EXTRIP@ExtripWorkgroup

The EXTRIP mission is to provide evidence-based recommendations on the use of extracorporeal treatments for toxin removal in poisoning.

 Based in Canada
extrip-workgroup.org
Joined October 2014
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Replying to @ThommyTox @EMPoisonPharmD
I sound like a broken record. VD= 30L/kg. You're not removing any bupropion with MARS (or otherwise)
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Replying to @baileympaterson
Happy to read the answers. Maximize clearance. You're not removing net fluid. HD is preferred.
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Stop the press! Our latest guideline: when to use dialysis for ethylene glycol poisoning. Perhaps our best paper yet. Hundreds of articles included, thousands of hours of work. ccforum.biomedcentral.com/ar…

Extracorporeal treatment for ethylene glycol poisoning: systematic review and recommendations from...

Critical Care - Ethylene glycol (EG) is metabolized into glycolate and oxalate and may cause metabolic acidemia, neurotoxicity, acute kidney injury (AKI), and death. Historically, treatment of EG...

link.springer.com
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3) Nothing corrects metformin-associated acidemia as quickly as HD
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2) The VD of metformin in AKI is actually quite low and you will remove it with HD.
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Replying to @MoreXGrok
As an author of the published paper referenced, here is my (MG) take: HD does it all. 1) It removes critical metformin from the blood (which is the toxic compartment, unlike lithium)
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Should we dialyze a patient who is toxic from high-dose or oral methotrexate? The jury is now out: cjasn.asnjournals.org/conten… Or on our website: extrip-workgroup.org/
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Replying to @MPCToxtidbits @EdinClinTox
All but 1 patient in the TK table for gabapentin had impaired kidney function. All had impaired kidney function for pregabalin. Half-life was during ECTR so includes ECTR and endogenous function, the latter being quite low presumably
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Just out: EXTRIP's recommendations for dialysis in gabapentin / pregabalin poisoning extrip-workgroup.org/gabapen…

GABAPENTIN / PREGABALIN | extrip-workgroup

extrip-workgroup.org
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The Extrip guideline for baclofen is dedicated to @Nephro_Sparks
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ASN we are live
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All star extrip team out there. @DavidJuurlink @weddellite @MarcGhannoum @VijayanMD @nephrotox and Etienne Macedo
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Replying to @MikeMullinsMD @MUHCPharmRes @saintlukeskc
T1/2 of EG during CKRT was 5.8h, not 2.8h as they state (first point was done prior to CKRT).
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Things are different in patients with impaired kidney function -Toxicity is LONG (extended T1/2) -HD does a better job than impaired kidneys -Less risk of withdrawal (patients develop toxicity within 3 days of baclofen initiation)
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Just out. EXTRIP's recommendations for baclofen. No added benefit from HD in patients with normal kidney function (OD): -Doesn't reduce length of coma -Healthy kidneys do a much better job than HD -Risk of withdrawal (serious) pubmed.ncbi.nlm.nih.gov/3435…
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Replying to @ExtripWorkgroup @bobhoffmd @MarcGhannoum @ValeryLavergne @1darren1Dmr @Tom_Nolin @VijayanMD @DrDianeC @cyatesb @IBerling @AnselmWong1 @LotteHoegberg @dmwood24
1) Several of our manuscripts from our second round of review have now been published
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Replying to @ExtripWorkgroup @bobhoffmd @MarcGhannoum @ValeryLavergne @1darren1Dmr @Tom_Nolin @VijayanMD @DrDianeC @cyatesb @IBerling @AnselmWong1 @LotteHoegberg @dmwood24
A few meaningful updates from EXTRIP!
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Replying to @bilalksheikh @askrenal
HD can remove MTX but you're at a point where toxicity has already occurred. You'll remove what's left in the blood but won't reduce length of AKI. Expect our publication soon!
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Today, EXTRIP-2 breaks the ice. First of 10 recommendations published in JASN. More to come soon. Thank you all! jasn.asnjournals.org/content…
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That's not surprising since HD was started a while after ingestion (most is already eliminated) but in the same period of time healthy kidneys were twice more efficient than HD (double the clearance)
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