616 - Analysis of Pediatric Extracorporeal Elimination Therapy Reported to the National Poison Data System (2009–2023)

Publication Number: 616.3753

Sage Timberline, University of Virginia, Charlottesville, VA, United States; Anna Zmuda, University of Virginia School of Medicine, Charlottesville, VA, United States; Rita Farah, University of Virginia School of Medicine, CHARLOTTESVILLE, VA, United States; Jennifer R Charlton, University of Virginia School of Medicine, charlottesville, VA, United States; Nathan P. Charlton, University of Virginia School of Medicine, Charlottesville, VA, United States

Background: Approximately 1.1 million cases of xenobiotic exposures in persons ≤19 years old are called to United States (US) Poison Centers each year. This represents roughly half of all poison center cases. The extracorporeal removal of xenobiotics in pediatric practice is uncommon and the agents responsible for needing extracorporeal elimination therapy (ECTR) in this age range are not well studied.

Objective: The purpose of this study was to identify the incidence of cases of xenobiotic toxicity in which ECTR was used in children ≤19 years old using US Poison Center data.

Design/Methods: This was a retrospective study of pediatric cases reported to the US National Poison Data System (NPDS) over a 15-year period from January 1st, 2009 to December 31st 2023. The NPDS was queried for cases in which ECTR was performed for single-substance exposures via all exposure routes in patients ≤19 years. Data extracted included total number of patients, age and the xenobiotics involved.

Results: Between 2009 and 2023, poison centers reported 1581 cases of patients ≤19 years old who received ECTR. In those age 13-19 years, 1308 cases were identified (83% of total cases, with an average of 87 cases per year). In children age 6-12 years, 105 cases were identified, representing 7% of cases. In those age ≤5 years, 168 cases were identified, representing 11% of cases. Salicylate was the most common agent resulting in ECTR (n=301, 19%), followed by lithium (n=230, 15%) and ethylene glycol (n=148, 9%). Acetaminophen resulted in 130 cases (8%) during the study period, biguanides (metformin) 68 cases (4%), methanol 42 cases (3%) and valproic acid 52 (3%). When divided by age group, lithium was the most common agent involved in ECTR in 6-12 year olds, whereas salicylate was the most common agent in both ≤5 and 13-19 year olds.

Conclusion(s): During the study period, there was an average incidence of 105 pediatric patients per year who received ECTR for single substance xenobiotic toxicity. This represents approximately 0.01% of all pediatric cases called in to US Poison Centers. Salicylate was the most common agent resulting in ECTR, including in children age ≤5 years. While rare, ECTR in young children may present a unique technical challenge, which can be additionally complicated by the hemodynamic, respiratory, and metabolic abnormalities that may occur in the poisoned patient. As CRRT became a unique poison center code in 2019, further research is needed to understand the specific modality of ECTR, as well as outcomes in these children.