Pub Date : 2022-01-01DOI: 10.1080/24734306.2021.2015551
Joshua Bloom, Teddy Uzamere, Yasmin Hurd, Alex F Manini
Introduction: Acetaminophen overdose is a leading cause of liver failure in the United States. Macrophage migration inhibitory factor (MIF) is a cytokine that is released early and promotes acetaminophen toxicity in preclinical models. This cytokine could prove a useful biomarker in emergency department (ED) patients immediately following an acute acetaminophen overdose.
Methods: We selected a convenience sample of thirteen patients from a prospective consecutive cohort of ED patients with suspected acute overdose. Research associates collected waste specimens for MIF analysis that remained after use for clinical care. Our team compared patients with confirmed acetaminophen overdose (n=9) to patients without acetaminophen exposure or liver injury (n=3) and a patient with liver injury in the absence of detectable acetaminophen (n=1).
Results: In our acetaminophen group, all nine patients had measurable acetaminophen concentrations. Median MIF serum concentrations were 16.08 ng/mL (IQR 2.06, 91.40) in the overdose group compared with the control group serum concentrations of 0.19 ng/mL (IQR 0.05, 0.32) (p = 0.0091).
Conclusion: In this pilot study, MIF was feasible to measure in specimens from an ED drug overdose cohort, and was significantly elevated in the acetaminophen group compared to non-acetaminophen controls without liver injury.
{"title":"Macrophage Migration Inhibitory Factor as a Potential Biomarker in Acetaminophen Overdose: A Pilot Study.","authors":"Joshua Bloom, Teddy Uzamere, Yasmin Hurd, Alex F Manini","doi":"10.1080/24734306.2021.2015551","DOIUrl":"https://doi.org/10.1080/24734306.2021.2015551","url":null,"abstract":"<p><strong>Introduction: </strong>Acetaminophen overdose is a leading cause of liver failure in the United States. Macrophage migration inhibitory factor (MIF) is a cytokine that is released early and promotes acetaminophen toxicity in preclinical models. This cytokine could prove a useful biomarker in emergency department (ED) patients immediately following an acute acetaminophen overdose.</p><p><strong>Methods: </strong>We selected a convenience sample of thirteen patients from a prospective consecutive cohort of ED patients with suspected acute overdose. Research associates collected waste specimens for MIF analysis that remained after use for clinical care. Our team compared patients with confirmed acetaminophen overdose (n=9) to patients without acetaminophen exposure or liver injury (n=3) and a patient with liver injury in the absence of detectable acetaminophen (n=1).</p><p><strong>Results: </strong>In our acetaminophen group, all nine patients had measurable acetaminophen concentrations. Median MIF serum concentrations were 16.08 ng/mL (IQR 2.06, 91.40) in the overdose group compared with the control group serum concentrations of 0.19 ng/mL (IQR 0.05, 0.32) (p = 0.0091).</p><p><strong>Conclusion: </strong>In this pilot study, MIF was feasible to measure in specimens from an ED drug overdose cohort, and was significantly elevated in the acetaminophen group compared to non-acetaminophen controls without liver injury.</p>","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"6 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8932641/pdf/nihms-1782128.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10484966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abbas Zabihi, Sanaz Pashapour, Noorolhoda Malakijoo
{"title":"Evaluation of cytotoxicity of rubiadine on MCf7 and AGO cell lines","authors":"Abbas Zabihi, Sanaz Pashapour, Noorolhoda Malakijoo","doi":"10.53388/2022020209","DOIUrl":"https://doi.org/10.53388/2022020209","url":null,"abstract":"","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85593474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sanaz Pashapour, M. Heshmati, Z. Mousavi, S. Esmaeili
{"title":"Effect of whole methanolic extract of Galium verum on AGO cell line","authors":"Sanaz Pashapour, M. Heshmati, Z. Mousavi, S. Esmaeili","doi":"10.53388/20220202010","DOIUrl":"https://doi.org/10.53388/20220202010","url":null,"abstract":"","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"216 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76979394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Siddig Ibrahim, A. Farasani, A. Jerah, M. Mohamed, A. Bidwai
{"title":"Molecular docking of amphetamine, cathine and cathinone with dihydrofolate reductase: a computational analysis of inhibition of dihydrofolate reductase by khat alkaloids","authors":"Siddig Ibrahim, A. Farasani, A. Jerah, M. Mohamed, A. Bidwai","doi":"10.53388/2022020208","DOIUrl":"https://doi.org/10.53388/2022020208","url":null,"abstract":"","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82921706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-16DOI: 10.1080/24734306.2021.2010955
Samita Acharya, Andrea Purpura, L. Kao, D. House
Abstract Incidence of carbon monoxide (CO) poisoning in Nepal has not been studied. The objective of this study was to evaluate baseline carboxyhemoglobin (COHb) concentrations, population risk factors, and incidence of CO poisoning at a single hospital in Nepal. This was a prospective, observational study of patients presenting to Patan Hospital Emergency Department from April 2019 to March 2020. Demographics, risk factors for CO poisoning, symptoms, and clinical pretest probability of CO poisoning was documented. COHb concentration was obtained using a noninvasive co-oximeter. Significant CO exposure was defined as COHb concentration > 10%. CO poisoning was defined as COHb > 10% coupled with symptoms. Of 1,040 patients, 745 patients had a recordable COHb concentration. Median age was 40 years (IQR 33) with 407 (55%) females. Average COHb was 7.2%. Warm months were associated with higher COHb concentrations (8.1% vs 6.0%, p < 0.05). Firewood use had higher COHb concentrations compared to gas heating (8.6% vs 7.0%, p < 0.05). Overall, 228 (31%) patients had a COHb concentration > 10% indicating significant CO exposure. Sixteen patients had CO poisoning. We found a significant baseline incidence of COHb > 10% (31%) in patients presenting to a hospital in Nepal. Risk factors for higher baseline COHb concentrations included warm months and cooking with firewood.
尼泊尔一氧化碳(CO)中毒的发生率尚未研究。本研究的目的是评估尼泊尔一家医院的基线碳氧血红蛋白(COHb)浓度、人群危险因素和CO中毒发生率。这是一项前瞻性观察性研究，研究对象是2019年4月至2020年3月在帕坦医院急诊科就诊的患者。人口统计学、一氧化碳中毒的危险因素、症状和一氧化碳中毒的临床试验前概率被记录下来。用无创共血氧计测定COHb浓度。显著CO暴露定义为COHb浓度> 10%。一氧化碳中毒定义为COHb > 10%并伴有症状。在1040例患者中，745例患者有可记录的COHb浓度。中位年龄为40岁(IQR 33)，女性407例(55%)。平均COHb为7.2%。温暖月份与较高的COHb浓度相关(8.1% vs 6.0%， p < 0.05)。木柴的COHb浓度高于燃气供暖(8.6% vs 7.0%， p < 0.05)。总体而言，228例(31%)患者COHb浓度> 10%，表明明显的一氧化碳暴露。16例出现一氧化碳中毒。我们发现，在尼泊尔一家医院就诊的患者中，COHb的基线发病率> 10%(31%)。较高基线COHb浓度的危险因素包括温暖的月份和用柴火做饭。
{"title":"Incidence and risk factors for carbon monoxide poisoning in an emergency department in Nepal","authors":"Samita Acharya, Andrea Purpura, L. Kao, D. House","doi":"10.1080/24734306.2021.2010955","DOIUrl":"https://doi.org/10.1080/24734306.2021.2010955","url":null,"abstract":"Abstract Incidence of carbon monoxide (CO) poisoning in Nepal has not been studied. The objective of this study was to evaluate baseline carboxyhemoglobin (COHb) concentrations, population risk factors, and incidence of CO poisoning at a single hospital in Nepal. This was a prospective, observational study of patients presenting to Patan Hospital Emergency Department from April 2019 to March 2020. Demographics, risk factors for CO poisoning, symptoms, and clinical pretest probability of CO poisoning was documented. COHb concentration was obtained using a noninvasive co-oximeter. Significant CO exposure was defined as COHb concentration > 10%. CO poisoning was defined as COHb > 10% coupled with symptoms. Of 1,040 patients, 745 patients had a recordable COHb concentration. Median age was 40 years (IQR 33) with 407 (55%) females. Average COHb was 7.2%. Warm months were associated with higher COHb concentrations (8.1% vs 6.0%, p < 0.05). Firewood use had higher COHb concentrations compared to gas heating (8.6% vs 7.0%, p < 0.05). Overall, 228 (31%) patients had a COHb concentration > 10% indicating significant CO exposure. Sixteen patients had CO poisoning. We found a significant baseline incidence of COHb > 10% (31%) in patients presenting to a hospital in Nepal. Risk factors for higher baseline COHb concentrations included warm months and cooking with firewood.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"20 1","pages":"13 - 19"},"PeriodicalIF":0.0,"publicationDate":"2021-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78260251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-28DOI: 10.1080/24734306.2021.1949518
R. Belcher, Crosby Oldham, A. M. Rapier, D. Gutteridge
Abstract Introduction Management of refractory shock in the setting of overdose can be challenging. We describe a case of vasodilatory and cardiogenic shock after bupropion and citalopram overdose. Vasopressors and conventional therapies failed to stabilize the patient resulting in placement of venoarterial extracorporeal membrane oxygenation (VA ECMO) for patient rescue and recovery. Case summary: A 23-year-old male presented after intentional bupropion and citalopram overdose. He developed seizures, acute respiratory failure, metabolic acidosis, severe refractory vasodilatory, and cardiogenic shock. The patient received mechanical ventilation, Advanced Cardiac Life Support (ACLS), Intralipid ® therapy, vasopressor support, and VA ECMO. Total duration of ECMO was 72 h. Serum laboratory studies drawn on the day of admission showed serum concentrations of citalopram (3400 ng/mL, reference range 9-200 ng/mL) and bupropion (597 ng/mL, reference range 50-100 ng/mL). The patient was extubated on hospital day 18 and discharged home with referral to outpatient psychiatry, 28 days after intentional overdose. Conclusions This case illustrates successful recovery after hydroxocobalamin and VA ECMO in severe vasodilatory and cardiogenic shock following overdose of bupropion and citalopram.
{"title":"Hydroxocobalamin and extracorporeal membrane oxygenation (ECMO) for severe refractory shock in bupropion and citalopram overdose: a case report","authors":"R. Belcher, Crosby Oldham, A. M. Rapier, D. Gutteridge","doi":"10.1080/24734306.2021.1949518","DOIUrl":"https://doi.org/10.1080/24734306.2021.1949518","url":null,"abstract":"Abstract Introduction Management of refractory shock in the setting of overdose can be challenging. We describe a case of vasodilatory and cardiogenic shock after bupropion and citalopram overdose. Vasopressors and conventional therapies failed to stabilize the patient resulting in placement of venoarterial extracorporeal membrane oxygenation (VA ECMO) for patient rescue and recovery. Case summary: A 23-year-old male presented after intentional bupropion and citalopram overdose. He developed seizures, acute respiratory failure, metabolic acidosis, severe refractory vasodilatory, and cardiogenic shock. The patient received mechanical ventilation, Advanced Cardiac Life Support (ACLS), Intralipid ® therapy, vasopressor support, and VA ECMO. Total duration of ECMO was 72 h. Serum laboratory studies drawn on the day of admission showed serum concentrations of citalopram (3400 ng/mL, reference range 9-200 ng/mL) and bupropion (597 ng/mL, reference range 50-100 ng/mL). The patient was extubated on hospital day 18 and discharged home with referral to outpatient psychiatry, 28 days after intentional overdose. Conclusions This case illustrates successful recovery after hydroxocobalamin and VA ECMO in severe vasodilatory and cardiogenic shock following overdose of bupropion and citalopram.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"14 1","pages":"136 - 139"},"PeriodicalIF":0.0,"publicationDate":"2021-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81971899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1080/24734306.2021.2005965
Jamie Prashek, Adham M. Mohamed, Tyler E. Barnes, Andrew B. Schlachter
We thank Ghannoum et al. for their observation [1, 2]. After receiving the tweet by the EXTRIP workgroup [3], we reviewed our half-life calculations. Upon further investigation, we discovered that the first ethylene glycol concentration was collected at 23:13 and resulted at 07:46 am. We incorrectly used the result time, not the collection time, in our calculations. We apologize for this oversight. We have verified that the second and third ethylene glycol measurements and times are correct. These yield a correct half-life of 5.8 h and an elimination rate constant of 0.12 h−1 during continuous kidney replacement therapy (CKRT) as reported by Ghannoum et al. The second and third ethylene glycol concentrations were collected while the patient was on CKRT and fomepizole, and thus are more appropriate to use for half-life calculation. The critical care and nephrology teams discussed the patient’s case and selected CKRT due to the hemodynamic instability and severe metabolic derangements. The Kidney Disease: Improving Global Outcomes guidelines suggest CKRT over standard intermittent hemodialysis (IHD) in hemodynamically unstable patients to avoid fluid shifts associated with rapid solute removal and higher blood flow rate with IHD [4]. The difference between CKRT and IHD in hemodynamically unstable patients who are treated with vasopressors remains an ongoing debate. The evidence on fomepizole dosing during CKRT and the modality of CKRT in patients with ethylene glycol poisoning are scarce. Our case provides a detailed description of the fomepizole dosing and the CKRT modality that was used. We also agree with Ghannoum et al. that IHD remains the recommended extracorporeal treatment for ethylene glycol poisoning. However, CKRT may be used in hemodynamically unstable patients or when intermittent hemodialysis is unavailable.
{"title":"The authors reply: intermittent high-efficiency hemodialysis remains preferable to CKRT in late ethylene glycol poisoning","authors":"Jamie Prashek, Adham M. Mohamed, Tyler E. Barnes, Andrew B. Schlachter","doi":"10.1080/24734306.2021.2005965","DOIUrl":"https://doi.org/10.1080/24734306.2021.2005965","url":null,"abstract":"We thank Ghannoum et al. for their observation [1, 2]. After receiving the tweet by the EXTRIP workgroup [3], we reviewed our half-life calculations. Upon further investigation, we discovered that the first ethylene glycol concentration was collected at 23:13 and resulted at 07:46 am. We incorrectly used the result time, not the collection time, in our calculations. We apologize for this oversight. We have verified that the second and third ethylene glycol measurements and times are correct. These yield a correct half-life of 5.8 h and an elimination rate constant of 0.12 h−1 during continuous kidney replacement therapy (CKRT) as reported by Ghannoum et al. The second and third ethylene glycol concentrations were collected while the patient was on CKRT and fomepizole, and thus are more appropriate to use for half-life calculation. The critical care and nephrology teams discussed the patient’s case and selected CKRT due to the hemodynamic instability and severe metabolic derangements. The Kidney Disease: Improving Global Outcomes guidelines suggest CKRT over standard intermittent hemodialysis (IHD) in hemodynamically unstable patients to avoid fluid shifts associated with rapid solute removal and higher blood flow rate with IHD [4]. The difference between CKRT and IHD in hemodynamically unstable patients who are treated with vasopressors remains an ongoing debate. The evidence on fomepizole dosing during CKRT and the modality of CKRT in patients with ethylene glycol poisoning are scarce. Our case provides a detailed description of the fomepizole dosing and the CKRT modality that was used. We also agree with Ghannoum et al. that IHD remains the recommended extracorporeal treatment for ethylene glycol poisoning. However, CKRT may be used in hemodynamically unstable patients or when intermittent hemodialysis is unavailable.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"1 1","pages":"160 - 160"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82471342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1080/24734306.2021.1878322
K. Baumgartner, M. Mullins
Abstract Clonidine and guanfacine are centrally acting sympatholytics (CAS). Poisoning with these agents is common in children, and management of this poisoning is controversial. We sought to characterize our experience with pediatric CAS poisonings. We used an internal database to identify patients with CAS poisoning seen by the medical toxicology service at our children’s hospital from January 2001 through November 2019. We performed a retrospective chart review. We identified 56 patients with clonidine poisoning and 19 patients with guanfacine poisoning. Sixty-six percent of patients with clonidine poisoning underwent any medical intervention, as did 32% of patients with guanfacine poisoning. The most common interventions were fluids and naloxone. Endotracheal intubation was uncommon. The median hospital length of stay was one day and the median ICU length of stay was one day. Two patients died; one co-ingested a large amount of bupropion and one aspirated charcoal, leading to pneumonitis and anoxic brain injury. No patient with isolated CAS poisoning died. In this retrospective single-center review, pediatric patients tolerated CAS poisoning well. CAS poisoning did not directly result in death. Most pediatric patients with CAS poisoning had short hospital lengths of stay and did not undergo critical care interventions.
{"title":"Pediatric clonidine and guanfacine poisoning: a single-center retrospective review","authors":"K. Baumgartner, M. Mullins","doi":"10.1080/24734306.2021.1878322","DOIUrl":"https://doi.org/10.1080/24734306.2021.1878322","url":null,"abstract":"Abstract Clonidine and guanfacine are centrally acting sympatholytics (CAS). Poisoning with these agents is common in children, and management of this poisoning is controversial. We sought to characterize our experience with pediatric CAS poisonings. We used an internal database to identify patients with CAS poisoning seen by the medical toxicology service at our children’s hospital from January 2001 through November 2019. We performed a retrospective chart review. We identified 56 patients with clonidine poisoning and 19 patients with guanfacine poisoning. Sixty-six percent of patients with clonidine poisoning underwent any medical intervention, as did 32% of patients with guanfacine poisoning. The most common interventions were fluids and naloxone. Endotracheal intubation was uncommon. The median hospital length of stay was one day and the median ICU length of stay was one day. Two patients died; one co-ingested a large amount of bupropion and one aspirated charcoal, leading to pneumonitis and anoxic brain injury. No patient with isolated CAS poisoning died. In this retrospective single-center review, pediatric patients tolerated CAS poisoning well. CAS poisoning did not directly result in death. Most pediatric patients with CAS poisoning had short hospital lengths of stay and did not undergo critical care interventions.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"62 1","pages":"61 - 65"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85183128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1080/24734306.2021.1997465
M. Ghannoum, D. Roberts, S. Gosselin, Robert S., Hoffman
Prashek and colleagues present a patient who underwent continuous kidney replacement therapy (CKRT) for removal of ethylene glycol [1]. We commend the authors for publishing such cases due to the scarcity of reports with CKRT, but express caution about the interpretation of many of their observations, calculations, and conclusions. The authors claim that “CVVHDF can effectively remove ethylene glycol with an extraction that is comparable to IHD”. This assumption is based on their calculation of an ethylene glycol half-life of 2.81 h during CVVHDF being comparable to other published cases in which intermittent hemodialysis was used. This ssertion is erroneous as the first ethylene glycol measurement used in their calculation was performed prior to the initiation of both CVVHDF and fomepizole therapy. Using the last 2 data points, we calculated the ethylene glycol half-life as 5.8 h which is in keeping with other cases in which CKRT was performed [2– 4]. This is double the ethylene glycol half-life achieved during high-efficiency intermittent hemodialysis (<3 h) [5]. Further evidence of the inferior performance of CKRT compared to intermittent hemodialysis is the maximum achievable clearance: clearance of solutes is limited by the lesser of either blood or effluent flow. In the present case, CVVHDF was performed with a blood flow = 200 mL/min and an effluent flow = 84 mL/min. Ethylene glycol clearance could therefore not exceed 84 mL/min which again is well under what can be achieved by intermittent hemodialysis (>200 mL/min). Finally, since the patient did not require net ultrafiltration for volume overload, it is unclear why the patient would tolerate CKRT better than intermittent hemodialysis. We agree that if CKRT is the only option available onsite, then it is preferable to use it instead of transferring the patient to a center that offers intermittent hemodialysis. However, when both options are available, we advocate for using the one that can maximize clearance, especially when a patient has evidence of extensive end-organ damage and accumulation of toxic metabolites. We encourage authors and journals to promote increased reliability of cases reporting poison removal during extracorporeal treatment, including more than 2 time points for half-life calculations and regular sampling of effluent and outflow blood concentration [6].
{"title":"Letter to the editor: Intermittent high-efficiency hemodialysis remains preferable to CKRT in late ethylene glycol poisoning","authors":"M. Ghannoum, D. Roberts, S. Gosselin, Robert S., Hoffman","doi":"10.1080/24734306.2021.1997465","DOIUrl":"https://doi.org/10.1080/24734306.2021.1997465","url":null,"abstract":"Prashek and colleagues present a patient who underwent continuous kidney replacement therapy (CKRT) for removal of ethylene glycol [1]. We commend the authors for publishing such cases due to the scarcity of reports with CKRT, but express caution about the interpretation of many of their observations, calculations, and conclusions. The authors claim that “CVVHDF can effectively remove ethylene glycol with an extraction that is comparable to IHD”. This assumption is based on their calculation of an ethylene glycol half-life of 2.81 h during CVVHDF being comparable to other published cases in which intermittent hemodialysis was used. This ssertion is erroneous as the first ethylene glycol measurement used in their calculation was performed prior to the initiation of both CVVHDF and fomepizole therapy. Using the last 2 data points, we calculated the ethylene glycol half-life as 5.8 h which is in keeping with other cases in which CKRT was performed [2– 4]. This is double the ethylene glycol half-life achieved during high-efficiency intermittent hemodialysis (<3 h) [5]. Further evidence of the inferior performance of CKRT compared to intermittent hemodialysis is the maximum achievable clearance: clearance of solutes is limited by the lesser of either blood or effluent flow. In the present case, CVVHDF was performed with a blood flow = 200 mL/min and an effluent flow = 84 mL/min. Ethylene glycol clearance could therefore not exceed 84 mL/min which again is well under what can be achieved by intermittent hemodialysis (>200 mL/min). Finally, since the patient did not require net ultrafiltration for volume overload, it is unclear why the patient would tolerate CKRT better than intermittent hemodialysis. We agree that if CKRT is the only option available onsite, then it is preferable to use it instead of transferring the patient to a center that offers intermittent hemodialysis. However, when both options are available, we advocate for using the one that can maximize clearance, especially when a patient has evidence of extensive end-organ damage and accumulation of toxic metabolites. We encourage authors and journals to promote increased reliability of cases reporting poison removal during extracorporeal treatment, including more than 2 time points for half-life calculations and regular sampling of effluent and outflow blood concentration [6].","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"31 1","pages":"158 - 159"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80294210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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