Enhanced elimination of poisons
- Michael J Burns, MD
Michael J Burns, MD
- Assistant Professor of Medicine
- Harvard Medical School
- Larissa I Velez, MD
Larissa I Velez, MD
- Professor of Emergency Medicine
- University of Texas Southwestern Medical Center
- Section Editors
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
Unintended and intentional poisonings and drug overdoses constitute a significant source of morbidity, mortality, and health care expenditures. An estimated two to five million such events occur annually in the United States, although the true incidence is unknown due to under diagnosis and underreporting [1-3].
Management of the poisoned patient begins with a thorough evaluation, recognition that poisoning has occurred, identification of the agent(s) involved, assessment of severity, and prediction of toxicity. Therapy involves the provision of supportive care, prevention of poison absorption, and, when appropriate, the administration of antidotes and enhancement of elimination of the poison.
Methods to enhance the rate of elimination of poisons following a toxic ingestion are reviewed here. General issues regarding the management of toxic ingestions, and specific issues related to decontamination and gastric emptying are discussed separately. (See "General approach to drug poisoning in adults" and "Gastrointestinal decontamination of the poisoned patient" and "Approach to the child with occult toxic exposure".)
Enhanced elimination techniques can accelerate removal of a toxin, but few studies have investigated whether they actually shorten the duration of clinical toxicity and/or improve clinical outcomes. The main methods of enhancing the elimination of toxins are listed in the table (table 1).
General indications for enhanced elimination techniques include:
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- MULTIPLE-DOSE ACTIVATED CHARCOAL
- URINARY ALKALINIZATION
- Indications and efficacy
- - Adults
- - Children
- HEMODIALYSIS AND HEMOPERFUSION
- EXCHANGE TRANSFUSION
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS