Epidemiological Pattern of Extracorporeal Methods in Acute Poisoning: A Five Year Study
Year 2024,
Volume: 6 Issue: 1, 1 - 5, 30.04.2024
Mohadeseh Sarbaz Bardsiri
,
Maral Ramezani
,
Shahin Shadnia
,
Mitra Rahimi
Abstract
Background: The use of hemodialysis is a prevalent extracorporeal technique for managing the poisoning of certain patients.
Objectives: In this study, we examined the frequency of extracorporeal methods and the prognosis of using these methods in various poisonings.
Methods: This retrospective study was conducted at Loghman Hakim hospital in Tehran between 2016 and 2020. The study investigated all patients who were hospitalized and underwent hemodialysis at the poisoning center. The study analyzed demographic data, clinical information, and certain laboratory findings from a sample size of 980 cases. The data obtained from the study were analyzed using SPSS 22.
Results: 793 (80/9%) males and 187 (19.1%) females were investigated. The mean age of the subjects was 36.5±14 years. Methanol consumption was the highest cause of poisoning (858 cases, 87.6%). Hemodialysis was the most widely used extracorporeal method (971 cases, 99.1%). The median number of hemodialysis was 1 times and the maximum was 18. The mortality rate was 13.3%. Metabolic acidosis was observed in 823 cases (84%). Acute kidney injury (AKI) was present in 536 cases (54.7%).
Conclusions: Although there have been some published studies and conferences on extracorporeal methods for treating poisonings, the lack of cases treated with these methods has resulted in weak evidence. To address this issue and provide more widely applicable data, studies like this can help to improve the treatment of poisoned patients.
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the circulating blood by means of dialysis. Trans Ass Am
Physicians. 1913;28:51.
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Pallotta A. The application of hemodialysis to the treatment of
barbiturate poisoning. The Journal of Clinical Investigation.
1953;32(4):364-71.
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in acute poisoning. AMA Archives of Internal Medicine.
1958;102(6):896-913.
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therapy of phenobarbital overdose. American journal of kidney
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H, Eden G, et al. Removal of methadone by extended dialysis
using a high cut-off dialyzer: implications for the treatment of
overdose and for pain management in patients undergoing light
chain removal. Clinical nephrology. 2016;85(6):353-7.
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Lavergne V, Roberts DM. Use of extracorporeal treatments in the management of poisonings. Kidney International. 2018;94(4):682-8.
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enhanced elimination of toxic ingestions and poisoning.
Therapeutic apheresis and dialysis. 2022;26(5):865-78.
- Majidi M, Delirrad M, Yousefpour A, Mehrno M. An
Investigation of Intoxicated Patients who Underwent
Hemodialysis: A-five Year Cross-sectional study. Asia Pacific
Journal of Medical Toxicology. 2021;10(4):128-33.
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treatment. Int J Med Toxicol Forensic Med. 2020;10(1):26639.
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Banimostafavi ES, Sharifpour A, et al. Methanol poisoning
as a new world challenge: A review. Annals of medicine and
surgery. 2021;66:102445.
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J, McMartin K, Aaron C, et al. Consensus statements on the
approach to patients in a methanol poisoning outbreak. Clinical
toxicology. 2019;57(12):1129-36.
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Vanikar AV, et al. Hemodialysis for methyl alcohol poisoning:
A single-center experience. Saudi Journal of Kidney Diseases
and Transplantation. 2012;23(1):37.
- Darracq MA, Cantrell FL. Hemodialysis and extracorporeal
removal after pediatric and adolescent poisoning reported to
a state poison center. The Journal of Emergency Medicine.
2013;44(6):1101-7.
- Hassanian-Moghaddam H, Nikfarjam A, Mirafzal A, Saberinia
A, Nasehi AA, Masoumi Asl H, et al. Methanol mass poisoning
in Iran: role of case finding in outbreak management. Journal
of public health. 2015;37(2):354-9.
- Gagnon DJ, Jwo K. Tremors and agitation following lowdose
intravenous hydromorphone administration in a patient
with kidney dysfunction. Annals of Pharmacotherapy.
2013;47(7-8):e34-e.
- Ghasemi S, Izadpanahi S, Yaghoubi MA, Brent J, Mehrpour
O. Methadone associated long term hearing loss and
nephrotoxicity; a case report and literature review. Substance
Abuse Treatment, Prevention, and Policy. 2019;14(1):1-5.
Year 2024,
Volume: 6 Issue: 1, 1 - 5, 30.04.2024
Mohadeseh Sarbaz Bardsiri
,
Maral Ramezani
,
Shahin Shadnia
,
Mitra Rahimi
References
- Shannon MW, Borron SW, Burns MJ, Haddad LM, Winchester
JF. Haddad and Winchester’s clinical management of poisoning
and drug overdose: Saunders/Elsevier; 2007.
- Al-Jelaify M, AlHomidah S. The individualized management
approach for acute poisoning. Advances in pharmacological
and pharmaceutical sciences. 2021;2021:1-5.
- Otten EJ. Goldfrank’s Toxicologic Emergencies, by Lewis S.
Nelson, Mary Ann Howland, Neal A. Lewin, Silas W. Smith,
Lewis R. Goldfrank, and Robert S. Hoffman. New York,
McGraw-Hill Education 2019, 2070 pages, $245.79. Elsevier;
2020.
- Arasu R, Jegatheesan D, Sivakumaran Y. Overview of
hemodialysis access and assessment. Canadian Family
Physician. 2022;68(8):577-82.
- Ronco C, Bellomo R. Hemoperfusion: technical aspects and
state of the art. Critical care. 2022;26(1):1-12.
- King JD, Kern MH, Jaar BG. Extracorporeal removal of
poisons and toxins. Clinical journal of the American Society of
Nephrology. 2019;14(9):1408-15.
- Abel JJ. On the removal of diffusable substances from
the circulating blood by means of dialysis. Trans Ass Am
Physicians. 1913;28:51.
- Kyle LH, Jeghers H, Walsh WP, Doolan PD, Wishinsky H,
Pallotta A. The application of hemodialysis to the treatment of
barbiturate poisoning. The Journal of Clinical Investigation.
1953;32(4):364-71.
- Schreiner GE. The role of hemodialysis (artificial kidney)
in acute poisoning. AMA Archives of Internal Medicine.
1958;102(6):896-913.
- Palmer BF. Effectiveness of hemodialysis in the extracorporeal
therapy of phenobarbital overdose. American journal of kidney
diseases. 2000;36(3):640-3.
- Quintero Parra N, Wurgaft Kirberg A, Orellana Araya YV,
Arellano Lorca J, Rojas Wettig L, Pefaur Penna J. Haemodialysis
management for salicylate intoxication. Nefrología (English
Edition). 2009;29(2):182-3.
- Lavergne V, Nolin TD, Hoffman RS, Roberts D, Gosselin S,
Goldfarb DS, et al. The EXTRIP (EXtracorporeal TReatments
in poisoning) workgroup: guideline methodology. Clinical
Toxicology. 2012;50(5):403-13.
- Arelin V, Schmidt JJ, Kayser N, Kühn-Velten WN, Suhling
H, Eden G, et al. Removal of methadone by extended dialysis
using a high cut-off dialyzer: implications for the treatment of
overdose and for pain management in patients undergoing light
chain removal. Clinical nephrology. 2016;85(6):353-7.
- Ghannoum M, Hoffman RS, Gosselin S, Nolin TD,
Lavergne V, Roberts DM. Use of extracorporeal treatments in the management of poisonings. Kidney International. 2018;94(4):682-8.
- Yaxley J, Scott T. Dialysis and extracorporeal therapies for
enhanced elimination of toxic ingestions and poisoning.
Therapeutic apheresis and dialysis. 2022;26(5):865-78.
- Majidi M, Delirrad M, Yousefpour A, Mehrno M. An
Investigation of Intoxicated Patients who Underwent
Hemodialysis: A-five Year Cross-sectional study. Asia Pacific
Journal of Medical Toxicology. 2021;10(4):128-33.
- Delirrad M, Mohammadi AB. New methanol poisoning
outbreaks in Iran following COVID-19 pandemic. Alcohol and
Alcoholism (Oxford, Oxfordshire). 2020:0-.
- Mehrpour O, Sadeghi M. Toll of acute methanol poisoning
for preventing COVID-19. Archives of toxicology.
2020;94(6):2259-60.
- Iranpour P, Firoozi H, Haseli S. Methanol poisoning emerging
as the result of COVID-19 outbreak; radiologic perspective.
Academic radiology. 2020;27(5):755-6.
- Shokoohi M, Nasiri N, Sharifi H, Baral S, Stranges S. A
syndemic of COVID-19 and methanol poisoning in Iran: Time
for Iran to consider alcohol use as a public health challenge? :
Elsevier; 2020. p. 25-7.
- Mousavi-Roknabadi RS, Arzhangzadeh M, Safaei-Firouzabadi
H, Mousavi-Roknabadi RS, Sharifi M, Fathi N, et al. Methanol
poisoning during COVID-19 pandemic; A systematic scoping
review. The American journal of emergency medicine.
2022;52:69-84.
- Najari F, Baradaran I, Najari D. Methanol poisoning and its
treatment. Int J Med Toxicol Forensic Med. 2020;10(1):26639.
- Nekoukar Z, Zakariaei Z, Taghizadeh F, Musavi F,
Banimostafavi ES, Sharifpour A, et al. Methanol poisoning
as a new world challenge: A review. Annals of medicine and
surgery. 2021;66:102445.
- Hassanian-Moghaddam H, Zamani N, Roberts DM, Brent
J, McMartin K, Aaron C, et al. Consensus statements on the
approach to patients in a methanol poisoning outbreak. Clinical
toxicology. 2019;57(12):1129-36.
- Kute VB, Godara SM, Shah PR, Gumber MR, Goplani KR,
Vanikar AV, et al. Hemodialysis for methyl alcohol poisoning:
A single-center experience. Saudi Journal of Kidney Diseases
and Transplantation. 2012;23(1):37.
- Darracq MA, Cantrell FL. Hemodialysis and extracorporeal
removal after pediatric and adolescent poisoning reported to
a state poison center. The Journal of Emergency Medicine.
2013;44(6):1101-7.
- Hassanian-Moghaddam H, Nikfarjam A, Mirafzal A, Saberinia
A, Nasehi AA, Masoumi Asl H, et al. Methanol mass poisoning
in Iran: role of case finding in outbreak management. Journal
of public health. 2015;37(2):354-9.
- Gagnon DJ, Jwo K. Tremors and agitation following lowdose
intravenous hydromorphone administration in a patient
with kidney dysfunction. Annals of Pharmacotherapy.
2013;47(7-8):e34-e.
- Ghasemi S, Izadpanahi S, Yaghoubi MA, Brent J, Mehrpour
O. Methadone associated long term hearing loss and
nephrotoxicity; a case report and literature review. Substance
Abuse Treatment, Prevention, and Policy. 2019;14(1):1-5.