Uremic Vascular Calcification: The Pathogenic Roles and Gastrointestinal Decontamination of Uremic Toxins

Uremic vascular calcification (VC) commonly occurs during advanced chronic kidney disease (CKD) and significantly increases cardiovascular morbidity and mortality. Uremic toxins are integral within VC pathogenesis, as they exhibit adverse vascular influences ranging from atherosclerosis, vascular inflammation, to VC. Experimental removal of these toxins, including small molecular (phosphate, trimethylamine-N-oxide), large molecular (fibroblast growth factor-23, cytokines), and protein-bound ones (indoxyl sulfate, p-cresyl sulfate), ameliorates VC. As most uremic toxins share a gut origin, interventions through gastrointestinal tract are expected to demonstrate particular efficacy. The “gastrointestinal decontamination” through the removal of toxin in situ or impediment of toxin absorption within the gastrointestinal tract is a practical and potential strategy to reduce uremic toxins. First and foremost, the modulation of gut microbiota through optimizing dietary composition, the use of prebiotics or probiotics, can be implemented. Other promising strategies such as reducing calcium load, minimizing intestinal phosphate absorption through the optimization of phosphate binders and the inhibition of gut luminal phosphate transporters, the administration of magnesium, and the use of oral toxin adsorbent for protein-bound uremic toxins may potentially counteract uremic VC. Novel agents such as tenapanor have been actively tested in clinical trials for their potential vascular benefits. Further advanced studies are still warranted to validate the beneficial effects of gastrointestinal decontamination in the retardation and treatment of uremic VC.

Pediatric Ingestions and Toxicologic Exposures

For the majority of emergency medicine providers, one of the most anxiety-provoking patients is a very sick child. This is especially true when pediatric patients present to the emergency department after a toxicologic exposure. Pediatric ingestions and toxicologic exposures are extremely common. Although only a small percentage of toxicologic exposures result in death, severe toxicity is frequently seen and requires substantial medical intervention. This chapter focuses on the approach to a poisoned pediatric patient (including gastrointestinal decontamination and common toxidromes) and common medications ingested by pediatric patients and their treatments. It also briefly discusses some recreational drugs that are commonly used in the pediatric community.

Clinical Pearls in Medical Toxicology: Updates Ranging From Decontamination to Elimination

Such as any field of medicine, it is imperative to stay current with the latest advances and treatment modalities in toxicology. With the absence of rigorous randomized controlled trials, many updated guidelines are created by expert consensus and/or case reports and clinical experience. Over the past 10 years, there have been several changes in the management of drug overdoses in light of new data available. Although this is not a comprehensive review of all available antidotes, this article will focus on several important interventions including the use of gastrointestinal decontamination, hyperinsulinemic–euglycemic therapy, methylene blue, intravenous lipid emulsion, hemodialysis, and extracorporeal membrane oxygenation.

Evaluatıon of Basal Metabolıc Panels in Drug Poısonıng Who Applıed Wıth Actıvated Charcoal

Introduction: Poisoning is the hindering of the bodily functions of the organism after it encounters a toxic factor. Poisoning may be the result of suicide attempts, overdose, or adverse effects. Some of these patients require gastrointestinal decontamination. The most commonly used material for this is activated charcoal. Activated charcoal may cause side-effects in the human body. Purpose: This study examines the effects of active charcoal on the basic metabolic panel when used on patients for any reason. Material and Method: This is a retrospective, single-center, and observational study. The subjects of the study are patients that were admitted to the emergency room between 01.01.2012 and 30.07.2017 with various cases of poisoning, and who underwent activated charcoal treatment. The ingested drugs were classified according to their active substances. The patients were evaluated with regard to their age, gender, vital findings, chronic diseases, chronic medication, whether they were referred from external centres, and whether or not they received active charcoal. Results: The changes in patients' levels of pCO2, Na, Ca, BUN, creatinine and blood glucose were found to be statistically significant. However, since all the obtained values were within reference ranges, the difference was not considered to be clinically significant. No significant change was observed in blood pH, K and Mg concentrations. Conclusion: This study is a first in the literature to indicate that there is no clinically significant change in the basic metabolic panels of patients who received active charcoal treatment. This study has shown that active charcoal treatment can be applied to patients with chronic diseases.

Evaluatıon of Basal Metabolıc Panels in Drug Poısonıng Who Applıed Wıth Actıvated Charcoal

Introduction: Poisoning is the hindering of the bodily functions of the organism after it encounters a toxic factor. Poisoning may be the result of suicide attempts, overdose, or adverse effects. Some of these patients require gastrointestinal decontamination. The most commonly used material for this is activated charcoal. Activated charcoal may cause side-effects in the human body. Purpose: This study examines the effects of active charcoal on the basic metabolic panel when used on patients for any reason. Material and Method: This is a retrospective, single-center, and observational study. The subjects of the study are patients that were admitted to the emergency room between 01.01.2012 and 30.07.2017 with various cases of poisoning, and who underwent activated charcoal treatment. The ingested drugs were classified according to their active substances. The patients were evaluated with regard to their age, gender, vital findings, chronic diseases, chronic medication, whether they were referred from external centres, and whether or not they received active charcoal. Results: The changes in patients' levels of pCO2, Na, Ca, BUN, creatinine and blood glucose were found to be statistically significant. However, since all the obtained values were within reference ranges, the difference was not considered to be clinically significant. No significant change was observed in blood pH, K and Mg concentrations. Conclusion: This study is a first in the literature to indicate that there is no clinically significant change in the basic metabolic panels of patients who received active charcoal treatment. This study has shown that active charcoal treatment can be applied to patients with chronic diseases.