Zehirlenmelerde Ekstrakorporeal Tedaviler

Abstract

Ekstrakorporeal tedaviler (EKT), endojen veya ekzojen toksinlerin vücuttan uzaklaştırılması ve/veya hayati organlardan birinin geçici bir süreliğine replasmanını içeren heterojen bir grup tedavi yöntemini içerir. Konvansiyonel tedavilere cevap vermeyen uygun intoksikasyon vakalarında EKT yöntemleri, mortalite ve morbiditenin önlenmesinde anahtar rol oynayabilir. Genel olarak molekül ağırlığı, endojen klirensi ve dağılım hacmi düşük olan ve proteine az bağlanan toksinler EKT uygulamaları ile uzaklaştırılmaya uygundur. Günümüzde en sık uygulanan EKT yöntemleri aralıklı hemodiyaliz, aralıklı hemofiltrasyon/hemodiafiltrasyon, sürekli renal replasman tedavileri, hemoperfüzyon, terapötik plazma değişimi, exchange transfüzyon, albümin diyalizi ve ekstrakorporeal membran oksijenizasyonudur. EKT yöntemleri, bazı komplikasyon risklerini de beraberinde getiren invaziv işlemlerdir. Bu nedenle, EKT’den olası fayda görebilecek tüm toksin maruziyetlerinde de mutlaka yarar ve risk oranı vaka bazlı değerlendirilerek uygulama kararı verilmelidir. Hasta için en uygun EKT yöntemi belirlenmesi sırasında ise hem maruzkalınantoksinin özellikleri hem de hastanın medikal öykü ve klinik durumu dikkate alınmalıdır. Yakın gelecekte EKT uygulamaları ile ilgili vaka takdiminin ötesinde geniş çapta verilerin literatüre sunulması, bu yöntemlerin optimal kullanım stratejilerini belirmeye yardımcı olacaktır.

Keywords

• ekstrakorporeal tedavi,intoksikasyon,hemodiyaliz,toksikoloji

Extracorporeal Treatments in Poisoning

Abstract

Extracorporeal treatments (ECT) include a heterogeneous group of methods for the removal of endogenous or exogenous toxins from the body and/or for the temporary replacement of one of the vital organs.ECT methods may play a key role in preventing mortality and morbidity in appropriate intoxication cases that do not respond to conventional treatments. In general, toxins with low molecular weight, low endogenous clearance, low volume of distribution and low protein binding are suitable for removal by ECT methods. Currently, the most common ECT methods are intermittent hemodialysis, intermittent hemofiltration/hemodiafiltration, continuous renal replacement therapy, hemoperfusion, therapeutic plasma exchange, exchange transfusion, albumin dialysis and extracorporeal membrane oxygenation.ECT methods are invasive procedures that bring some risks of complications. Therefore, in all toxin exposures that may benefit from ECT, the application decision should be made by evaluating the benefit and risk ratio on a case-by-case basis. In determining the most appropriate ECT method for the patient, both the characteristics of the toxin exposed and also the medical history and clinical status of the patient should be taken into consideration.In the near future, presenting a wide range of data about ECT applications beyond the case presentations to the literature will help to determine the optimal use strategies of these methods.

Keywords

• extracorporeal treatment,intoxication,toxicology,hemodialysis

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