血液灌注 charcoal hemoperfusion

可由活性炭血液灌注(charcoal hemoperfusion)排除之毒物:

Barbiturates [1]

 
Carbamazepine[2] 

Glutethimide[3]

 

Paraquat[4] 

Star Fruit [5]

 

Theophylline用hemoperfusion效果比hemodialysis好 [6]
 

Valproic acid.[7]

REFERENCES

 
1.      急性中毒救命術 急診醫學會 三版, p.378

2.      Peces R, Azorín S, Peces C, Selgas R. Tratamiento con hemoperfusión prolongada en la intoxicación aguda por carbamazepina [Extended hemoperfusion in the treatment of acute carbamazepine intoxication]. Nefrologia. 2010;30(1):127–130. doi:10.3265/Nefrologia.pre2010.Jan.10217

3. Peces R, Azorín S, Peces C, Selgas R. Tratamiento con hemoperfusión prolongada en la intoxicación aguda por carbamazepina [Extended hemoperfusion in the treatment of acute carbamazepine intoxication]. Nefrologia. 2010;30(1):127–130. doi:10.3265/Nefrologia.pre2010.Jan.10217

4 .Nasr Isfahani S, Farajzadegan Z, Sabzghabaee AM, Rahimi A, Samasamshariat S, Eizadi-Mood N. Does hemoperfusion in combination with other treatments reduce the mortality of patients with paraquat poisoning more than hemoperfusion alone: A systematic review with meta-analysis. J Res Med Sci. 2019;24:2. Published 2019 Jan 31. doi:10.4103/jrms.JRMS_478_18

5. Chan CK, Li R, Shum HP, et al. Star fruit intoxication successfully treated by charcoal haemoperfusion and intensive haemofiltration. Hong Kong Med J. 2009;15(2):149–152.

6. Shannon MW. Comparative efficacy of hemodialysis and hemoperfusion in severe theophylline intoxication. Acad Emerg Med. 1997;4(7):674–678. doi:10.1111/j.1553-2712.1997.tb03758.x

7. Peces R, Fernández EJ, Sánchez RJ, Peces C, Montero A, Selgas R. Tratamiento con hemoperfusión de la intoxicación aguda por ácido valproico [Hemoperfusion in the treatment of acute valproic acid intoxication]. Nefrologia. 2007;27(3):370–373.

-- edited 24th Dec, 2019 Yu-Jang Su.

 

Poison, Hemodialysis is helpful

可血液透析(hemodialysis):急性中毒 consult Nephrologist  
Acetaminophen (paracetamol level >900 mg/L) [1, 2]

Barbiturates (>100 mg/dL) [1, 3]

Carbamazepine (serum levels >40 mg/L or hemodynamic instability). [1, 4]

Lithium (3--4.0 mEq/L with serious symptoms) [5].

Metformin (lactate >15 mmol/L and ABG pH < 7.0 with shock or organ failure) [1, 6]

Methanol (50 mg/dL) and Ethylene glycol (50 mg/dL) [7].

Mushroom, Amanita [8]

Salicylates (>100 mg/dL, AKI, lung edema, AMS, hepatic failure, coagulopathy.) [9]

Theophylline (level >100 mg/L) with acute overdose

Theophylline level >60 mg/L) with chronic toxicity

severe toxicity – dysrhythmia, hypotension or seizures. [10].

Valproic acid (> 700mcg/ml) [11]

 REFERENCES

1.      https://www.dynamed.com/management/dialysis-for-acute-poisonings

2.      Serjeant L, Evans J, Sampaziotis F, Petchey WG. Haemodialysis in acute paracetamol poisoning. BMJ Case Rep. 2017;2017:bcr2016218667. Published 2017 Jan 17. doi:10.1136/bcr-2016-218667

3.      https://emedicine.medscape.com/article/813155-followup

4.      https://litfl.com/carbamazepine-toxicity-tox-library/

5.      http://www.tsim.org.tw/journal/jour12-5/P12_241.PDF

6.      https://www.hindawi.com/journals/cricc/2018/3868051/

7.      急診醫學會 AILS第三版，p. 258

8.      Warden CR, Benjamin DR. Acute renal failure associated with suspected Amanita smithiana mushroom ingestions: a case series. Acad Emerg Med. 1998;5(8):808–812. doi:10.1111/j.1553-2712.1998.tb02508.x

9.      急診醫學會 AILS第三版，p. 348

10.  https://litfl.com/theophylline-tox-library/

11.  Nasa P, Sehrawat D, Kansal S, Chawla R. Effectiveness of hemodialysis in a case of severe valproate overdose. Indian J Crit Care Med. 2011 Apr;15(2):120-2. doi: 10.4103/0972-5229.83020. PMID: 21814378; PMCID: PMC3145297.

-- edited 21th December 2019, Yu-Jang Su.