Extracorporeal Treatment for Metformin Poisoning: Systematic Review and Recommendations From the Extracorporeal Treatments in Poisoning Workgroup

  title={Extracorporeal Treatment for Metformin Poisoning: Systematic Review and Recommendations From the Extracorporeal Treatments in Poisoning Workgroup},
  author={Diane P. Calello and Kathleen D. Liu and Timothy J. Wiegand and Darren M. Roberts and Val{\'e}ry Lavergne and Sophie Gosselin and Robert S. Hoffman and Thomas D. Nolin and Marc Ghannoum},
  journal={Critical Care Medicine},
Background:Metformin toxicity, a challenging clinical entity, is associated with a mortality of 30%. The role of extracorporeal treatments such as hemodialysis is poorly defined at present. Here, the Extracorporeal Treatments In Poisoning workgroup, comprising international experts representing diverse professions, presents its systematic review and clinical recommendations for extracorporeal treatment in metformin poisoning. Methods:A systematic literature search was performed, data extracted… 

Extracorporeal treatment for digoxin poisoning: systematic review and recommendations from the EXTRIP Workgroup

It was concluded that digoxin is slightly dialyzable (level of evidence) and that ECTR is unlikely to improve the outcome of digoxin-toxic patients whether or not digoxin immune Fab (Fab) is administered, and ECTr, in any form, is not indicated for either suspected or proven digoxin toxicity.

Extracorporeal treatment for valproic acid poisoning: Systematic review and recommendations from the EXTRIP workgroup

The workgroup concluded that VPA is moderately dialyzable in the setting of overdose and made the following recommendations: ECTR is recommended in severe VPA poisoning, and intermittent hemoperfusion or continuous renal replacement therapy (2D) is an acceptable alternative.

Extracorporeal treatments for isoniazid poisoning: Systematic review and recommendations from the EXTRIP workgroup

No benefit could be extrapolated from ECTR, although there was evidence of added costs and harms related to the double lumen catheter insertion, the extracorporeal procedure itself, and the extacorporeal removal of pyridoxine.

Extracorporeal Treatment in Phenytoin Poisoning: Systematic Review and Recommendations from the EXTRIP (Extracorporeal Treatments in Poisoning) Workgroup.

  • K. AnseeuwJ. Mowry T. Nolin
  • Medicine, Biology
    American journal of kidney diseases : the official journal of the National Kidney Foundation
  • 2016
Peytoin appears to be amenable to extracorporeal removal, however, because of the low incidence of irreversible tissue injury or death related to phenytoin poisoning and the relatively limited effect of ECTR on pheny toin removal, the workgroup proposed the use ofECTR only in very select patients with severe phenyToin poisoning.

Metformin Poisoning: A Debate on Recommendations for Extracorporeal Treatment.

Before excluding tigecycline from the authors' extremely exiguous antimicrobial armamentarium against XDR bacteria, new interventional studies are urgently needed to verify its clinical activity at higher, more appropriate, doses.

Extracorporeal treatment for calcium channel blocker poisoning: systematic review and recommendations from the EXTRIP workgroup

Both dialyzability and clinical data do not support a clinical benefit from ECTRs for CCB poisoning, and the EXTRIP workgroup recommends against using extracorporeal methods to enhance the elimination of amlodipine, diltiazem, and verapamil in patients with severe poisoning.

Availability and cost of extracorporeal treatments for poisonings and other emergency indications: a worldwide survey

The superior efficacy of IHD for enhanced elimination, added to its lower cost and wider availability, strengthens its preference as the ECTR of choice in most cases of acute poisoning.

Continuous extracorporeal clearance in metformin-associated lactic acidosis and metformin-induced lactic acidosis: a systematic review

Overall survival among patients suffering from metformin toxicity who received continuous extracorporeal treatment was 85.8%, an overall slightly greater survival percentage compared to previous publications of individuals requiring any modality of renal replacement therapy.

Metformin toxicity: A meta-summary of case reports

Most of the reported cases were on therapeutic doses of metformin but developed toxicity after an acute deterioration in renal functions, which may indicate the severity of toxicity and the need for aggressive therapeutic measures but may not necessarily indicate poor outcomes.



Extracorporeal treatment for carbamazepine poisoning: Systematic review and recommendations from the EXTRIP workgroup

Despite the low quality of the available clinical evidence and the high protein binding capacity of carbamazepine, the workgroup suggested extracorporeal removal in cases of severe carbazepine poisoning.

Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup.

The workgroup concluded that lithium is dialyzable (Level of evidence=A) and made the following recommendations: Hemodialysis is the preferred extracorporeal treatment, but continuous RRT is an acceptable alternative (1D).

Extracorporeal treatment for acetaminophen poisoning: Recommendations from the EXTRIP workgroup

The workgroup agreed that N-acetylcysteine (NAC) is the mainstay of treatment, and that ECTR is not warranted in most cases of APAP poisoning, but is suggested in patients with excessively large overdoses who display features of mitochondrial dysfunction.

Extracorporeal Treatment for Tricyclic Antidepressant Poisoning: Recommendations from the EXTRIP Workgroup

The workgroup considers that poisoned patients with TCAs are not likely to have a clinical benefit from extracorporeal removal and recommends it NOT to be used in TCA poisoning.

Recommendations for the Role of Extracorporeal Treatments in the Management of Acute Methanol Poisoning: A Systematic Review and Consensus Statement

Extracorporeal treatment has a valuable role in the treatment of patients with methanol poisoning and a range of clinical indications for extracorpreal treatment is provided and duration of therapy can be guided through the careful monitoring of biomarkers of exposure and toxicity.

The EXTRIP (EXtracorporeal TReatments In Poisoning) workgroup: Guideline methodology

Rigorous methodology, using the AGREE instrument, was developed and ratified, and will permit the production of the first important practice guidelines on this topic.

Guidelines for Reporting Case Studies on Extracorporeal Treatments in Poisonings: Methodology

A checklist that systematically outlines the minimum essential items to be reported in a case study of poisoned patients undergoing extracorporeal treatments in poisoning is constructed and proposed, believing that this guideline will improve the completeness and transparency of published case reports and that the systematic aggregation of information from case reports may provide early signals of effectiveness and/or harm, thereby improving healthcare decision‐making.

Extracorporeal treatment for thallium poisoning: recommendations from the EXTRIP Workgroup.

Tl's low dialyzability and the limited evidence, the workgroup strongly recommended extracorporeal removal in the case of severe Tl poisoning, and concluded that Tl is slightly dialyzable and made the following recommendations.

Extracorporeal treatment for barbiturate poisoning: recommendations from the EXTRIP Workgroup.

Patients with long-acting barbiturate poisoning should be treated with ECTR provided at least one of the specific criteria in the first recommendation is present, and the rationale for all recommendations is provided.

Metformin toxicity: a report of 204 cases from Iran.

Although lactic acidosis is considered to be a serious condition resulting in high mortality and morbidity rates, it seems that metformin-intoxicated patients can easily and safely be managed with conservative therapies.