Intermittent peritoneal dialysis using 5 per cent albumin in the treatment of salicylate intoxication in children

Etteldorf, James N.; Dobbins, William T.; Summitt, Robert L.; Rainwater, Weldon T.; Fischer, Robert L.

doi:10.1016/s0022-3476(61)80162-5

Cited by 66 publications

(9 citation statements)

References 7 publications

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“…This opens up the possibility of removing protein-bound uremic toxins and the treatment of intoxications from drugs that are highly protein-bound, e.g., digoxin and salicylates. In children with salicylate intoxication, three exchanges of peritoneal dialysate containing 5% albumin removed 574 mg of salicylate in 9 h. Over the same period of time, only 128 mg of salicylate were excreted by the kidneys [23].…”

Section: Awak: Proof Of Conceptsmentioning

confidence: 99%

A peritoneal-based automated wearable artificial kidney

Lee

Roberts

2008

Clin Exp Nephrol

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Work on wearable kidneys has evolved around the technology of hemodialysis or hemofiltration, which call for continuous anticoagulation of the extracoporeal circulation and are encumbered with potential immunologic and non-immunologic complications of continuous blood-artificial membrane interactions. A peritoneal-based automated wearable artificial kidney (AWAK) requires no extracorporeal circulation and is therefore "bloodless." Because AWAK is designed to continuously regenerate and reuse the spent dialysate in perpetuity, it is also "waterless." A sorbent-based assembly regenerates both the aqueous and the protein components (AqC and PrC) of the spent dialysate, producing a novel, autologous protein-containing dialysate. The regenerated AqC has the same composition as the commercially available peritoneal dialysate, but contains bicarbonate instead of lactate and has a more physiological pH. The regenerated PrC is recycled back into the peritoneal cavity, thereby ameliorating or eliminating protein loss. Depending on the steady-state protein concentrations that can be achieved (under the condition of continuous dialysate regeneration and recycling), the PrC also has the potential of both augmenting ultrafiltration and mediating the removal of protein-bound toxins. Additional sorbents can be incorporated into AWAK for the removal of middle molecular weight uremic toxins. At a regeneration rate of 4 l/h, AWAK provides a dialysate flow of 96 l/day (8-12 times the current rate). Round-the-clock dialysis and ultrafiltration provide steady-state metabolic-biochemical and fluid balance regulation, thereby eliminating "shocks" of abrupt changes in these parameters that characterize the current dialytic modalities. Dialysis-on-the-go, made possible by AWAK's "wearability" and automation, frees end-stage renal failure patients from the servitude that is demanded by the current dialytic regimentations.

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Section: Awak: Proof Of Conceptsmentioning

confidence: 99%

A peritoneal-based automated wearable artificial kidney

Lee

Roberts

2008

Clin Exp Nephrol

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“…Three children developed symptoms within 24 hours of ingestion, but the exact time is unknown (33,39). Two reports (level 4) described cases in which effects began 7-8 hours after ingestion (112,183). In a case series (level 4), some children who arrived at a hospital as late as 54 hours after ingestion with symptoms were noted, but their clinical effects had developed at an unknown time prior to arrival (184).…”

Section: Aspirinmentioning

confidence: 99%

Salicylate poisoning: An evidence-based consensus guideline for out-of-hospital management

Chyka

Erdman

Christianson

et al. 2007

Clinical Toxicology

114

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American Association of Poison Control Centers, Washington, District of Columbia, USAA review of U.S. poison center data for 2004 showed over 40,000 exposures to salicylate-containing products. A guideline that determines the conditions for emergency department referral and pre-hospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial out-of-hospital management of patients with a suspected exposure to salicylates by 1) describing the process by which a specialist in poison information should evaluate an exposure to salicylates, 2) identifying the key decision elements in managing cases of salicylate exposure, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses: 1) Patients with stated or suspected self-harm or who are the victims of a potentially malicious administration of a salicylate, should be referred to an emergency department immediately. This referral should be guided by local poison center procedures. In general, this should occur regardless of the dose reported (Grade D).2) The presence of typical symptoms of salicylate toxicity such as hematemesis, tachypnea, hyperpnea, dyspnea, tinnitus, deafness, lethargy, seizures, unexplained lethargy, or confusion warrants referral to an emergency department for evaluation (Grade C). 3) Patients who exhibit typical symptoms of salicylate toxicity or nonspecific symptoms such as unexplained lethargy, confusion, or dyspnea, which could indicate the development of chronic salicylate toxicity, should be referred to an emergency department (Grade C). 4) Patients without evidence of self-harm should have further evaluation, including determination of the dose, time of ingestion, presence of symptoms, history of other medical conditions, and the presence of co-ingestants. The acute ingestion of more than 150 mg/kg or 6.5 g of aspirin equivalent, whichever is less, war...

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“…These advances were so pivotal that pediatric nephrology subsequently could never be considered as part of any other discipline (Table 2). In order of discovery, these events were: 1) that ACTH or glucocorticoids could induce remission in the common form of childhood nephrotic syndrome; 2) that a percutaneous renal biopsy in a child with urinary abnormalities could help define the clinicopathologic features of the underlying renal disorder and could distinguish histologic variants of the nephrotic syndrome; 3) newly emerging immunologic techniques could be used to help define the 772 CHESNEY nature and mechanism of glomerular injury; 4) children could be treated with hemo-or peritoneal dialysis for chronic renal failure to prolong life; 5) children could have renal function restored by renal transplantation; 6) and hypertension in childhood was largely (80%) the result of renal disease (17)(18)(19)(20)(21)(22)(23). Of these six discoveries, the fact that ACTH or glucocorticoids could induce remission in children with nephrotic syndrome and prevent death due to infection and malnutrition was clearly the seminal event.…”

Section: Emergence Of Pediatric Nephrology As a Distinct Disciplimentioning

confidence: 99%

The Development of Pediatric Nephrology

CHESNEY

2002

Pediatric Research

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The following is the first article in this series. It Pediatric nephrology, as a discipline, arose from descriptive studies of childhood glomerulonephritis in Europe and the field of pediatric metabolism in the United States. While pediatric scientists before 1950 were concerned with fluid and electrolyte metabolism, regulation of intracellular and extracellular fluid, acid-base homeostasis, and parenteral fluid therapy, the defined field of nephrology developed after the Second World War around six major advances: ACTH and glucocorticoid therapy for nephrotic syndrome; renal biopsy to diagnose glomerular disease; the role of immunologic factors in glomerular injury; the use of dialysis as renal replacement therapy; renal transplantation as the optimal form of therapy in children with end stage renal failure; and recognition of renal disease in the etiology of 80% of cases of childhood hypertension. These discoveries led to focused research, the definition of specific training in nephrology, establishment of an American, European, and an International Society of Pediatric Nephrology, as well as an American SubBoard of Pediatric Nephrology, and the inception of a journal, Pediatric Nephrology, now in its 15th year. Major research themes have included developmental nephrology, transplantation immunology, and concerns about growth in children with renal disease. Many clinical entities have been described in detail, some of which are almost confined to children. The scientific basis of pediatric nephrology, ongoing patient care needs, and its technical aspects -renal biopsy, dialysis and transplantationassure its continuing future as a major pediatric discipline on all continents. (Pediatr Res 52: 770-778, 2002) I. THE ORIGINS OF INTEREST IN CHILDHOOD RENAL DISEASES: 1820 -1950The development of the discipline of pediatric nephrology arose from clinical research conducted in the 130-year period from 1820 to 1950. It was during this period that pediatric scientists became interested in the definition of glomerular disorders and in fluid and electrolyte metabolism, the maintenance of normal volume and tonicity and acid-base status, as well as the pathophysiology of such disorders as rickets and diarrhea (1-5) ( Table 1).Pediatric kidney disease was initially considered from a descriptive rather than quantitative perspective. Early treatises on kidney diseases in children were remarkably accurate in terms of their clinical descriptions of various renal disorders, particularly glomerular conditions. In the 11th edition of Eduard Henoch's classic text Kinderkrankheiten (6), he describes

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Intermittent peritoneal dialysis using 5 per cent albumin in the treatment of salicylate intoxication in children

Cited by 66 publications

References 7 publications

A peritoneal-based automated wearable artificial kidney

A peritoneal-based automated wearable artificial kidney

Salicylate poisoning: An evidence-based consensus guideline for out-of-hospital management

The Development of Pediatric Nephrology

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