Blood purification for intoxication

Blood purification is administered in cases of acute intoxication when the substance causing the intoxication is to be eliminated or when the substance leads to a case of organ dysfunction, such as in renal or hepatic failure. The causative substances cover a wide range, from medical drugs or agrichemicals to natural poisons (such as poisonous mushrooms). In removing these substances, gastric lavage, activated carbon administration, laxative administration or enema cleaning are the preferred methods, and blood purification is not routinely conducted. However, when the causative substance is unknown or when there are several causative substances, it is not easy to immediately grasp the disposition of the patient and so judge whether or not blood purification should be performed. In such cases, blood purification must be conducted in a timely manner and in accordance with the crisis management principle of 'prepare for the worst'. In general, substances whose molecular weight is within the removal spectrum, having a small distribution volume and a low protein-binding rate, are easier to remove. For substances with high protein-binding rates, albumin dialysis (MARS and Prometheus) is performed in order to remove albumin-binding substances. Since MARS and Prometheus have not been introduced in Japan, plasma diafiltration, employing selective plasma filtration with dialysis, is a practical alternative.