Blood Purification in Toxicology: Nephrology’s Ugly Duckling

Ghannoum, Marc; Nolin, Thomas D.; Lavergne, Valéry; Hoffman, Robert S.

doi:10.1053/j.ackd.2011.01.008

Cited by 49 publications

(33 citation statements)

References 29 publications

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“…In a review of the history of blood purification in toxicology, Ghannoum and colleagues examined changes in technology over time [37].…”

Section: Changes In Technologymentioning

confidence: 99%

“…But even as the technologies evolved as well, there is little data on outcomes beyond case reports to describe the optimal use of those technologies to improve patient outcomes [79,80]. Few toxicokinetic studies have been performed in clinical poisoning, and data are largely extrapolated from animal studies or studies in humans of pharmacokinetics of therapeutic drugs [37]. Some experts consider that to be effective, extracorporeal therapy must increase clearance of poisons by 30-40% over their endogenous removal [81], extrapolating from basic principles put forth in the 1950s that the removal of poisons can best be increased by enlarging the membrane surface area and the time on dialysis [82].…”

Section: Extripmentioning

confidence: 99%

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Developments in extracorporeal therapy for the poisoned patient

Patel

Bayliss

2015

Advanced Drug Delivery Reviews

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“…In a review of the history of blood purification in toxicology, Ghannoum and colleagues examined changes in technology over time [37].…”

Section: Changes In Technologymentioning

confidence: 99%

Section: Extripmentioning

confidence: 99%

Developments in extracorporeal therapy for the poisoned patient

Patel

Bayliss

2015

Advanced Drug Delivery Reviews

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“…The Extracorporeal Treatments in Poisoning (EXTRIP) Workgroup consists of an international panel of experts whose primary mission is to develop evidence-based recommendations for the use of extracorporeal treatments (ECTRs) for poisonings (1)(2)(3)(4)(5)(6)(7). Members of the EXTRIP Workgroup provide expertise from a broad range of medical specialties and represent diverse professional societies (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal Treatment for Lithium Poisoning

Decker¹,

Goldfarb²,

Dargan³

et al. 2015

Clinical Journal of the American Society of Nephrology

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139

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on behalf of the EXTRIP Workgroup Abstract The Extracorporeal Treatments in Poisoning Workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments in poisoning. Here, the EXTRIP workgroup presents its recommendations for lithium poisoning. After a systematic literature search, clinical and toxicokinetic data were extracted and summarized following a predetermined format. The entire workgroup voted through a two-round modified Delphi method to reach a consensus on voting statements. A RAND/UCLA Appropriateness Method was used to quantify disagreement, and anonymous votes were compiled and discussed in person. A second vote was conducted to determine the final workgroup recommendations. In total, 166 articles met inclusion criteria, which were mostly case reports, yielding a very low quality of evidence for all recommendations. A total of 418 patients were reviewed, 228 of which allowed extraction of patient-level data. The workgroup concluded that lithium is dialyzable (Level of evidence=A) and made the following recommendations: Extracorporeal treatment is recommended in severe lithium poisoning (1D).

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“…It was assembled to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning (www.extrip-workgroup.org). Rationale, background, objectives, and complete methods of this endeavor, supported by the Acute Dialysis Quality Initiative, were reported previously (1,2).…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal Treatment for Thallium Poisoning

Ghannoum¹,

Nolin²,

Goldfarb³

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl).Methods After an extensive search, the co-chairs reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Blinded votes were compiled, returned, and discussed during a conference call. A second vote determined the final recommendations.Results Forty-five articles met inclusion criteria. Only case reports and case series were identified, yielding a very low quality of evidence for all recommendations. Data on 74 patients, including 11 who died, were abstracted. The workgroup concluded that Tl is slightly dialyzable and made the following recommendations: ECTR is recommended in severe Tl poisoning (1D). ECTR is indicated if Tl exposure is highly suspected on the basis of history or clinical features (2D) or if the serum Tl concentration is .1.0 mg/L (2D). ECTR should be initiated as soon as possible, ideally within 24-48 hours of Tl exposure (1D), and be continued until the serum Tl concentration is ,0.1 mg/L for a minimal duration of 72 hours (2D).Conclusion Despite Tl's low dialyzability and the limited evidence, the workgroup strongly recommended extracorporeal removal in the case of severe Tl poisoning.

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Blood Purification in Toxicology: Nephrology’s Ugly Duckling

Cited by 49 publications

References 29 publications

Developments in extracorporeal therapy for the poisoned patient

Developments in extracorporeal therapy for the poisoned patient

Extracorporeal Treatment for Lithium Poisoning

Extracorporeal Treatment for Thallium Poisoning

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