Table 1.

Utility of extracorporeal modalities in poisoning

ModalityToxin Molecular Mass (Da)Toxin Volume of Distribution (L/kg)Protein Binding of ToxinExamples of Toxins Amenable to TherapyPrimary Limitations of Therapy
HemodialysisUp to 10,000–15,000≤1.5–2≤80%Salicylates, toxic alcohols, lithiumHemodynamic stability
HCO filter HDUp to 50,000≤1.5–2≤80%Small peptide therapeutics; any therapy amenable to HDLimited availability
Limited role in poisoning
CRRTUp to 15,000–25,000≤1.5–2≤80%LithiumSlow toxin clearance (excepting toxins with slow redistribution)
HemoperfusionUnclear, but high≤1 L/kgAnyValproic acid, carbamazepineLimited availability
Clotting
Hypocalcemia
Plasma exchangeNo limit≤1 L/kgAnyMonoclonal antibodies, arsineLimited availability
Very slow clearance
  • HCO, high-molecular-mass cutoff; HD, hemodialysis; CRRT, continuous renal replacement therapy.