ELIMINATION ENHANCEMENT

ELIMINATION

• It is defined as the act of removing or getting rid of  bodily discharged waste matter.

•The elimination systems in our body,eliminates about two pounds of material per day in the normal healthy adult.

• If any one of these channels become overloaded or clogged and slowed down, there will be an accumulation of toxic material in the body tissues.

ELIMINATION SYSTEMS

• There are 5 elimination systems in body, THE BOWL(colon) KIDNEYS LUNGS SKIN LIVER• The lymph system works with these five systems by

serving as a "garbage collector" to carry metabolic by-products and accumulated cellular waste from tissues to the elimination organs.

ELIMINATION ENHANCEMENT• Accidental and intentional poisonings or drug overdoses

constitute a significant source of aggregate morbidity, mortality, and health care expenditures.

• Management of the poisoned patient begins with a thorough evaluation, identification of the agent(s) involved, assessment of severity, and prediction of toxicity.

• Therapy involves the provision of supportive care, prevention of poison absorption, the administration of antidotes and enhancement of elimination of the poison.

METHODS OF ENHANCEMENT

•Multiple dose activated charcoal•Saline diuresis•Extracorporial methods-dialysis hemo

perfusion hemo

filtration

plasmapheresis exchange

transfusion

Other therapies:

•Hyperbaric oxygen•Chelation therapy•Cerebrospinal fluid removal•Immunological therapy-specific antibody

toxin binding.

Multiple dose activated charcoal•Charcoal slurry along the entire intestinal tract•Large surface area for adsorption of drug diffusing

across intestinal epithelium from capillaries• MDAC can also enhance elimination of absorbed

toxins by interrupting enterohepatic and enteroenteric recirculation and by promoting passive diffusion of drugs from the intestine.

Some Agents for which MDAC may enhance elimination are:•Dapsone•Amitriptaline•Diazepam•Methotrexate•Salicylate •Valproate

Saline diuresis

•The urinary excretion of some drugs can be enhanced by increasing the urine output and, more importantly, altering the urine pH.

•urinary acidification (urine pH below 5.5) with ammonium chloride or ascorbic acid will increase the excretion of weak bases.

•For drugs that are weak acids (eg, salicylates, phenobarbital), raising the urine pH to 7.5 to 8.0 .

Some Agents

•Forced diuresis -barium chromium iodide calcium potassium lithium alkaline diuresis -salicylates barbiturates sulfonamides

hemodialysis

•Can be arteriovenous or veno-venous (double-lumen catheter)

•Requires anticoagulation•Best if drug is:

▫water-soluble▫small (MW <500)▫not highly protein bound

•Also good for correcting fluid & electrolyte abnormalities.

Some Agents

•Barbiturates•Alcohols•Lithium•Salicylates•Atenolol•Theophylline etc

Peritoneal dialysis

•Tubes are inserted into the peritoneal cavity. electrolytes and fluids were sent and waste matter is collected out side.

•Theoretically useful if drug is:▫water soluble▫small (MW <500)▫not highly protein bound

•Rarely performed unless it’s the only available method.

hemoperfusion

•Hemoperfusion refers to the circulation of blood through an extracorporeal circuit containing an adsorbent such as activated charcoal or polystyrene resin.

Some agents

•Phenobarbitol•Sedatives•Phynitoin•Chloramphenicol•Carbamazepine•Caffeine.

hemofiltration•Blood that enters the hemofiltration circuit

passes through filters with large pores, and an ultrafiltrate forms which drags solutes with molecular weights up to 50,000 daltons .

•Cells and solutes larger than the pore size remain in the blood and return to the circulation. Plasma moves across semipermeable membrane under hydrostatic pressure

•No dialysate.

Some agents

•Aminoglycosides,•Vancomycin, and• Metal chelate complexes.

plasmapheresis

• It is the removal, treatment, and return of (components of) blood plasma from blood circulation. It is thus an extracorporeal therapy (a medical procedure performed outside the body). • The method is also used to collect

plasma, which is frozen to preserve it for eventual use in the manufacture of a variety of medications.

Exchange transfusion

•Exchange transfusion refers to the removal of a quantity of blood from a poisoned patient and its replacement with an identical quantity of whole blood

• The process is usually repeated two to three times.

•for methemoglobinemia, sulfhemoglobinemia (eg, secondary to hydrogen sulfide exposure), or in neonatal drug toxicity.

Hyperbaric oxygen

•Hyperbaric oxygen therapy uses a special chamber, sometimes called a pressure chamber, to increase the amount of oxygen in the blood.

•The air pressure inside a hyperbaric oxygen chamber is about two and a half times greater than the normal pressure in the atmosphere. This helps your blood carry more oxygen to organs and tissues in your body.

Chelation therapy

•Chelation therapy is the administration of chelating agents to remove heavy metals from the body.

•Heavy metals include-  lead, 

arsenic or mercury.• chelating agents include

 dimercaptosuccinic acid, and alpha lipoic acid.

Cerebrospinal fluid removal

•It is performed in order to collect a sample of cerebrospinal fluid containing poision.

Immunological therapy

•The use of antibodies in the diagnosis and treatment of drug poisoning is becoming an important aspect of emergency medicine.

•Digoxin-specific antibodies selectively inhibit the pharmacologic and toxic effects of the digitalis glycosides.

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