ELIMINATION

Question 1

What is the purpose of elimination in poisoning management?

Answer 1

A: Remove poison from the patient’s systemic circulation

Rationale: Helps decrease toxin levels in blood and prevent further tissue damage.

Question 2

What is urine manipulation in poison elimination?

Answer 2

A: Altering urine pH to enhance renal excretion of toxins if kidney function is optimal

Rationale: Weak acids or bases can be excreted faster by changing urine pH.

Question 3

How does urine alkalinization work and what is the agent used?

Answer 3

A: Increases urine pH to eliminate weak acids

Agent: Sodium bicarbonate (NaHCO₃)

Rationale: Alkaline urine ionizes weak acids → trapped in urine → faster excretion.

Question 4

How does urine acidification work and what agents are used?

Answer 4

A: Decreases urine pH to eliminate weak bases

Agents: Ammonium chloride (NH₄Cl), Vitamin C

Rationale: Acidic urine ionizes weak bases → prevents reabsorption → faster excretion.

Question 5

When are extracorporeal methods used?

Answer 5

A: When kidney function is impaired/ DAMAGED

Indications:
o Acidosis (severe)
o Electrolye Imbalance (Refractory)
o Intoxication w/ several substances
o Overload (Fluid)
o Uremia (↑BUN, ↑creatinine, darkened skin)

Question 6

What are the types of extracorporeal elimination methods?

Answer 6

Hemodialysis – uses a dialysis membrane to filter toxins

Hemoperfusion – blood passes through an adsorbent column to remove poisons

Peritoneal dialysis – uses the peritoneum as a semipermeable membrane to clear toxins

Mnemonic: “HHP clears the blood” → Hemodialysis, Hemoperfusion, Peritoneal dialysis

Question 7

Serous membrane that line the abdominal cavity

Provides insulation to abdominal organs & hold them in place

Answer 7

Peritoneum

Question 8

What type of drugs is best removed by hemodialysis?

Answer 8

A: Polar (water-soluble), small, non-protein bound drugs

Examples: Alcohols, Aspirin

Rationale: Hemodialysis uses diffusion across a semipermeable membrane, which works best for small, water-soluble, unbound molecules.

Question 9

What type of drugs is best removed by hemoperfusion?

Answer 9

A: Nonpolar or large, protein-bound drugs

CNS drugs, Methotrexate, Theophylline

Rationale: Hemoperfusion uses adsorption onto activated charcoal or resin, which can remove substances that cannot cross dialysis membranes.

Question 10

Which extracorporeal methodorrects fluid and electrolyte imbalances?

Answer 10

A: Hemodialysis
R

ationale: Hemodialysis not only removes toxins but also restores electrolyte and fluid balance.

Question 11

Which extracorporeal method works faster for poison elimination?

Answer 11

A: Hemoperfusion
Rationale: Adsorption is faster than diffusion across a membrane.

Question 12

Compare the mechanism of hemodialysis and hemoperfusion.

Answer 12

Hemodialysis: Diffusion across a semipermeable membrane

Hemoperfusion: Adsorption onto activated charcoal or resin

Question 13

Compare the duration of toxin removal in hemodialysis vs hemoperfusion.

Answer 13

Hemodialysis: Slow

Hemoperfusion: Fast

Question 14

What type of filter is used in hemodialysis vs peritoneal dialysis?

Answer 14

Hemodialysis: Artificial filter

Peritoneal Dialysis: Natural filter (peritoneum)

Rationale: Hemodialysis uses a synthetic membrane outside the body, while peritoneal dialysis uses the patient’s own peritoneum.

Question 15

Where is the filter placed in hemodialysis vs peritoneal dialysis?

Answer 15

Hemodialysis: Outside the body

Peritoneal Dialysis: Inside the body

Rationale: Determines procedure setup and invasiveness.

Question 16

Which dialysis method is more efficient in removing toxins?

Answer 16

Hemodialysis: More efficient, more complex

Peritoneal Dialysis: Less efficient, more simple

Rationale: Hemodialysis uses a high-flow system and synthetic membrane for faster clearance.