Department of Medicine/Nephrology, Mount Sinai Beth Israel/Icahn School of Medicine, New York, NY.
Adv Chronic Kidney Dis. 2020 Jan;27(1):11-17. doi: 10.1053/j.ackd.2019.08.016.
Extracorporeal modalities have been used for detoxification for decades, with hemodialysis the preferred and most commonly used modality. Salicylates, lithium, methanol, and ethylene glycol are the most common poisonings treated with dialysis. For each of these common poisonings, a description of the toxidrome including pharmacokinetics, clinical presentation, an overview of treatment, and the role and application of dialysis is outlined. Inhibition of alcohol dehydrogenase to prevent the formation of toxic metabolites in methanol and ethylene glycol is discussed in detail, including the use of fomepizole and ethanol to complement and in some cases prevent the need for hemodialysis. Hemodialysis has been attempted to treat many poisonings, often without success. A description of EXTRIP (Extracorporeal Treatments in Poisoning), a multidisciplinary project examining the evidence for extracorporeal treatments in poisoning, is also described. Recommendations for poisoning with acetaminophen, baclofen, barbiturates, carbamazepine, digoxin, metformin, phenytoin, thallium, theophylline, tricyclic antidepressants, and valproic acid are provided in a comprehensive table.
几十年来，体外治疗方法一直被用于解毒，其中血液透析是首选且最常用的方法。水杨酸盐、锂、甲醇和乙二醇是最常见的用透析治疗的中毒。对于这些常见的中毒，本文概述了包括药代动力学、临床表现、治疗概述以及透析的作用和应用在内的中毒症状描述。详细讨论了抑制醇脱氢酶以防止甲醇和乙二醇中有毒代谢物形成的方法，包括使用甲福明和乙醇来补充，在某些情况下还可以预防需要血液透析。血液透析已被尝试用于治疗许多中毒，但往往不成功。本文还描述了一项名为 EXTRIP（中毒体外治疗）的多学科项目，该项目旨在研究中毒体外治疗的证据。此外，本文还提供了一个全面的表格，列出了对乙酰氨基酚、巴氯芬、巴比妥酸盐、卡马西平、地高辛、二甲双胍、苯妥英钠、铊、茶碱、三环抗抑郁药和丙戊酸中毒的建议。
