Extracorporeal Elimination in Toxicology
HAEMODIALYSIS FILTER
- = membrane contains long, tortuous interconnecting channels -> high resistance to flow
- allow the removal of H2O and solutes by diffusion across a concentration gradient.
- physical features of agent being removed: small molecule ( low resistance to flow
- recommended for the following intoxications: methotrexate, procanamide, lithium, metformin, ethanol, methanol, ethylene glycol, salicylates, theophylline, sodium valproate.
HAEMOPERFUSION FILTER
Provides a way for exposing blood to charcoal and allowing the binding of free drug
- blood runs directly through charcoal
- uses same vascular access and dialysis pumps
- greater anticoagulation required
- saturation of charcoal limits duration
- can place in series with dialysis
- physical features of agent being removed: larger (1000-1500 kDa), non-protein bound recommended the following intoxications: carbamazepine, phenobarbitone, barbiturates, phenytoin, verapamil, paraquat.
- disadvantages: expensive, won’t correct acidosis, electrolyte disturbances or fluid overload, hypoglycaemia, hypocalcaemia, thrombocytopaenia.
HAEMOFILTRATION FILTER
- membrane consists of relatively straight channels of every increasing diameter -> low resistance to flow
- recommended for the following intoxications: methotrexate, procanamide
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC