Dialysis

Hemodialysis or hemoperfusion usually has limited use in the treatment of intoxication with chemicals. However, under certain circumstances, such procedures can be lifesaving. The utility of dialysis depends on the amount of poison in the blood relative to the total-body burden. Thus, if a poison has a large volume of distribution, as is the case for the tricyclic antidepressants, the plasma will contain too little of the compound for effective removal by dialysis. Extensive binding of the compound to plasma proteins impairs dialysis greatly. The elimination of a toxicant by dialysis also depends on dissociation of the compound from binding sites in tissues; for some chemicals, this rate may be slow and limiting.

Although peritoneal dialysis requires a minimum of personnel and can be started as soon as the patient is admitted to the hospital, it is too inefficient to be of value for the treatment of acute intoxications. Hemodialysis (extracorporeal dialysis) is much more effective than peritoneal dialysis and may be essential in a few life-threatening intoxications, such as with methanol, eth-ylene glycol, and salicylates.

Passage of blood through a column of charcoal or adsorbent resin (hemoperfusion) is a technique for the extracorporeal removal of a poison. Because of the high adsorptive capacity and affinity of the material in the column, some chemicals that are bound to plasma proteins can be removed. The principal side effect of hemoperfusion is depletion of platelets.

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