بسم الله الرحمن الرحيم Enhanced Elimination & Antidote د/ عبد المنعم جودة مدبولى دكتوراة الطب الشرعى و السموم الأكلينيكية, مدرس الطب الشرعى و السموم الأكلينيكية, استشاري علاج التسمم بمستشفى بنها الجامعى 19/11/1439 Dr Abdel Moniem Gouda Madbouly

Dr Abdel Moniem Gouda Madbouly Objectives: General management of poisoned patient: WITH SPECIAL CONCENTRATION TO: Enhanced (Active) Elimination. = (Systemic" blood & tissues" circulation decontamination) Antidotes. 19/11/1439 Dr Abdel Moniem Gouda Madbouly

Dr Abdel Moniem Gouda Madbouly Definition: Removal of toxin after absorption to systemic circulation. Types: Urine manipulation ……………………….. Extracorporeal Removal of Toxins….. Essential modalities that may be life-saving in the treatment of selected poisoned patients. Removal is enhanced 30 per cent or more by extracorporeal techniques 19/11/1439 Dr Abdel Moniem Gouda Madbouly

Dr Abdel Moniem Gouda Madbouly Methods used for elimination 1- Forced diuresis. 2- pH alteration (urinary alkalinization). 3- Heamodialysis. 4- Hemoperfusion. 5- Gut dialysis. 6- Exchange transfusion. 7- Plasmapheresis 8- Hemofiltration 9- Hemodiafiltration 10- Peritoneal dialysis 11- Plasma perfusion 12- Hyperbaric oxygen 13- Cardiopulmonary bypass. 19/11/1439 Dr Abdel Moniem Gouda Madbouly

Extracorporeal Removal: Enhanced Elimination Urine manipulation: 1- Forced diuresis 2- pH alteration Extracorporeal Removal: 1- Heamodialysis 2- Hemoperfusion 3- Hemofiltration 4- Peritoneal dialysis 5- Plasma perfusion 6- Plasmapheresis & Plasma exchange 7- Plasma perfusion Other Methods: 1- Gut dialysis 2- Exchange transf. 3- immuno-pharmacology 4- HBO 19/11/1439 Dr Abdel Moniem Gouda Madbouly

Indications for elimination of a toxic agent: Patient’s deteriorates despite supportive care. Toxic agent produce severe (lethal) toxicity. Blood concentration is very high. Impaired normal routes of elimination (renal failure). Toxic agent, metabolized to a toxic metabolite. 19/11/1439 Dr Abdel Moniem Gouda Madbouly

Dr Abdel Moniem Gouda Madbouly الشروط العامة Small Volume of Distribution (VD). High plasma concentration. ------------------------------------------------- Low molecular weight. Low protein binding. Water solubility. Renally excreted. 19/11/1439 Dr Abdel Moniem Gouda Madbouly

Dr Abdel Moniem Gouda Madbouly Antidote 19/11/1439 Dr Abdel Moniem Gouda Madbouly

Dr Abdel Moniem Gouda Madbouly Def: “A chemical agent used to neuterlize toxin effects.” Types: Physical antidotes. Chemical inactivators. Antagonists: Physiological Competieive. 19/11/1439 Dr Abdel Moniem Gouda Madbouly

Dr Abdel Moniem Gouda Madbouly Toxidromes: Physiologic fingerprints” = groups of symptoms & signs in response to exposure to one of similar group of agents 19/11/1439 Dr Abdel Moniem Gouda Madbouly

Dr Abdel Moniem Gouda Madbouly 19/11/1439 Dr Abdel Moniem Gouda Madbouly