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

JOURNAL TITLE: Indian Journal of Critical Care Medicine

Author
1. Abhijit Taraphder
2. Sayandeep Jana
3. Chandrashish Chakravarty
ISSN
0972-5229
DOI
10.4103/0972-5229.138159
Volume
18
Issue
8
Publishing Year
2014
Pages
3
Author Affiliations
    1. Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
    2. Apollo Gleneagles Hospital, Kolkata, West Bengal, India
    3. Apollo Hospital, Kolkata, West Bengal, India
    4. Apollo Hospitals, Kolkata, West Bengal, India
    5. Apollo Multispecialty Hospital, Kolkata, West Bengal, India
    1. Department of Critical Care, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
    1. Department of Nephrology, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
  • Article keywords
    Barbiturate, hemodialysis, phenobarbital, poisoning, sustained low efficiency dialysis

    Abstract

    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.

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