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Principles and Operational Parameters to Optimize Poison Removal with Extracorporeal Treatments

Authors

  • Josée Bouchard,

    1. Division of Nephrology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
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  • Darren M. Roberts,

    1. Burns, Trauma and Critical Care Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
    2. Department of Renal Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom
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  • Louise Roy,

    1. Division of Nephrology, Centre Hospitalier Universitaire de Montréal, University of Montreal, Montreal, Quebec, Canada
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  • Georges Ouellet,

    1. Division of Nephrology, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Quebec, Canada
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  • Brian S. Decker,

    1. Division of Nephrology, Indiana Institute for Personalized Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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  • Bruce A. Mueller,

    1. Department of Clinical Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, Michigan
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  • Simon Desmeules,

    1. Division of Nephrology, CHUQ-L'Hôtel Dieu de Québec Hospital, Laval University, Québec City, Quebec, Canada
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  • Marc Ghannoum

    Corresponding author
    1. Department of Nephrology, Verdun Hospital, University of Montreal, Montreal, Quebec, Canada
    • Address correspondence to: Dr. Marc Ghannoum, Verdun Hospital, 4000 Lasalle Blvd, Montreal, QC, Canada, Tel.: 514 362-1000, Fax: 514 504-1245, or

      e-mail: marcghannoum@gmail.com.

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Abstract

A role for nephrologists in the management of a poisoned patient involves evaluating the indications for, and methods of, enhancing the elimination of a poison. Nephrologists are familiar with the various extracorporeal treatments (ECTRs) used in the management of impaired kidney function, and their respective advantages and disadvantages. However, these same skills and knowledge may not always be considered, or applicable, when prescribing ECTR for the treatment of a poisoned patient. Maximizing solute elimination is a key aim of such treatments, perhaps more so than in the treatment of uremia, because ECTR has the potential to reverse clinical toxicity and shorten the duration of poisoning. This manuscript reviews the various principles that govern poison elimination by ECTR (diffusion, convection, adsorption, and centrifugation) and how components of the ECTR can be adjusted to maximize clearance. Data supporting these recommendations will be presented, whenever available.

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