Pharmacokinetic Principles for Toxin Elimination in Poisoning

Abstract

Today hospital mortality in self-poisoning is in most centres less than 1%. The development of intensive care over the last thirty years has contributed significantly to the decreased mortality in self-poisoning. In the 1950’s the “Scandinavian method” was introduced, involving careful observation, respiratory care with ventilatory support, and increased elimination of long acting barbiturates with forced diuresis. In the 1960’s haemoperfusion was first used in barbiturate overdose. Along with dialysis, more recently introduced techniques such as plasma exchange and haemofiltration are now at hand for the intensive care therapist faced with the poisoned patient. Unfortunately many patients are subjected to such techniques in the mistaken belief that the elimination of a particular toxin is enhanced. A critical appraisal of the poisons pharmacology can save the patient from an unnecessary and ineffective invasive procedure. The object of this review is to present those physical and pharmacokinetic factors which limit the application of these techniques.