Enhanced Elimination

Consult Poison Control Center to determine suitability, timing, and dosing.

Urinary Alkalinization

• Indication
  • Weak acids
• Example Substances
  • Salicylates
  • Rarely: chlorpropamide, phenobarbital
• Mechanism
  • Prevents reabsorption of substance in kidneys enhancing urinary excretion
• Administration
  • IV sodium bicarbonate
  • Poison Control Center consultation available for precise IV fluid composition and dosing advice
• Comments
  • Can cause hypokalemia
  • Requires close electrolyte monitoring

Multiple Dose Activated Charcoal

• Indications
  • Rarely recommended, consider for substances with:
    • Enterohepatic recirculation and/or
    • Bind strongly with activated charcoal
    • Low volume of distribution and low protein binding
• Example Substances
  • Carbamazepine
  • Phenobarbital
  • Salicylates
  • Theophylline
• Mechanism
  • Interrupts enterohepatic circulation
  • “Intestinal dialysis” effect: pulls substances along a concentration gradient from intestinal vasculature into the intestinal lumen to be bound to activated charcoal
• Administration
  • PO or NG
  • Repeated in 2-4 hrs
  • Re-evaluation after 2-3 doses
• Comments
  • Aspiration, emesis risk with administration
  • Requires intact peristalsis

Hemodialysis

• Indications
  • Small molecular weight compounds with low volume of distribution and low protein binding
  • Significant, reversible metabolic disturbances associated with poisoning
• Example Substances
  • Lithium, salicylates, theophylline, toxic alcohols
  • Refer to EXTRIP list   for additional substances
• Mechanism
  • Removal via diffusion and convection through dialysis membrane
• Administration
  • Intermittent versus CRRT
• Comments
  • Initiate timely consultation with nephrology and PICU for management/disposition