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We use Continuous Renal Replacement Therapy for Overdoses and Intoxications
Valerie Jorge Cabrera1, Anushree C Shirali1
1Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut.
Seminars in Dialysis
|April 30, 2016
Summary
Continuous renal replacement therapy (CRRT) is increasingly reported for drug and toxin removal in overdoses. However, CRRT generally lacks a role in routine intoxication management, with few exceptions.
Area of Science:
- Nephrology
- Toxicology
- Critical Care Medicine
Background:
- Extracorporeal therapies like hemodialysis (HD) and charcoal hemoperfusion (HP) are established for drug/toxin removal in overdoses.
- Continuous renal replacement therapy (CRRT) modalities (CVVHD, CVVH, CVVHDF) are increasingly explored for intoxications.
Purpose of the Study:
- To discuss factors influencing drug and toxin clearance by extracorporeal methods.
- To evaluate the utility of CRRT in the routine management of intoxications.
Main Methods:
- Review of established and emerging extracorporeal removal techniques for drugs and toxins.
- Analysis of factors affecting clearance rates in different modalities.
Main Results:
- Hemodialysis (HD), high-flux HD (HfD), and charcoal hemoperfusion (HP) are well-established.
- CRRT modalities show potential but require careful consideration of clearance factors.
- CRRT is generally not recommended for routine intoxication management.
Conclusions:
- The efficacy of extracorporeal therapies depends on drug/toxin properties and modality characteristics.
- CRRT has limited application in standard intoxication treatment protocols.
- Further research may define specific indications for CRRT in complex poisoning cases.
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