Citation

Kielstein JT, Kielstein R. Nephrologe 2014; 9(4): 273-277.

Copyright

(Copyright © 2014)

DOI

10.1007/s11560-013-0842-0

PMID

unavailable

Abstract

BACKGROUND: Extracorporeal treatment of intoxication is an integral part of nephrological intensive care medicine. Although rare, the indications, limitations and potential side effects of these treatments belong to the core curriculum of critical care nephrology.

AIM: In the era of evidence-based medicine prospective controlled trials have become an integral part of guidance in critical care medicine. However, due to the very nature of acute poisoning, case reports remain the most common publication type in the toxicological literature. This is particularly true concerning extracorporeal treatment (ECTR) of poisoning. Material and methods: The EXTRIP (EXtracorporeal Treatments In Poisoning) working group is a collaborative international effort of pharmacologists, toxicologists, critical care physicians and nephrologists which is reviewing all available evidence on extracorporeal procedures for the treatment of intoxications in a standardized way to formulate recommendations for the physician at the bedside. The recommendations are endorsed by several national and international professional societies including the German Society of Nephrology and the European Renal Association, European Dialysis and Transplant Association (ERA-EDTA).

RESULTS and discussion: The advent of new technical characteristics of extracorporeal techniques, especially the availability of new filters, has rendered some older recommendations obsolete. Drugs that were not considered dialyzable in case of severe overdose in the 1970s, such as valproic acid, carbamazepine, theophylline and amitryptilline, are nowadays dialyzable. Charcoal hemoperfusion, once the mainstay of extracorporeal treatment of intoxication is rarely used and indicated as it is associated with potentially severe side effects which led to a decreasing availability of this treatment method. © 2014 Springer-Verlag.

Language: de

Keywords

human; Suicide; hemodialysis; disease severity; intoxication; Hemoperfusion; article; physician; amitriptyline; medical society; intensive care; carbamazepine; Dialysis; theophylline; valproic acid; prospective study; evidence based medicine; charcoal; standardization; hemoperfusion; controlled clinical trial (topic); Acute kidney injury; ECMO; extracorporeal treatment; nephrologist