Management of poisoning
Bev-Lorraine True, Robert H. Dreisbach in Dreisbach’s HANDBOOK of POISONING, 2001
Hemodialysis and peritoneal dialysis are used to removing certain poisons from the body, especially if kidney function is impaired (Table 4.2). These procedures are not necessary if safer, equally effective or more effective interventions are available. For example, supportive care to treat/manage barbiturate overdose or urine alkalinization to treat salicylate intoxication can be employed. However, dialysis is used when these interventions fail. In addition, dialysis is used to remove excess drugs, etc. that are known to cause significant detrimental outcomes. For example, a patient may have an elevated theophylline level with absolutely no symptoms. However, if they were to suddenly develop seizures, it is known that seizures from theophylline toxicity are difficult to treat and the outcome is often fatal. Therefore, it is prudent to remove the excess drug by dialysis. Indications for dialysis include deep coma with low blood pressure, anuria, and apnea following severe poisoning with any agents for which dialysis is effective. Lipid dialysis has been successfully used to remove the lipid-soluble agent camphor. Hemoperfusion through resin or coated charcoal columns is another method used to remove toxins. Peritoneal dialysis was originally used to cleanse the bowel before colon surgery. This ‘flushing of the intestine’ is performed with a hypotonic electrolyte-containing solution administered. It has been tried in the treatment of paraquat ingestion, but its effectiveness is unknown.
The Role of Kinetic Analysis and Mathematical Modeling in the Study of Bilirubin Metabolism in Vivo
Karel P. M. Heirwegh, Stanley B. Brown in Bilirubin, 1982
The simulated effects over 2 days of a single 4 hr hemoperfusion on plasma bilirubin concentration and on the mass of bilirubin in the extrahepatic-extravascular pool are illustrated in Figure 10. Note that the bilirubin content of the extravascular pool continued to fall after the completion of the perfusion as a result of re-equilibration with the partially depleted plasma pool. A nadir of 60% of baseline was reached at approximately 24 hr after initiation of the procedure, consistent with the time course of arousal of comatose patients with fulminant hepatic failure after charcoal hemoperfusion therapy. The simulated results of several alternative hemoperfusion schedules over a 5-day period are illustrated in Figure 11.
Targeting regulation of the tumour microenvironment induces apoptosis of breast cancer cells by an affinity hemoperfusion adsorbent
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2021
Lichun Wang, Jian Chen, Yamin Chai, Wenyan Han, Jie Shen, Nan Li, Jinyan Lu, Yunzheng Du, Zhuang Liu, Yameng Yu, Jingzhe Dong, Lailiang Ou
For instance, Christopher G Willett et al. [9] used bevacizumab to cure rectal cancer patients and indicated that VEGF blockade had a direct and rapid antivascular effect in human tumours. Jianming Xu et al. [2] developed a novel small-molecule inhibitor (Surufatinib) that targets proangiogenic factors, which could reduce tumour angiogenesis and enhance antitumor activity. However, the cost of these drugs treatment is high, and it also has clinically obvious pharmacodynamic limitations in respect of hypertension and proteinuria. Beyond conventional drug administration, hemoperfusion has been proved to be an effective and safe therapy to eliminate toxins in blood and is very successfully used in clinical. Yoshiki Yamamoto et al. [10] reported extra-fine fibres for efficiently TGF-β removal and prolonged a longer survival time of the tumor-bearing rats through hemoperfusion. Therefore, it is of great clinical significance to develop a novel selectively adsorbent with higher adsorption capacity, aiming at simultaneous tumour-induced immunosuppressive cytokines (VEGF and TGF-β) cleansing, without a significant reduction of immune-stimulating cytokine (TNF-α) in a hemoperfusion system, to offer another effective technique for the regulation of TME in cancer treatment.
The role of artificial cells in the fight against COVID-19: deliver vaccine, hemoperfusion removes toxic cytokines, nanobiotherapeutics lower free radicals and pCO2 and replenish blood supply
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2022
Hemoperfusion is now an accepted routine clinical use for the treatment of patients around the world. A 2017 book [27] by specialists around the world shows that this approach is being used extensively around the world. There are now at least 10 commercial devices around the world [28]. Each company has their own proprietary methods. There are variations in the type of adsorbent, membrane material and membrane thickness and as a result, they are different in effectiveness [28]. There is a new commercial hemoperfusion device (HA330) not included in the 2017 review that has been approved for emergency use for COVID-19 in China, Europe and Canada. This is based on the use of collodion membrane with novel adsorbent in the form of synthetic styrene divinylbenzene copolymers macroporous resin [29,30].
Pharmaceutical strategies for preventing toxicity and promoting antioxidant and anti-inflammatory actions of bilirubin
Published in Journal of Enzyme Inhibition and Medicinal Chemistry, 2022
Alessio Nocentini, Alessandro Bonardi, Simone Pratesi, Paola Gratteri, Carlo Dani, Claudiu T. Supuran
The two most common treatments for infant jaundice are phototherapy and exchange transfusion73. Other serious liver diseases (e.g. acute liver failer) dramatically reduce the liver ability to remove waste products such as albumin, leading to further damages in patients74. The application of hemoperfusion (i.e. a method of filtering the blood extracorporeally to remove a toxin) for the removal of BR has been also pursued for over 30 years to reduce the risk associated with exchange transfusion (e.g. hypoglycaemia, hypocalcaemia, acidosis, coagulopathies, graft-versus host disease, transmission of infectious diseases)75. In this context, several adsorption technologies have been suggested and applied in clinical treatment as extracorporeal methods to remove BR from blood, such as activated charcoal, ionic exchange resins, adsorptive membranes and some polymeric adsorbents76. However, the application of such first materials has been limited by their poor biocompatibility, lack of specificity (undesired removal of essential compounds as thyroxine, cortisol, and aldosterone) and low capacity77. The development of bilirubin adsorbents with excellent mechanical properties, adsorption performance and hemocompatibility is still a considerable challenge.