{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T10:32:14Z","timestamp":1794047534135,"version":"4.8.0"},"reference-count":51,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:p>\n                    Poisoning occurs after exposure to any of a number of substances, including medicines, which can result in severe toxicity including death. The nephrologist may be involved in poisonings that cause kidney disease and for targeted treatments. The overall approach to the poisoned patient involves the initial acute resuscitation and performing a risk assessment, whereby the exposure is considered in terms of the anticipated severity and in the context of the patient's status and treatments that may be required. Time-critical interventions such as gastrointestinal decontamination (\n                    <jats:italic toggle=\"yes\">e.g.<\/jats:italic>\n                    , activated charcoal) and antidotes are administered when indicated. The nephrologist is usually involved when elimination enhancement techniques are required, such as urine alkalinization or extracorporeal treatments. There is increasing data to guide decision making for the use of extracorporeal treatments in the poisoned patient. Principles to consider are clinical indications such as whether severe toxicity is present, anticipated, and\/or will persist and whether the poison will be significantly removed by the extracorporeal treatment. Extracorporeal clearance is maximized for low\u2013molecular weight drugs that are water soluble with minimal protein binding (&lt;80%) and low endogenous clearance and volume of distribution. The dosage of some antidotes (\n                    <jats:italic toggle=\"yes\">e.g.<\/jats:italic>\n                    , N-acetylcysteine, ethanol, fomepizole) should be increased to maintain therapeutic concentrations once the extracorporeal treatment is initiated. To maximize the effect of an extracorporeal treatment, blood and effluent flows should be optimized, the filter with the largest surface area selected, and duration tailored to remove enough poison to reduce toxicity. Intermittent hemodialysis is recommended in most cases when an extracorporeal treatment is required because it is the most efficient, and continuous kidney replacement therapy is prescribed in some circumstances, particularly if intermittent hemodialysis is not readily available.\n                  <\/jats:p>","DOI":"10.2215\/cjn.0000000000000057","type":"journal-article","created":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T09:03:24Z","timestamp":1674205404000},"page":"1210-1221","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":32,"title":["Management of Poisonings and Intoxications"],"prefix":"10.2215","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4794-4127","authenticated-orcid":false,"given":"Marc","family":"Ghannoum","sequence":"first","affiliation":[{"name":"Research Center, CIUSSS du Nord-de-l'\u00eele-de-Montr\u00e9al, University of Montreal, Montreal, Quebec, Canada, and Department of Nephrology and Hypertension, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9101-7577","authenticated-orcid":false,"given":"Darren M.","family":"Roberts","sequence":"additional","affiliation":[{"name":"New South Wales Poisons Information Centre, Sydney Children's Hospitals Network, Westmead, and Edith Collins Centre, Drug Health Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,1,13]]},"reference":[{"issue":"12","key":"B1-20250823","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1080\/15563650.2021.1989785","article-title":"2020 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 38th Annual report","volume":"59","author":"Gummin","year":"2021","journal-title":"Clin Toxicol (Phila)."},{"issue":"5","key":"B3-20250823","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1136\/emj.2005.030312","article-title":"A risk assessment based approach to the management of acute poisoning","volume":"23","author":"Daly","year":"2006","journal-title":"Emerg Med J."},{"issue":"4","key":"B4-20250823","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.ccc.2012.07.008","article-title":"Toxidromes","volume":"28","author":"Holstege","year":"2012","journal-title":"Crit Care Clin."},{"issue":"4","key":"B5-20250823","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1046\/j.1365-2125.2003.01772.x","article-title":"Valproate overdose: a comparative cohort study of self poisonings","volume":"55","author":"Isbister","year":"2003","journal-title":"Br J Clin Pharmacol."},{"issue":"10","key":"B6-20250823","doi-asserted-by":"crossref","first-page":"993","DOI":"10.3109\/15563650.2014.973572","article-title":"Extracorporeal treatment for carbamazepine poisoning: systematic review and recommendations from the EXTRIP workgroup","volume":"52","author":"Ghannoum","year":"2014","journal-title":"Clin Toxicol."},{"issue":"2","key":"B7-20250823","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.annemergmed.2015.03.031","article-title":"Extracorporeal treatment for salicylate poisoning: systematic review and recommendations from the EXTRIP workgroup","volume":"66","author":"Juurlink","year":"2015","journal-title":"Ann Emerg Med."},{"issue":"8","key":"B8-20250823","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.1097\/CCM.0000000000001002","article-title":"Extracorporeal Treatments in Poisoning Workgroup. 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