Key messages

• Elimination techniques should be evaluated on a case by case basis and never viewed as routine.

• Gastric emptying is associated with significant complications and should be utilized in a selected group of patients.

• Activated charcoal is a useful adjunct with rare complications, but is not efficacious in some poisonings, particularly those involving metals.

• Enhanced elimination (diuresis) is applicable to a small group of toxins. While alkaline diuresis is generally safe, acid diuresis is generally not indicated because of the potential for complications.

• Extracorporeal elimination methods (dialysis and hemoperfusion) are effective for rare toxins with small apparent volumes of distribution, limited protein binding, and toxicity which correlates with plasma concentrations.

• Certain antidotes work by modifying the toxicokinetics of the associated toxin, thus providing the opportunity to affect the toxin's elimination favorably.

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