An intensive care unit admission for the management of poisonings is, unfortunately, a commonplace event. The traditional treatments for most drug ingestions are gastric decontamination, the measurement of drug level in plasma, or antidotal therapy. To our surprise, the binding of the drugs to specific serum proteins is an additional variable with severe impact on the pharmacokinetics of some poisons. According to our database of data in the field, the albumin concentration in the blood is the most important determinant of the serum half-life of many drugs and, thus, is one of the key components of the pharmacokinetics of each and every drug administered. This makes a dose regimen to achieve a desired serum concentration a difficult task, especially in the case of intoxications with multiple drugs.
We review and elaborate on the available evidence for the assay of albumin in the course of antidotal therapy to treat poisonings. We also review the role of other proteins, other markers of liver function and the behavior of albumin during decompensation of hepatic disease in the perioperative management of poisoned patients.
The factors that influence the plasma half-life of drugs in poisoned patients, and the variables that affect the binding of drugs to different proteins are considered. The potential of measurement of the concentration of albumin in the plasma and/or serum to increase the success of antidotal therapy in patients with substantial ingestion of various drugs is then analyzed. We conclude that knowledge of the pharmacokinetics of a variety of drugs is mandatory in order to make reasonable decisions regarding dose or mode of administration and, very importantly, to avoid the occurrence of toxic and potentially fatal adverse effects.
In only several minutes, the stomach releases a massive amount of gastric acid which can destroy the contents of the stomach. Gastric decontamination can be accomplished by various pharmacological approaches. When administered early in the course of the poisoning, some of these maneuvers can provide immediate benefits to poisoned patients by accelerating drug excretion or by neutralizing and preventing toxic effects of the ingested substance. When administered later, they can be of some use as an adjunct to conventional therapy. The serum half-life of most drugs ranges from a few minutes to several hours in normal subjects. The constant of protein binding represents the fraction of the free (unbound) drug .
This is a mechanism whereby the concentrations of many drugs in the plasma and serum are lower than in the whole blood. Drugs that have a high percentage of unbound drug available for extra-v
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