Extracorporeal therapies for acute intoxications

Accidental and intentional intoxications are a common cause of major medical catastrophe. In the United States alone, at least 7.5 million cases of intoxication occur annually, resulting in approximately 10,000 deaths each year. Approximately 10% of these cases are intentional [96]. The general approach to the management of toxic substances has been extensively reviewed [87,90,136]. In addition, specific antidotes are available for ameliorating the toxicity of many compounds [55,90,124]. This review focuses on intoxicants that cause perturbations in metabolic homeostasis, intravascular volume or renal function and warrant consideration of extracorporeal techniques for removing the offending agent. For small compounds that are concentrated in the intravascular compartment and are loosely protein bound, hemodialysis is effective for removing these agents. For larger, lipid-soluble compounds with greater avidity for plasma proteins, charcoal hemoperfusion is preferred. Despite theoretical benefits, surprisingly few intoxicants require extracorporeal extraction. The evidence for instituting either procedure in a variety of commonly encountered intoxications will be critically reviewed.