Why are we Still Dialyzing Overdoses to Tricyclic Antidepressants? A subanalysis of the NPDS database

Abstract

A recent analysis of the American Association of Poison Control Centers database, showed that poisonings from toxins not usually considered amenable to extracorporeal purification ("non-classic toxins" such as ethanol and tricyclic antidepressants) continue to be reported. This publication investigates factors that may explain these findings. Our results suggest that: 1) the relatively high absolute number of ECTR performed for non-classic toxins may simply reflect the large number of exposures to these toxins, 2) poisoning from another toxin may have been the reason for ECTR initiation in some exposures to non-classic toxins, 3) poisoning from non-classic toxins may receive ECTR for purposes other than toxin removal, and 4) the decisional threshold to initiate ECTR may be lower for non-classic toxins because of heightened toxicity.

Extracorporeal treatment in the management of acute poisoning: What an intensivist should know?

“…[36] Indications other than poison removal (e.g., acute kidney injury or acidemia) may be the reason for ECTR. [3738]…”

Use of extracorporeal treatments in the management of poisonings

“…Table 1 presents some of these, as reported by US poison control centers (2010-2014), although the reason for ECTR may have been for indications other than poison removal (e.g., acute kidney injury or acidemia). 15,16 ECTR selection in the treatment of poisoning ECTRs are classified according to their mechanism: diffusion (hemodialysis and peritoneal dialysis), convection (hemofiltration), adsorption (hemoperfusion), and centrifugation (therapeutic plasma exchange). 17,18 Each modality has potentially differing impacts on enhancing the elimination of a poison from the body.…”

Incidence of rhabdomyolysis occurrence in psychoactive substances intoxication: a systematic review and meta-analysis

“…Rhabdomyolysis has been reported in a growing number of studies as one of the worst results of drug poisoning but with different incidences 8 . For instance, the incidence of cocaine-induced rhabdomyolysis is reported from 25 9 to 46.7% 10 and this value for methadone is between 14.7 11 and 34.6% 12 .…”