tailieunhanh - Nephrology and methods critical care (Third edition): Part 2

(BQ) Continued part 1, part 2 of the document Nephrology and methods critical care (Third edition) has contents: Bleeding and hemostasis in acute renal failure, gastrointestinal problems in acute kidney injury, cardiovascular problems in acute kidney injury, neurologic problems in acute renal failure,. and other contents. Invite you to refer. | Chapter 100 Plasmapheresis in Acute Intoxication and Poisoning 595 CHAPTER 100 Plasmapheresis in Acute Intoxication and Poisoning Francois Madore and Josée Bouchard Objectives This chapter will 1. Review the possible mechanisms of actionof pla ima of i i in poisoning and drug overdose. 2. Describe the pharmacokinetic factors that affect the elimination of poisons and drugs by plasmapheresis. 3. Explain the limitations of published studies on the efficacy of plasmapheresis in poisoning and drug overdose. 4. Review published data on the efficacy of plasmapheresis for specific poisons drugs. Plasmapheresis is widely accepted as a therapeutic modality for a number of immunologic metabolic and inherited Plasmapheresis is also useful as an extracorporeal blood purification technique in the treatment of various intoxications and poisonings. The basic premise of plasmapheresis use in poisoning and drug overdose is that removal of the circulating toxin drug will reduce toxic-induced damage and minimize related complications. Plasmapheresis can clear albumin-poison complexes which is not feasible with other extracorporeal therapies other than liver support devices. Although the clearance attainable by plasma exchange is relatively low it may be the only practical option for some poisons that are highly 90 bound to proteins. MECHANISMS OF ACTION The therapeutic benefit of plasmapheresis in acute poisoning and drug overdose is based on the rapid removal of drugs or toxins that cannot be eliminated adequately by usual therapeutic interventions. Plasmapheresis can remove rapidly toxins of all sizes including protein- and lipid-bound toxins with a low volume of As for any extracorporeal technique plasmapheresis only removes substances located in the vascular compartment. As the volume of distribution increases the usefulness of any extracorporeal treatments ECTR decreases The tissue stores of a poison will remain unaffected except for .