RESUMEN
Poisoning with a large variety of drugs and naturally occurring toxins may result in acute liver injury and failure. Drug-induced liver injury is a major cause of liver failure nationwide, and it is likely that nephrologists will be involved in treating patients with these conditions. A number of xenobiotics resulting in liver toxicity may cause acute kidney injury or other organ injury as well. Most agents causing drug- or toxin-induced liver failure lack specific therapies, although a few xenobiotics such as acetaminophen have effective antidotal therapies if administered prior to development of hepatotoxicity. The nephrologist should be aware that extracorporeal treatment of liver failure associated with drugs and toxins may be indicated, including therapies conventionally performed by nephrologists (hemodialysis, continuous kidney replacement therapy), therapies occasionally performed by nephrologists and other specialists (plasma exchange, albumin dialysis, hemadsorption), and therapies performed by other specialists (extracorporeal membrane oxygenation). An overview of the role of these therapies in liver failure is provided, as well as a review of their limitations and potential complications.
Asunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas , Oxigenación por Membrana Extracorpórea , Fallo Hepático , Humanos , Enfermedad Hepática Inducida por Sustancias y Drogas/terapia , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Oxigenación por Membrana Extracorpórea/métodos , Oxigenación por Membrana Extracorpórea/efectos adversos , Fallo Hepático/terapia , Fallo Hepático/inducido químicamente , Diálisis Renal/métodos , Intercambio Plasmático/métodos , Fallo Hepático Agudo/terapia , Fallo Hepático Agudo/inducido químicamente , Xenobióticos/efectos adversosRESUMEN
OBJECTIVE: The aim of this study was to perform an updated description of adolescent occupational exposures reported to the US poison centers. METHODS: We performed a descriptive analysis of adolescents aged 13 to 19 years with unintentional occupational exposures from 2011 to 2020 using the National Poison Data System. A clinically significant occupational poisoning (CSOP) case is defined as exposures with moderate effect, major effect, or death. Differences in substance categories between younger (13 to 17 years) and older (18 to 19 years) adolescents with CSOP were compared. RESULTS: There were 14,374 adolescent occupational exposures. There were 2151 CSOPs. The most common substance categories associated with CSOP were household cleaners (22.3%), chemicals (20.8%), industrial cleaners (14.2%), fumes/gases/vapors (10.8%), and hydrocarbons (5.9%). Categories of exposures were similar across age groups. CONCLUSIONS: This study found that, despite a reduction in the number of adolescent occupational exposures, CSOPs persist.