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Extracorporeal treatments in poisonings from four non‐traditionally dialysed toxins (acetaminophen, digoxin, opioids and tricyclic antidepressants): A combined single‐centre and national study
Author(s) -
Campion Gabriel H.,
Wang Josh J.,
Hoffman Robert S.,
Cormier Monique,
Lavergne Valéry,
Mowry James B.,
Roberts Darren M.,
Ghannoum Marc,
Su Mark K.,
Gosselin Sophie
Publication year - 2019
Publication title -
basic and clinical pharmacology and toxicology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.805
H-Index - 90
eISSN - 1742-7843
pISSN - 1742-7835
DOI - 10.1111/bcpt.13135
Subject(s) - poison control center , medicine , acetaminophen , digoxin , tricyclic , demographics , surgery , anesthesia , emergency medicine , poison control , pharmacology , injury prevention , heart failure , demography , sociology
The use of extracorporeal treatments ( ECTR s) for poisonings with four non‐traditionally dialysed toxins ( NTDT s) is increasing in the United States. This study evaluated whether ECTR s are prescribed for toxin removal or the treatment of other medical illnesses or complications. We performed a 2‐Phase retrospective analysis evaluating the main indication for ECTR s in patients with poisoning from a NTDT (defined for this study as acetaminophen, opioids, tricyclic antidepressants ( TCA s) or digoxin) and ECTR . The first phase assessed all cases from a single site (New York City Poison Control Center) between the years 2000 and 2016, and the second phase surveyed all United States Poison Control Centers ( PCC s). In Phase 1, demographics, toxin ingested and main indication for ECTR were extracted. In Phase 2, a query to the National Poison Data System using the a pragmatic subset of inclusion criteria from Phase 1 restricted to single toxin ingestions over a narrower time frame (2014‐2016) provided the cases for study. A structured online questionnaire was sent to all United States PCC s to request their database review regarding the indication for ECTR for their cases. In Phase 1, 92 cases met inclusion criteria. In Phase 2, 519 cases were screened and 425 met inclusion criteria. In Phase 1 91/92 (98.9%) and Phase 2 411/425 (96.7%), of extracorporeal treatments were used to treat underlying medical conditions or poisoning‐related complications rather than accelerate toxin removal. The increasing number of ECTR s reported in patients who ingested one of the four NTDT s thus appears to be for medical indications rather than attempts at toxin removal, a distinction that is important.