Role of extracorporeal therapy in poisoning - A case based narrative.

Abstract

Background: Extracorporeal treatment (ECTR) have been employed for poison elimination dating back to as early as the 1960s, but during the current day and time, the indications for ECTR are mostly arbitrary and are considered when other treatments of poison elimination or reduction below toxic levels are not available. It is invaluable, especially when the toxins or poison are amendable to removal by ECTR, especially in a setting of clinical deterioration, the unavailability of specific antidotes, or when other treatment modalities are cost prohibitive in a tertiary setting with ECTR facilities.

Objective: To reiterate the efficacy of extracorporeal therapy techniques in poisoning focusing on the indications, available modalities, and outcomes.

Methods: Three clinical cases of acute poisoning with phenobarbitone, copper sulfate, and snake envenomation, effectively managed by ECTR, in detail were reviewed. A literature review on ECTR in poisoning was also conducted to summarize the principles.

Results: All three patients were managed with appropriate ECTR modalities. Therapeutic plasma exchange was used to treat snakebite-induced thrombotic microangiopathy, hemodialysis was used to treat phenobarbital toxicity, and plasma exchange was used effectively for copper sulfate poisoning. ECTR was initiated early, which resulted in clinical improvement and recovery in all cases.

Conclusion: HD remains a pivotal treatment option for the management of severe poisonings. Nevertheless, given the rare possibility of an encounter with cases necessitating treatment with extracorporeal therapies and the lack of recommendations and guidelines to standardize the practice, the evidence supporting the application of ECTR still remains limited and needs to be studied further for high-quality evidence.