Can you dialyze a patient into withdrawal?

Specialties Urology

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We have a fairly new patient who tested positive for amphetamines in the hospital but denied it. Lately she comes in fine but 3hrs or so into treatment she gets ridiculous acting nervous and jittery and wanting off NOW. QUESTION: Can we be dialyzing drug off and forcing her body into withdrawal??

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In the Dialysis of Drugs reference, there is NoData for amphetamine.

According to Drugs.com: The duration of effect of 30 mg (PO, orally) mixed amphetamine salts of a single entity (generic for Adderall) in tablet form - immediate release - typically ranges from 4 to 6 hours.

So, this is pretty much a non answer, but maybe.

After 3 hours it is naturally wearing off and dialysis (I would *guess*) is speeding up the process at least some.

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Specializes in Medical-Surgical/Float Pool/Stepdown.

It has been my experience that you can dialyze a Pt into ETOH WD so one could make an educated guess that amphetamines would too!

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Just wondering if anyone knows specific amphetamines that dialyze off. They have a short half life right? So maybe it's just "time for a fix?"vitals are WNL start of tx or possibly a little high. 3 hrs in... Bp is off the chart and non responsive to clonidine.

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Specializes in Transitional Nursing.

I take amphetamines and they start wearing off around 4-5 hours, i don't get W/D but I also have ADHD. I think dialysis would certainly speed up the process at least a little, but probably they were wearing off anyways.

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Specializes in Pediatric Hematology/Oncology.

This is a really interesting question. I looked at the research and there is no data on amphetamines being removed by dialysis (it is known, however, that cocaine use is frequent in the dialysis population, which I thought oddly specific). There are some known substances, like oxycodone, that are removed by high-flux dialysis so it might be possible to cause opiate withdrawal this way. As far as meth goes, the half-life is 9-12 hours with a duration of action being 10-12 with primarily renal excretion. Depending on when the pt used, they either might be ready for the next fix or dialysis is making them feel it faster. It makes sense since you can change a person's world around with all the things getting dialyzed off of them (and hemodialysis is being explored as a drug free alternative to detoxing someone off opiates).

http://heartlandkidney.org/article_resources/Killion_Drugs_of_Abuse_in_the_Dialysis_Population-011314_%282%29.pdf

Opiate Detoxification Using the Combined Hemoperfusion-hemodialysis

(I also acknowledge the above resources are kind of wonky -- it just doesn't look like there's been too much research into the subject.)

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