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Detoxification or detoxication (detox for short) [1] is the physiological or medicinal removal of toxic substances from a living organism, including the human body, which is mainly carried out by the liver. Additionally, it can refer to the period of drug withdrawal during which an organism returns to homeostasis after long-term use of an addictive substance. [2] [3] In medicine, detoxification can be achieved by decontamination of poison ingestion and the use of antidotes as well as techniques such as dialysis and (in a limited number of cases) chelation therapy. [4]
Many alternative medicine practitioners promote various types of detoxification such as detoxification diets. Sense about Science, a UK-based charitable trust, determined that most such dietary "detox" claims lack any supporting evidence. [5] [6] [ obsolete source ][ independent source needed ]
The liver and kidney are naturally capable of detox, as are intracellular (specifically, inner membrane of mitochondria or in the endoplasmic reticulum of cells) proteins such as CYP enzymes. In cases of kidney failure, the action of the kidneys is mimicked by dialysis; kidney and liver transplants are also used for kidney and liver failure, respectively.
Heavy metal detox, or detoxification, is the removal of toxic heavy metal substances from the body. In conventional medicine, detoxification can also be achieved artificially by techniques such as dialysis and (in a very limited number of cases) chelation therapy. There is a firm scientific base in evidence-based medicine for this treatment. [7]
Many alternative medicine practitioners promote various other types of detoxification such as "diet detoxification". These procedures generally possess no sound scientific basis and are often seen as unnecessary. [8] [ medical citation needed ]Alcohol detoxification is a process by which a heavy drinker's system is brought back to normal after being habituated to having alcohol in the body continuously for an extended period of substance abuse. Serious alcohol addiction results in a downregulation of GABA neurotransmitter receptors. Precipitous withdrawal from long-term alcohol addiction without medical management can cause severe health problems and can be fatal. Alcohol detox is not a treatment for alcoholism. After detoxification, other treatments must be undertaken to deal with the underlying addiction that caused alcohol use.
Clinicians use drug detoxification to reduce or relieve withdrawal symptoms while helping an addicted person adjust to living without drug use. Drug detoxification does not aim to treat addiction but rather represents an early step within long-term treatment. Detoxification may be achieved drug-free or may use medications as an aspect of treatment. Often drug detoxification and treatment will occur in a community program that lasts several months and takes place in a residential setting rather than in a medical center.
Drug detoxification varies depending on the location of treatment, but most detox centers provide treatment to avoid the symptoms of physical withdrawal from alcohol and from other drugs. Most also incorporate counseling and therapy during detox to help with the consequences of withdrawal.
An animal's metabolism can produce harmful substances which it can then make less toxic through reduction, oxidation (collectively known as redox reactions), conjugation and excretion of molecules from cells or tissues. [9] This is called xenobiotic metabolism. [10] [11] [12] [13] Enzymes that are important in detoxification metabolism include cytochrome P450 oxidases, [14] UDP-glucuronosyltransferases, [15] and glutathione S-transferases. [16] These processes are particularly well-studied as part of drug metabolism, as they influence the pharmacokinetics of a drug in the body. [17] [18] [19]
Certain approaches in alternative medicine claim to remove alleged "toxins" from the body through herbal, electrical, electromagnetic or other treatments. These toxins may not be linked to symptoms and treatments have no scientific evidence, [20] [21] making the validity of such techniques questionable. There is little evidence for toxic accumulation in these cases, as the liver and kidneys automatically detoxify and excrete many toxic materials including metabolic wastes. [21] Under this theory, if toxins are too rapidly released without being safely eliminated (such as when metabolizing fat that stores toxins), they can damage the body and cause malaise. Such alternative therapies include contrast showers, detoxification foot pads, oil pulling, Gerson therapy, snake-stones, body cleansing, Scientology's and Narconon's Purification Rundown, water fasting, and metabolic therapy. [22]
Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal. Problematic use of alcohol has been mentioned in the earliest historical records. The World Health Organization (WHO) estimated there were 283 million people with alcohol use disorders worldwide as of 2016. The term alcoholism was first coined in 1852, but alcoholism and alcoholic are sometimes considered stigmatizing and to discourage seeking treatment, so diagnostic terms such as alcohol use disorder or alcohol dependence are often used instead in a clinical context.
Disulfiram is a medication used to support the treatment of chronic alcoholism by producing an acute sensitivity to ethanol. Disulfiram works by inhibiting the enzyme aldehyde dehydrogenase, causing many of the effects of a hangover to be felt immediately following alcohol consumption. Disulfiram plus alcohol, even small amounts, produces flushing, throbbing in the head and neck, a throbbing headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, fast heart rate, low blood pressure, fainting, marked uneasiness, weakness, vertigo, blurred vision, and confusion. In severe reactions there may be respiratory depression, cardiovascular collapse, abnormal heart rhythms, heart attack, acute congestive heart failure, unconsciousness, convulsions, and death.
A xenobiotic is a chemical substance found within an organism that is not naturally produced or expected to be present within the organism. It can also cover substances that are present in much higher concentrations than are usual. Natural compounds can also become xenobiotics if they are taken up by another organism, such as the uptake of natural human hormones by fish found downstream of sewage treatment plant outfalls, or the chemical defenses produced by some organisms as protection against predators. The term "xenobiotic" is also used to refer to organs transplanted from one species to another.
Hepatotoxicity implies chemical-driven liver damage. Drug-induced liver injury (DILI) is a cause of acute and chronic liver disease caused specifically by medications and the most common reason for a drug to be withdrawn from the market after approval.
Uremia is the condition of having high levels of urea in the blood. Urea is one of the primary components of urine. It can be defined as an excess in the blood of amino acid and protein metabolism end products, such as urea and creatinine, which would normally be excreted in the urine. Uremic syndrome can be defined as the terminal clinical manifestation of kidney failure. It is the signs, symptoms and results from laboratory tests which result from inadequate excretory, regulatory, and endocrine function of the kidneys. Both uremia and uremic syndrome have been used interchangeably to denote a very high plasma urea concentration that is the result of renal failure. The former denotation will be used for the rest of the article.
Hyperammonemia, or high ammonia levels, is a metabolic disturbance characterised by an excess of ammonia in the blood. Severe hyperammonemia is a dangerous condition that may lead to brain injury and death. It may be primary or secondary.
Drug metabolism is the metabolic breakdown of drugs by living organisms, usually through specialized enzymatic systems. More generally, xenobiotic metabolism is the set of metabolic pathways that modify the chemical structure of xenobiotics, which are compounds foreign to an organism's normal biochemistry, such as any drug or poison. These pathways are a form of biotransformation present in all major groups of organisms and are considered to be of ancient origin. These reactions often act to detoxify poisonous compounds. The study of drug metabolism is the object of pharmacokinetics. Metabolism is one of the stages of the drug's transit through the body that involves the breakdown of the drug so that it can be excreted by the body.
Toxication, toxification or toxicity exaltation is the conversion of a chemical compound into a more toxic form in living organisms or in substrates such as soil or water. The conversion can be caused by enzymatic metabolism in the organisms, as well as by abiotic chemical reactions. While the parent drug is usually less active, both the parent drug and its metabolite can be chemically active and cause toxicity, leading to mutagenesis, teratogenesis, and carcinogenesis. Different classes of enzymes, such as P450 monooxygenases, epoxide hydrolase, or acetyltransferases can catalyze the process in the cell, mostly in the liver.
Glutathione S-transferases (GSTs), previously known as ligandins, are a family of eukaryotic and prokaryotic phase II metabolic isozymes best known for their ability to catalyze the conjugation of the reduced form of glutathione (GSH) to xenobiotic substrates for the purpose of detoxification. The GST family consists of three superfamilies: the cytosolic, mitochondrial, and microsomal—also known as MAPEG—proteins. Members of the GST superfamily are extremely diverse in amino acid sequence, and a large fraction of the sequences deposited in public databases are of unknown function. The Enzyme Function Initiative (EFI) is using GSTs as a model superfamily to identify new GST functions.
Fomepizole, also known as 4-methylpyrazole, is a medication used to treat methanol and ethylene glycol poisoning. It may be used alone or together with hemodialysis. It is given by injection into a vein.
Detoxification is a type of alternative-medicine treatment which aims to rid the body of unspecified "toxins" – substances that proponents claim accumulate in the body over time and have undesirable short-term or long-term effects on individual health. It is not to be confused with detoxification carried out by the liver and kidneys, which filter the blood and remove harmful substances to be processed and eliminated from the body. Activities commonly associated with detoxification include dieting, fasting, consuming exclusively or avoiding specific foods, colon cleansing, chelation therapy, certain kinds of IV therapy and the removal of dental fillings containing amalgam.
NAPQI, also known as NAPBQI or N-acetyl-p-benzoquinone imine, is a toxic byproduct produced during the xenobiotic metabolism of the analgesic paracetamol (acetaminophen). It is normally produced only in small amounts, and then almost immediately detoxified in the liver.
Alcohol detoxification is the abrupt cessation of alcohol intake in individuals that have alcohol use disorder. This process is often coupled with substitution of drugs that have effects similar to the effects of alcohol in order to lessen the symptoms of alcohol withdrawal. When withdrawal does occur, it results in symptoms of varying severity.
Xenobiotic metabolism is the set of metabolic pathways that modify the chemical structure of xenobiotics, which are compounds foreign to an organism's normal biochemistry, such as drugs and poisons. These pathways are a form of biotransformation present in all major groups of organisms, and are considered to be of ancient origin. These reactions often act to detoxify poisonous compounds; however, in cases such as in the metabolism of alcohol, the intermediates in xenobiotic metabolism can themselves be the cause of toxic effects.
Drug detoxification is variously construed or interpreted as a type of "medical" intervention or technique in regards to a physical dependence mediated by a drug; as well as the process and experience of a withdrawal syndrome or any of the treatments for acute drug overdose (toxidrome). The first definition however, in relation to substance dependence and its treatment is arguably a misnomer and even directly contradictory since withdrawal is neither contingent upon nor alleviated through biological excretion or clearance of the drug. In fact, excretion of a given drug from the body is one of the very processes that leads to withdrawal since the syndrome arises largely due to the cessation itself and the drug being absent from the body; especially the blood plasma, not from ‘leftover toxins’ or traces of the drug still being in the system.
Heavy metal detox, or detoxification, is the removal of toxic heavy metal substances from the body. In conventional medicine, detoxification can also be achieved artificially by techniques such as dialysis and chelation therapy. There is a firm scientific base in evidence-based medicine for this treatment.
A liver support system or diachysis is a type of therapeutic device to assist in performing the functions of the liver. Such systems focus either on removing the accumulating toxins, or providing additional replacement of the metabolic functions of the liver through the inclusion of hepatocytes to the device. A diachysis machine is used for acute care i.e. emergency care, as opposed to a dialysis machine which are typically used over the longer term. These systems are being trialed to help people with acute liver failure (ALF) or acute-on-chronic liver failure.
Detoxification is the physiological or medicinal removal of toxic substances from a living organism, including the human body.
A xenobiotic-sensing receptor is a receptor that binds xenobiotics. They include the following nuclear receptors:
Detoxification foot baths, also known as foot detox, ionic cleansing, ionic foot bath and aqua/water detox are pseudoscientific alternative medical devices marketed as being able to remove toxins from the human body. They work by providing an electric current to an electrode array immersed in a salt water solution. When switched on, the electrodes rapidly rust in a chemical process called electrolysis which quickly turns the water brown. This reaction happens regardless of whether or not a person's feet are immersed in the water and no toxins from the human body have ever been detected in the water after use.