EXTRIP

@ThommyTox @EMPoisonPharmD I sound like a broken record. VD= 30L/kg. You're not removing any bupropion with MARS (or otherwise)

@EMPoisonPharmD They claim MARS helped the patient recover… yet they did not report any bupropion [conc], let alone pre/post filter [conc]. From the literature I’ve read, drug clearance from MARS is pretty slowww. I guess you throw the kitchen sink at toxicity like this (benefit/risk).

When you consult on a critical bupropion overdose, recommend MARS based on theory, and it WORKS (or it was going to happen anyway, n=1)... THEN YOU FIND OUT IT WAS PUBLISHED AND THEY DIDN’T MENTION CONSULTING A POISON CENTER WHO GAVE THEM THE IDEA: pmc.ncbi.nlm.nih.gov/articles/PMC10…

EMCrit 370 - Extracorporeal Therapies for Poisoning #ExTRIP #NephMadness A panel of brilliant nephrologists discuss RRT for the Poisoned Patient. Modality choice, how to consult, access, hemodynamic stability and so much more! [#FOAMed] emcrit.org/370

@JEGAYTAN90 @ArgaizR @alfonsogindl @hydws_ @Elena_Cervants @AJKDonline @NephMadness @weddellite @DrDianeC @MarcGhannoum @NefroINCMNSZ @medicinterna There's a cool case report of someone using isopropanol (a less toxic alcohol) as an antidote for EG poisoning (although I would contend that a cheap scotch bottle is easy enough to find).

#NephMadness 2024 ☠️ region: Antidotes are strong contenders. A few years ago, we needed to treat ethylene glycol poisoning with an oral ethanol recipe using rum @ArgaizR @alfonsogindl @hydws_ Does anyone have other exciting anecdotes using antidotes? ajkdblog.org/2024/03/01/nep……

@hswapnil @weddellite @DrDianeC @JEGAYTAN90 Sorry, was late to the party! Everything said here for glucarpidase is correct. Removes MTX from the blood, but not where it hurts (inside the cells). If AKI has occurred, it's probably too late. And no data of improved outcomes. Obs data suggests outcomes unchanged.

The #NephMadness #Toxicology Region is very cool reading @weddellite @ExtripWorkgroup @DrDianeC and @JEGAYTAN90 ajkdblog.org/2024/03/01/nep… Did you know about glucarpidase?

@baileympaterson Happy to read the answers. Maximize clearance. You're not removing net fluid. HD is preferred.

Interesting case this weekend. Sick patient ?metformin toxicity with profound AGMA, AKI, Bicarb 5 pH <6.8. lactate >20. May have element of euglycemic DKA (on dapa). On levo 1mcg/min. Intubated dt Kussmauling. Needs RRT. What would you choose?

Stop the press! Our latest guideline: when to use dialysis for ethylene glycol poisoning. Perhaps our best paper yet. Hundreds of articles included, thousands of hours of work. ccforum.biomedcentral.com/articles/10.11…

@Sthanu5 3) Nothing corrects metformin-associated acidemia as quickly as HD

@Sthanu5 2) The VD of metformin in AKI is actually quite low and you will remove it with HD.

Q: The primary goal of hemodialysis (HD) in Metformin toxicity is to clear the drug from circulation? A) True B) False

Si eres un #believer de los #some en la formación continuada tienes que seguir a @ExtripWorkgroup: Perfil que se dedica a informar sobre las técnicas de depuración extracorpórea en casos de envenenamiento extrip-workgroup.org @SENefrologia @senjoven @SOMANEorg @nefrocat

Extracorporeal Treatment for Gabapentin and Pregabalin Poisoning: Systematic Review and Recommendations From the @ExtripWorkgroup buff.ly/31g3bxe (FREE temporarily)

Checkout this handout from todays #AAEM22 talk on Toxic Ingestion and Dialysis. Thanks @ExtripWorkgroup for such great guidelines. dropbox.com/s/cskha940sk8b…

Should we dialyze a patient who is toxic from high-dose or oral methotrexate? The jury is now out: cjasn.asnjournals.org/content/early/… Or on our website: extrip-workgroup.org

@drmjkulkarni I would be extremely dubious about any potential benefit.

@ExtripWorkgroup what is the role of hemodialysis is sea snake venom poisoning due bite? Saw this report of 1971 pubmed.ncbi.nlm.nih.gov/5559044/

Extracorporeal Treatment for Gabapentin and Pregabalin Poisoning: Systematic Review and Recommendations From the @ExtripWorkgroup buff.ly/3AZi701 (FREE temporarily)

Extracorporeal Treatment for Gabapentin and Pregabalin Poisoning: Systematic Review and Recommendations From the @ExtripWorkgroup buff.ly/31g3bxe @sgosselinmd

@MPCToxtidbits @EdinClinTox All but 1 patient in the TK table for gabapentin had impaired kidney function. All had impaired kidney function for pregabalin. Half-life was during ECTR so includes ECTR and endogenous function, the latter being quite low presumably

@ExtripWorkgroup @EdinClinTox Nice! In table 2, did all the patients who underwent HD have kidney impairment or is the half-life listed a combination of HD and endogenous clearance?

Just out: EXTRIP's recommendations for dialysis in gabapentin / pregabalin poisoning extrip-workgroup.org/gabapentin-pre…

not simu-live tweeting as absolutely cannot do justice to the excellent @ExtripWorkgroup session at #KidneyWk organized by @weddellite but want to highlight this @DavidJuurlink quotes the IBCC on the big screen! @PulmCrit Salicylate is a huge mimic!

The Extrip guideline for baclofen is dedicated to @Nephro_Sparks