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Related Concept Videos

Extracorporeal Removal of Drugs: Hemoperfusion and Hemofiltration01:25

Extracorporeal Removal of Drugs: Hemoperfusion and Hemofiltration

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Hemoperfusion and hemofiltration are critical techniques in medical treatments to eliminate accumulated drugs, metabolites, and electrolytes from the bloodstream. These methods are particularly vital in cases of accidental poisoning and drug overdose.Hemoperfusion involves passing blood through an adsorbent material to remove unwanted substances. The main adsorbents used in hemoperfusion include activated charcoal and Amberlite resins. Activated charcoal can adsorb both polar and nonpolar...
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Extracorporeal Removal of Drugs: Peritoneal Dialysis and Hemodialysis01:30

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Patients with end-stage renal disease (ESRD) or those experiencing drug overdose often require extracorporeal methods to eliminate accumulated drugs and metabolites. Hemoperfusion, hemofiltration, and dialysis are the primary techniques to rapidly remove harmful substances without disrupting the patient's fluid and electrolyte balance. For those with compromised renal function, dosage adjustments of concurrent medications may be necessary during extracorporeal drug removal.Dialysis is a process...
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Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow01:26

Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow

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Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug...
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Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy01:26

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Continuous Renal Replacement Therapy (CRRT) is an essential intervention for patients experiencing severe kidney dysfunction. This therapy offers a continuous mechanism for removing fluids and toxins from the bloodstream, leveraging the patient’s blood pressure to facilitate filtration through a specialized filter. This method contrasts with intermittent dialysis, providing a gentler and more consistent removal of waste products and excess fluid, which is particularly beneficial in...
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Acute Kidney Injury V: Interprofessional Care01:20

Acute Kidney Injury V: Interprofessional Care

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Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
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Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test01:22

Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test

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In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
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Plasma exchange in acute liver failure.

Hampton B Sasser1, David G Koch

  • 1Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA.

Current Opinion in Gastroenterology
|March 5, 2026
PubMed
Summary

Plasma exchange offers a survival benefit for acute liver failure patients, acting as a bridge to recovery or transplant. Effective use requires careful patient selection and prompt initiation of this critical intervention.

Keywords:
acute liver failureoverall survivalplasma exchangetransplant-free survival

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Area of Science:

  • Hepatology
  • Critical Care Medicine
  • Transplantation

Background:

  • Acute liver failure (ALF) is a critical condition necessitating intensive care or liver transplantation.
  • Plasma exchange (PLEX) is explored as a supportive therapy to facilitate hepatic recovery or bridge to transplant.

Purpose of the Study:

  • To elucidate the physiological rationale behind PLEX in ALF.
  • To provide historical context for PLEX application in ALF.
  • To review and analyze recent evidence regarding PLEX efficacy in ALF management.

Main Methods:

  • Review of existing literature and meta-analyses on plasma exchange for acute liver failure.
  • Analysis of heterogeneity in study designs, patient characteristics, and outcome measures.
  • Discussion of recent clinical trial results and their implications.

Main Results:

  • Meta-analyses suggest a survival benefit with PLEX in ALF, but individual study results are inconsistent.
  • Significant heterogeneity exists in studies regarding patient populations, ALF etiologies, PLEX protocols, and outcome assessments.
  • Recent evidence presents a complex and mixed picture of PLEX's role in current ALF treatment strategies.

Conclusions:

  • PLEX has a sound physiological basis for treating ALF.
  • Prospective studies indicate PLEX can improve survival rates in ALF patients.
  • Optimal outcomes with PLEX are contingent upon judicious patient selection and timely intervention.