1. 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

2. 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

3. 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

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

5. 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

6. 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

7. 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

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

9. 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

10. 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

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