[Secondary decontamination: when are hemodialysis and hemoperfusion indicated?]

Invasive methods of active removal, i.e., hemodialysis and hemoperfusion, are indicated for severely poisoned patients with substances causing tissue damage. Both methods will only be efficacious if the relative contribution of the extracorporal clearance to the overall elimination for a given substance is high and if the toxin has a relatively low apparent volume of distribution and a low tissue binding. Hemodialysis is recommended in severe life threatening intoxications with methanol, ethylene glycol, isopropyl alcohol, salicylates and lithium. Hemoperfusion is effective in removing theophylline and barbiturates. Patients with severe acute theophylline intoxication will benefit from hemoperfusion. Despite the very high clearance rates of barbiturates that can be obtained with hemoperfusion, the clinical usefulness of hemoperfusion remains to be proven.