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

https://doi.org/10.51262/ejtox.1435690

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.

Keywords

extracorporeal, hemodialysis, methanol, poisoning

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.