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Title:
A PerPLEXing Procedure for Poisonings

Description:
The clinical applications for therapeutic plasma exchange (PLEX) or plasmapheresis have evolved over the years. Its different modalities and ability to be performed in tandem with dialysis circuits may have benefit in toxicologic cases. The rationale for its use in poisonings and envenomations stems from its ability to remove substances with larger molecular weight (>15,000 Da), prolonged half-lives, and high plasma protein binding that are not otherwise reliably removed via hemodialysis or hemoperfusion. Additionally, it has benefit in removing pathogens in systemic conditions including autoimmune diseases, hemolytic anemias, severe sepsis, and cytokine storms which may result from a wide array of severe poisonings. While it has been previously employed in amanita phalloides ingestions and acute liver failure, its application in toxicology has been limited to case reports. A review of its modern mechanics and recent successful clinical uses may support its application as a reasonable therapeutic adjunct in severe toxicities or envenomations when no antidote or definitive treatment is available, or when other specialized modalities such as ECMO are otherwise unavailable.

Presenter:
Andrea Nillas, MD

Kathleen Chen, MD

Moderator:
Michael Keenan, MD