Elimination enhancement,Elimination enhancement, pharmd, doctor of pharmacy,

1. ELIMINATION ENHANCEMENT

2. ELIMINATION
• It is defined as the act of removing or getting rid
of bodily discharged waste matter.
• The elimination systems in our body,eliminates about
two pounds of material per day in the normal healthy
adult.
• If any one of these channels become overloaded or
clogged and slowed down, there will be an
accumulation of toxic material in the body tissues.

3. ELIMINATION SYSTEMS
• There are 5 elimination systems in body,
THE BOWL(colon)
KIDNEYS
LUNGS
SKIN
LIVER
• The lymph system works with these five systems by
serving as a "garbage collector" to carry metabolic
by-products and accumulated cellular waste from
tissues to the elimination organs.

4. ELIMINATION ENHANCEMENT
• Accidental and intentional poisonings or drug overdoses
constitute a significant source of aggregate
morbidity, mortality, and health care expenditures.
• Management of the poisoned patient begins with a
thorough evaluation, identification of the agent(s)
involved, assessment of severity, and prediction of
toxicity.
• Therapy involves the provision of supportive
care, prevention of poison absorption, the administration
of antidotes and enhancement of elimination of the
poison.

5. METHODS OF ENHANCEMENT
• Multiple dose activated charcoal
• Saline diuresis
• Extracorporial methods-dialysis
hemo perfusion
hemo filtration
plasmapheresis
exchange transfusion

6. Other therapies:
• Hyperbaric oxygen
• Chelation therapy
• Cerebrospinal fluid removal
• Immunological therapy-specific antibody toxin
binding.

7. Multiple dose activated charcoal
• Charcoal slurry along the entire intestinal tract
• Large surface area for adsorption of drug diffusing
across intestinal epithelium from capillaries
• MDAC can also enhance elimination of absorbed
toxins by interrupting enterohepatic and enteroenteric
recirculation and by promoting passive diffusion of
drugs from the intestine.

8. Some Agents for which MDAC may
enhance elimination are:
• Dapsone
• Amitriptaline
• Diazepam
• Methotrexate
• Salicylate
• Valproate

9. Saline diuresis
• The urinary excretion of some drugs can be enhanced
by increasing the urine output and, more
importantly, altering the urine pH.
• urinary acidification (urine pH below 5.5)
with ammonium chloride or ascorbic acid will
increase the excretion of weak bases.
• For drugs that are weak acids
(eg, salicylates, phenobarbital), raising the urine pH
to 7.5 to 8.0 .

10. Some Agents
• Forced diuresis -barium
chromium
iodide
calcium
potassium
lithium
alkaline diuresis -salicylates
barbiturates
sulfonamides

11. hemodialysis
• Can be arteriovenous or veno-venous (double-
lumen catheter)
• Requires anticoagulation
• Best if drug is:
▫ water-soluble
▫ small (MW <500)
▫ not highly protein bound
• Also good for correcting fluid & electrolyte
abnormalities.

13. Some Agents
• Barbiturates
• Alcohols
• Lithium
• Salicylates
• Atenolol
• Theophylline etc

14. Peritoneal dialysis
• Tubes are inserted into the peritoneal cavity.
electrolytes and fluids were sent and waste
matter is collected out side.
• Theoretically useful if drug is:
▫ water soluble
▫ small (MW <500)
▫ not highly protein bound
• Rarely performed unless it’s the only available
method.

15. hemoperfusion
• Hemoperfusion refers to the circulation of blood
through an extracorporeal circuit containing an
adsorbent such as activated charcoal or
polystyrene resin.

17. Some agents
• Phenobarbitol
• Sedatives
• Phynitoin
• Chloramphenicol
• Carbamazepine
• Caffeine.

18. hemofiltration
• Blood that enters the hemofiltration circuit
passes through filters with large pores, and an
ultrafiltrate forms which drags solutes with
molecular weights up to 50,000 daltons .
• Cells and solutes larger than the pore size
remain in the blood and return to the
circulation. Plasma moves across semipermeable
membrane under hydrostatic pressure
• No dialysate.

19. Some agents
• Aminoglycosides,
• Vancomycin, and
• Metal chelate complexes.

20. plasmapheresis
• It is the removal, treatment, and return of
(components of) blood plasma from blood
circulation. It is thus an extracorporeal
therapy (a medical procedure performed outside
the body).
• The method is also used to collect
plasma, which is frozen to preserve it for
eventual use in the manufacture of a variety of
medications.

21. Exchange transfusion
• Exchange transfusion refers to the removal of a
quantity of blood from a poisoned patient and its
replacement with an identical quantity of whole
blood
• The process is usually repeated two to three
times.
• for methemoglobinemia, sulfhemoglobinemia
(eg, secondary to hydrogen sulfide exposure), or
in neonatal drug toxicity.

22. Hyperbaric oxygen
• Hyperbaric oxygen therapy uses a special
chamber, sometimes called a pressure
chamber, to increase the amount of oxygen in
the blood.
• The air pressure inside a hyperbaric oxygen
chamber is about two and a half times greater
than the normal pressure in the atmosphere.
This helps your blood carry more oxygen to
organs and tissues in your body.

23. Chelation therapy
• Chelation therapy is the administration
of chelating agents to remove heavy metals from
the body.
• Heavy metals include- lead,
arsenic or mercury.
• chelating agents include dimercaptosuccinic
acid, and alpha lipoic acid.

24. Cerebrospinal fluid removal
• It is performed in order to collect a sample
of cerebrospinal fluid containing poision.

25. Immunological therapy
• The use of antibodies in the diagnosis and
treatment of drug poisoning is becoming an
important aspect of emergency medicine.
• Digoxin-specific antibodies selectively inhibit
the pharmacologic and toxic effects of the
digitalis glycosides.

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