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Acquired cystic kidney disease: occurrence, prevalence, and renal cancers Medicine (Baltimore) 1990;69(4):217–26 119 Farivar-Mohseni H, Perlmutter AE, Wilson S, Shingleton WB, Bigler SA, Fowler JE Jr Renal cell carcinoma and end stage renal disease J Urol 2006;175(6):2018–20; discussion 21 Extracorporeal Therapy for Drug Overdose and Poisoning 38 Vimal Chadha Introduction antidepressants (5.2%) In children ≤5 years, analgesics (9%) were surpassed by cosmetics/ Poisoning continues to be a significant cause of personal care products (12.1%) and household morbidity and mortality The 2018 Annual Report cleaning substances (10.7%) [1] of the American Association of Poison Control Of note, there has been a steady decline Centers National Poison Data System (NPDS): (15.7% since 2008) in the number of poisoning 36th Annual Report published information on cases, but this has been accompanied by an 2,099,751 human exposure cases of poisoning of increase (4.45% per year since 2000) in the numwhich more than half (59%) were children and ber of cases with serious outcomes The most adolescents 80%) substances are therefore not amenable to therapy with extracorporeal modalities However, at toxic levels the protein binding sites are usually saturated, thus increasing the proportion of free fraction which potentially increases poisoning severity because the Table 38.1 Pharmacokinetic properties of some of the drugs frequently involved in poisoning Drug Acetaminophen Carbamazepine Digoxin Ethanol Ethylene glycol Isopropanol Lithium Metformin Methanol Phenobarbital Phenytoin Salicylate Thallium Theophylline Tricyclic antidepressant Valproate Vancomycin Molecular weight (Da) 151 236 765 46 62 60 129 32 232 252 180 204 180 263–314 Volume of distribution (L/kg) 0.8–1.0 0.8–1.4 5–8 0.7 0.5–0.8 0.7 0.7–0.9 1–5 0.6–0.8 0.25–1.2 0.6–0.8 0.2 3–10 0.5 5–78 Protein binding (%) 25 75 20–30 0 10 0 20–60 90 90b 50 73–98 Preferred extracorporeal modality IHD IHD — IHD IHD IHD IHD IHD IHD IHD IHDa IHD IHD IHD — 144 1449 0.1–0.5