Haemodialysis, peritoneal dialysis, haemoperfusion, exchange transfusion and forced diuresis have all been used in attempts to increase the rate of removal of drugs and poisons. How­ever, the amount of active drug removed is often disappointingly small, and the indications for the use of such measures is very limited.

Never­theless, poisoned patients are often unnecessar­ily subjected to these potentially harmful meas­ures, and the literature is full of anecdotal accounts of miraculous recovery attributed to such treatment (Winchester et al. 1977). Prop­erly controlled clinical trials are difficult to carry out, and very few have been published. With the possible exception of forced alkaline di­uresis for poisoning with salicylate and long act­ing barbiturates such as phenobarbitone, none of these methods for enhancement of drug re­moval has ever been shown to reduce morbidity or mortality in poisoned patients (Todd 1984).

Indeed, some studies suggest the opposite result. This is not to say that such measures are never necessary, or indeed sometimes life saving, but a more critical appraisal of their role is required.

Absorption, Acidic, Alkaline, Analytical, Bentonite, Chemical, Clinical, Dialysis, Dose, Fraction, Method, Paracetamol, Poison, Recovery, Therapeutic, Toxic, Treatment, Trial

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