Dialyzer Selection and Optimization for Poisoning Treatment

Primary Dialyzer Selection

High-flux dialyzers should be used when hemodialysis is indicated for poisoning, as they provide superior clearance of middle-molecular-weight toxins compared to low-flux membranes 3
The American Journal of Kidney Diseases defines high-flux as β2-microglobulin clearance of at least 20 mL/min, though modern dialyzers achieve substantially higher clearances 3
High-flux membranes are particularly effective for water-soluble toxins with low protein binding, according to the American Journal of Kidney Diseases 4

The Critical Care society recommends using dialyzers with the largest available surface area to enhance clearance 1, 2
Maximize blood flow rates, typically 300-400 mL/min, as recommended by the American Journal of Kidney Diseases 5
Optimize dialysate flow rates to maintain concentration gradients, as suggested by the Critical Care society 1, 2
Consider dialysate temperature reduction to minimize hemodynamic compromise, according to the Critical Care society 1, 2

The Critical Care society recommends intermittent hemodialysis as the primary extracorporeal treatment for most dialyzable poisons, including salicylates, toxic alcohols, lithium, and hydrophilic beta-blockers 1, 2, 6, 7
Intermittent hemodialysis provides the highest clearance rates, exceeding 100 mL/min for salicylates, as reported by the Annals of Emergency Medicine 6, 7
The Annals of Emergency Medicine suggests that peritoneal dialysis has inferior clearance rates, ≤10 mL/min, and should not be used when hemodialysis is available 6, 8

The Annals of Emergency Medicine recommends hemodialysis for salicylates when concentration >7.2 mmol/L (100 mg/dL) in acute poisoning or >6.5 mmol/L (90 mg/dL) in chronic poisoning 6, 7
Hemodialysis clearance can surpass 100 mL/min for salicylates, providing at least 3 times the clearance of urinary alkalinization alone, as reported by the Annals of Emergency Medicine 6, 7, 8
The Critical Care society suggests that for sotalol, serum magnesium should be maintained >1 mmol/L and potassium 4.5-5 mmol/L during dialysis to prevent torsades de pointes 1, 2

The Annals of Emergency Medicine advises against delaying hemodialysis while attempting less effective modalities like urinary alkalinization alone in severe poisonings 6, 7
The Critical Care society recommends not ceasing dialysis based solely on toxin concentration; clinical improvement should guide cessation 1, 2, 6
The Critical Care society suggests ensuring appropriate electrolyte concentrations in dialysate to minimize dysrhythmias and hemodynamic compromise 1, 2, 9