We frequently encounter overdoses in the emergency department. When the overdose is significant, a common question asked is “Can I use dialysis for this overdose?” Thankfully, several EB Medicine authors have already compiled a collection of material that can help answer that question. Below is a description of the 3 types of renal replacement therapies and a table of the toxins they can remove.
Hemofiltration is a process of convective solute transport. In this scenario, the solute (what you want to remove) and the solvent (the blood it is mixed in) pass across a highly permeable membrane. This process can remove:
Hemoperfusion involves passing blood through a cartridge containing either charcoal or a resin that is capable of absorbing toxins directly. This process can remove:
Hemodialysis involves diffusion of smaller molecules across a membrane. It is most similar to hemofiltration but is only capable of removing smaller molecules. This process can remove:
Drug | Hemodialysis | Hemofiltration | Hemoperfusion |
Aminoglycosides | X | ||
Atenolol | X | ||
Barbiturates | X | ||
Carbamazepine | X | ||
Chloral Hydrate | X | ||
Dapsone | X | ||
Diphenhydramine | X | ||
Ethylene Glycol | X | X | |
Iron | X | ||
Isopropanol | X | ||
Isoniazid | X | ||
Lithium | X | X | |
Metal chelate complexes- iron and aluminum deferoxamine | X | ||
Metformin | X | ||
Methanol | X | X | |
Organophosphates | X | ||
Procainamide | X | ||
Salicylate | X | ||
Theophylline | X | X | |
Vancomycin | X | X |
Though we may not be in the position to select the type of renal replacement therapy required, it is still helpful to be familiar with the terminology when speaking with our nephrology colleagues about our patients with life threatening overdoses.
If the drug you are searching for is not listed above, it may still be amenable to dialysis. This document published by Nephrology Pharmacy Associates in 2000 is a helpful reference. It includes a chart of drugs encountered up to the year 2000 and their dialysis status by type. In addition, there is an excellent summary of the chemistry of dialysis and its application to toxicology published by EMCrit here.
For further reading, here are two outstanding resources from the EB Medicine library:
- Pediatric Toxicology Update: Rational Management of Pediatric Exposures and Poisonings (2007)
- Toxic Alcohol Ingestion: Prompt Recognition and Management in the Emergency Department (2016)
Last Updated on January 25, 2023
