Extracorporeal Elimination in Toxicology


  • = 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.


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.


  • membrane consists of relatively straight channels of every increasing diameter -> low resistance to flow
  • recommended for the following intoxications: methotrexate, procanamide

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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