Successful use of haemodialysis to treat phenobarbital overdose

Hoyland, Kimberley; Hoy, Michael; Austin, Richard C.; Wildman, Martyn

doi:10.1136/bcr-2013-010011

Cited by 15 publications

(7 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Applications of hemodialysis and hemoperfusion in phenobarbital intoxications have been reported in the literature. Hoyland et al reported that they used hemodialysis in 2 sessions of 2.5 hours in a patient who had phenobarbital intoxication (9). In their study, it was reported that blood phenobarbital levels were reduced from 115 mcg/mL to 84 mcg/ mL in the first session and from 78 mcg/mL to 55 mcg/ mL (approximately 30%) in the second session.…”

Section: Discussionmentioning

confidence: 90%

Single-pass albumin dialysis in a child aged six months with phenobarbital poisoning

et al. 2016

View full text Add to dashboard Cite

A girl aged six months was hospitalized because of resistant seizures and was discharged with phenobarbital and carbamazepine therapy. She was admitted to a state hospital with symptoms of inability to waken and difficulty in breathing. It was learned that phenobarbital had been used incorrectly and the patient was sent to our pediatric intensive care unit because of severe phenobarbital overdose. The decision was taken for hemodialysis. Single-pass albumin dialysis was planned because phenobarbital can bind to high levels of plasma protein. The process was undertaken with 1% albumin-containing dialysate, which was prepared manually. After 6 hours of dialysis, the phenobarbital blood level measured 62 mcg/mL (>140 mcg/mL on admission) and the patient's clinical findings were markedly regressed. There are no case reports about phenobarbital overdose treated with single-pass albumin dialysis in the literature. We conclude that single-pass albumin dialysis may be a useful treatment, especially with intoxications of drugs that bind protein at high levels. (Turk Pediatri Ars 2016; 51: 228-30)

show abstract

Section: Discussionmentioning

confidence: 90%

Single-pass albumin dialysis in a child aged six months with phenobarbital poisoning

et al. 2016

View full text Add to dashboard Cite

show abstract

“…A few studies have been done to correlate early hemodialysis with decreased morbidity and early recovery. [ 3 11 ]…”

Section: Discussionmentioning

confidence: 99%

“…Two previous case reports showed similar favorable results in phenobarbital overdosage treated by hemodialysis with a blood-flow rate between 180 ml/min and 200 ml/min and dialysate-flow rate of 500 ml/min. [ 11 14 ]…”

Section: Discussionmentioning

confidence: 99%

Successful use of sustained low efficiency dialysis in a case of severe phenobarbital poisoning

Jana

Chakravarty

Taraphder

et al. 2014

Indian Journal of Critical Care Medicine

View full text Add to dashboard Cite

A 30-year-old female presented with coma and subsequent cardiac arrest caused by phenobarbital overdosage, requiring ventilatory and vasopressor support. She had also developed severe hypoxia following gastric aspiration. Initial therapy, including activated charcoal and forced alkaline diuresis, failed to significantly lower her drug levels and there was minimal neurological improvement. As she was hemodynamically unstable, and unsuitable for conventional dialysis, she was put on sustained low efficiency dialysis (SLED) to facilitate drug removal. SLED resulted in marked reduction in plasma level of phenobarbital, which eventually led to early extubation, improved cognition and aided full recovery. Thus, we concluded that SLED can be an effective alternative in cases of severe phenobarbital poisoning, where conventional hemodialysis or hemoperfusion cannot be initiated, to hasten drug elimination and facilitate early recovery.

show abstract

“…There have been multiple case reports regarding successful extracorporeal treatment in severe barbiturate intoxication. 3,4,6,[9][10][11][12][13][14] Haemodialysis involves solute removal by diffusion whereas haemofiltration uses convection with hydrostatic pressure inducing plasma water filtration across the haemofilter. 6 Haemoperfusion is ideal in the removal of lipid soluble or highly protein bound drugs.…”

Section: Discussionmentioning

confidence: 99%

“…2 Prescription rates have also declined with the development of safer antiepileptics like levetiracetam and anxiolytics like benzodiazepine. 3 Despite these two factors, acute barbiturate poisoning is still common due to its affordability in developing countries and ongoing prescription in human/animal epilepsy disorders such as partial and tonicclonic generalized seizures. 4 Clinicians need to recognise the symptoms and physiology of barbiturate overdose.…”

Section: Introductionmentioning

confidence: 99%

Successful haemofiltration therapy in severe phenobarbital overdose

Tan¹,

Moser²,

Duke³

2018

AMJ

View full text Add to dashboard Cite

In the 19 th century, barbiturates were first-line treatment as hypnotic and anticonvulsants, then gradually replaced by agents with a safer clinical profile. However, its ongoing use in Australian veterinary medicine and steadfast prescriptions in developing countries/our migrant population, still contributes to overdoses.We present a case of a middle-aged man with a lifethreatening phenobarbital overdose. Haemofiltration was trialled, causing a rapid fall in phenobarbital levels and a speedy recovery. Through a review of the literature, treatment options of barbiturate overdose presentations will be discussed. It is imperative clinicians are aware of barbiturate's mechanism and its enhanced elimination through extracorporeal treatment. Key WordsPhenobarbital overdose, haemofiltration, extracorporeal treatment Implications for Practice: What is known about this subject?Barbiturates were once a very common cause of drug dependence and overdoses. Extracorporeal elimination has been trialled in low-quality evidence only, with positive conclusions. What new information is offered in this case study?Phenobarbital overdose of this prolonged period has rarely been reported in the literature. The trial of haemofiltration successfully eliminated the drug, facilitating early recovery. What are the implications for research, policy, or practice?In the absence of adequate phenobarbital elimination with forced alkaline diuresis, clinicians should consider extracorporeal treatment; so as to prevent prolonged hospital stay and complications.

show abstract

Successful use of haemodialysis to treat phenobarbital overdose

Cited by 15 publications

References 8 publications

Single-pass albumin dialysis in a child aged six months with phenobarbital poisoning

Single-pass albumin dialysis in a child aged six months with phenobarbital poisoning

Successful use of sustained low efficiency dialysis in a case of severe phenobarbital poisoning

Successful haemofiltration therapy in severe phenobarbital overdose

Contact Info

Product

Resources

About