück zum Zitat Korsheed S, Selby NM, Fluck RJ (2007) Treatment of severe theophylline poisoning with the molecular adsorbent recirculating system (MARS). Nephrol Dial Transplant 22:969–970CrossRefPubMed Korsheed S, Selby NM, Fluck RJ (2007) Treatment of severe theophylline poisoning with the molecular adsorbent recirculating system (MARS). Nephrol Dial Transplant 22:969–970CrossRefPubMed
38.
Zurück zum Zitat Wittebole X, Hantson P (2011) Use of the molecular adsorbent recirculating system (MARS™) for the management of acute poisoning with or without liver failure. Clin Toxicol 49:782–793CrossRef Wittebole X, Hantson P (2011) Use of the molecular adsorbent recirculating system (MARS™) for the management of acute poisoning with or without liver failure. Clin Toxicol 49:782–793CrossRef
39.
Zurück zum Zitat Lavergne V, Nolin TD, Hoffman RS, Roberts D, Gosselin S, Goldfarb DS, Kielstein JT, Mactier R, Maclaren R, Mowry JB (2012) The EXTRIP (extracorporeal treatments in poisoning) workgroup: guideline methodology. Clin Toxicol 50:403–413CrossRef Lavergne V, Nolin TD, Hoffman RS, Roberts D, Gosselin S, Goldfarb DS, Kielstein JT, Mactier R, Maclaren R, Mowry JB (2012) The EXTRIP (extracorporeal treatments in poisoning) workgroup: guideline methodology. Clin Toxicol 50:403–413CrossRef
Metadaten
Titel
Use of extracorporeal therapies to treat life-threatening intoxications
verfasst von
Kyle Deville
Nathan Charlton
David Askenazi
Publikationsdatum
29.03.2023
Verlag
Springer Berlin Heidelberg
Erschienen in
Pediatric Nephrology / Ausgabe 1/2024
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-023-05937-7

Weitere Artikel der Ausgabe 1/2024

Pediatric Nephrology 1/2024 Zur Ausgabe

Embryotransfer erhöht womöglich Leukämierisiko der Kinder

13.05.2024 Assistierte Reproduktion Nachrichten

Reproduktionsmedizinische Techniken haben theoretisch das Potenzial, den epigenetischen Code zu verändern und somit das Krebsrisiko der Kinder zu erhöhen. Zwischen Embryotransfer und Leukämie scheint sich ein solcher Zusammenhang bestätigt zu haben.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Häufigste Gründe für Brustschmerzen bei Kindern

06.05.2024 Pädiatrische Diagnostik Nachrichten

Akute Brustschmerzen sind ein Alarmsymptom par exellence, schließlich sind manche Auslöser lebensbedrohlich. Auch Kinder klagen oft über Schmerzen in der Brust. Ein Studienteam ist den Ursachen nachgegangen.

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.