Continuous Renal Replacement Therapy Clearance Rate for Salicylate Toxicity in Multi-System Trauma
Affiliation(s)
School of Medicine, Oregon Health & Science University, Portland, USA. Department of Emergency Medicine, Oregon Health & Science University, Portland, USA.
School of Medicine, Oregon Health & Science University, Portland, USA. Department of Emergency Medicine, Oregon Health & Science University, Portland, USA.
ABSTRACT
The management of patients with concomitant xenobiotic toxicity and multisystem trauma can be complex. While hemodialysis is generally the modality of choice for extracorporeal elimination of salicylates, the potential for large volume shifts and hypotension may pose a risk in patients with traumatic brain injury. An alternative therapy to hemodialysis is continuous renal replacement therapy, which has slower clearance rates than hemodialysis, but has decreased adverse effects in cases of traumatic brain injury. However, there are few published reports of clearance rates of salicylates using continuous renal replacement therapy. We report a case of multisystem trauma with concomitant intentional salicylate overdose in which continuous renal replacement therapy was employed. The salicylate clearance rate that was obtained in this case was 7.5 mL/minute using continuous veno-venous hemodiafiltration, a form of continuous renal replacement therapy.
The management of patients with concomitant xenobiotic toxicity and multisystem trauma can be complex. While hemodialysis is generally the modality of choice for extracorporeal elimination of salicylates, the potential for large volume shifts and hypotension may pose a risk in patients with traumatic brain injury. An alternative therapy to hemodialysis is continuous renal replacement therapy, which has slower clearance rates than hemodialysis, but has decreased adverse effects in cases of traumatic brain injury. However, there are few published reports of clearance rates of salicylates using continuous renal replacement therapy. We report a case of multisystem trauma with concomitant intentional salicylate overdose in which continuous renal replacement therapy was employed. The salicylate clearance rate that was obtained in this case was 7.5 mL/minute using continuous veno-venous hemodiafiltration, a form of continuous renal replacement therapy.
Cite this paper
D. Silverman, L. French and R. Hendrickson, "Continuous Renal Replacement Therapy Clearance Rate for Salicylate Toxicity in Multi-System Trauma," International Journal of Clinical Medicine, Vol. 3 No. 6, 2012, pp. 552-553. doi: 10.4236/ijcm.2012.36099.
D. Silverman, L. French and R. Hendrickson, "Continuous Renal Replacement Therapy Clearance Rate for Salicylate Toxicity in Multi-System Trauma," International Journal of Clinical Medicine, Vol. 3 No. 6, 2012, pp. 552-553. doi: 10.4236/ijcm.2012.36099.
References
[1] P. Kramer, W. Wigger and J. Rieger, “Arteriovenous Hemofiltration: A New and Simple Method for the Treatment of Overhydrated Patients Resistant to Diuretics,” Journal of Molecular Medicine, Vol. 55, No. 22, 1977, pp. 1121-1122. doi:10.1007/BF01477940 [2] M. S. Joy, G. R. Matzke, D. K. Armstrong, M. A. Marx, and B. J. Zarowitz, “A Primer on Continuous Renal Replacement Therapy for Critically Ill Patients,” Annals of Pharmacotherapy, Vol. 32, No. 3, 1998, pp. 362-75. doi:10.1345/aph.17105 [3] J. W. Goodman and D. S. Goldfarb, “The Role of Continuous Renal Replacement Therapy in the Treatment of Poisoning,” Seminars in Dialysis, Vol. 19, No. 5, 2006, pp. 402-407. doi:10.1111/j.1525-139X.2006.00194.x [4] Z. Kim and D. S. Goldfarb, “Continuous Renal Replacement Therapy Does Not Have a Clear Role in the Treatment of Poisoning,” Nephron Clinical Practice, Vol. 115, No. 1, 2010, pp. c1-c6. doi:10.1159/000286343 [5] P. K. Tyagi, J. F. Winchester and D. A. Feinfeld, “Extracorporeal Removal of Toxins,” Kidney International, Vol. 74, No. 10, 2008, pp. 1231-1233. doi:10.1038/ki.2008.476 [6] G. Wrathall, R. Sinclair, A. Moore and D. Pogson, “Three Case Reports of the Use of Haemodiafiltration in the Treatment of Salicylate Overdose,” Human & Experimental Toxicology, Vol. 20, No. 9, 2001, pp. 491-495. doi:10.1191/096032701682693071
[1] P. Kramer, W. Wigger and J. Rieger, “Arteriovenous Hemofiltration: A New and Simple Method for the Treatment of Overhydrated Patients Resistant to Diuretics,” Journal of Molecular Medicine, Vol. 55, No. 22, 1977, pp. 1121-1122. doi:10.1007/BF01477940 [2] M. S. Joy, G. R. Matzke, D. K. Armstrong, M. A. Marx, and B. J. Zarowitz, “A Primer on Continuous Renal Replacement Therapy for Critically Ill Patients,” Annals of Pharmacotherapy, Vol. 32, No. 3, 1998, pp. 362-75. doi:10.1345/aph.17105 [3] J. W. Goodman and D. S. Goldfarb, “The Role of Continuous Renal Replacement Therapy in the Treatment of Poisoning,” Seminars in Dialysis, Vol. 19, No. 5, 2006, pp. 402-407. doi:10.1111/j.1525-139X.2006.00194.x [4] Z. Kim and D. S. Goldfarb, “Continuous Renal Replacement Therapy Does Not Have a Clear Role in the Treatment of Poisoning,” Nephron Clinical Practice, Vol. 115, No. 1, 2010, pp. c1-c6. doi:10.1159/000286343 [5] P. K. Tyagi, J. F. Winchester and D. A. Feinfeld, “Extracorporeal Removal of Toxins,” Kidney International, Vol. 74, No. 10, 2008, pp. 1231-1233. doi:10.1038/ki.2008.476 [6] G. Wrathall, R. Sinclair, A. Moore and D. Pogson, “Three Case Reports of the Use of Haemodiafiltration in the Treatment of Salicylate Overdose,” Human & Experimental Toxicology, Vol. 20, No. 9, 2001, pp. 491-495. doi:10.1191/096032701682693071