Extracorporeal treatment of intoxications.

PURPOSE OF REVIEW: The purpose of this article is to provide the critical care clinician with a comprehensive review of the indications for extracorporeal elimination of toxic substances, to summarize the different techniques and the intoxications for which these techniques are suitable.

RECENT FINDINGS: In the last year, several excellent reviews about toxicological topics have been published. These reviews focused on intoxications in children, the approach of the patient with an unknown overdose, management of intoxications with salicylates, beta-blockers and calcium antagonists and liver support systems. Important developments include the use of high-flux, high-efficiency membranes and albumin dialysis using the molecular adsorbent recirculating system (MARS). This system offers possibilities for the removal of protein-bound substances such as diltiazem, phenytoin and theophylline.

SUMMARY: Although large randomized controlled trials are scarce in the field of toxicology, the treatment of intoxications is becoming more and more evidence based. This review summarizes the current knowledge and recommendations concerning the extracorporeal treatment of intoxications and discusses new developments in the field, such as the use of high-flux, high-efficiency membranes and albumin dialysis.