Enhanced elimination in acute barbiturate poisoning - A systematic review

Clinical Toxicology

Volumn 49, Issue 1, 2011, Pages 2-12

  Roberts, Darren M ^a,b   Buckley, Nick A ^c  

^a UNIVERSITY OF QUEENSLAND   (Australia)

^b ST VINCENT S HOSPITAL   (Australia)

^c UNIVERSITY OF NEW SOUTH WALES   (Australia)

Author keywords

Barbiturate; Dialysis; Pentobarbital; Pharmacokinetics; Phenobarbital

Indexed keywords

ACTIVATED CARBON; BARBITURIC ACID DERIVATIVE; PHENOBARBITAL; PRIMIDONE;

ACUTE TOXICITY; ALKALINIZATION; CONSTIPATION; DATA BASE; DRUG INTOXICATION; DRUG OVERDOSE; DRUG WITHDRAWAL; HALF LIFE TIME; HEMODIALYSIS; HEMOFILTRATION; HEMOPERFUSION; HUMAN; HYPERCAPNIA; HYPOCALCEMIA; HYPOTENSION; INTESTINE OBSTRUCTION; LEUKOPENIA; MULTIPLE DRUG DOSE; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; SINGLE DRUG DOSE; SYSTEMATIC REVIEW; THROMBOCYTOPENIA; VASOCONSTRICTION; VOMITING;

ACUTE DISEASE; ADULT; BARBITURATES; CLINICAL TRIALS AS TOPIC; FEMALE; HUMANS; PENTOBARBITAL; PHENOBARBITAL; POISONING;

EID: 79551677826     PISSN: 15563650     EISSN: 15569519     Source Type: Journal    
DOI: 10.3109/15563650.2010.550582     Document Type: Review

References (107)

1. Mawer GE, Lee HA. Value of forced diuresis in acute barbiturate poisoning. Br Med J 1968; 2:790-793.
2. Linton AL, Luke RG, Briggs JD. Methods of forced diuresis and its application in barbiturate poisoning. Lancet 1967; 2:377-379.
3. Linton AL, Luke RG, Speirs I, Kennedy AC. Forced diuresis and haemodialysis in severe barbiturate intoxication. Lancet 1964; 283:1008-1010.
4. Berman LB, Jeghers HJ, Schreiner GE, Pallotta AJ. Hemodialysis, an effective therapy for acute barbiturate poisoning. JAMA 1956; 161:820-827.
5. Cravey RH, Reed D, Sedgwick PR, Turner JE. Toxicologic data from documented drug-induced or drug-related fatal cases. Clin Toxicol 1977; 10:327-339.
6. Buckley NA, McManus PR. Changes in fatalities due to overdose of anxiolytic and sedative drugs in the UK (1983-1999). Drug Saf 2004; 27:135-141.
7. Office for National Statistics. Deaths related to drug poisoning: England and Wales, 1998-2000. Health Stat Q 2004; 21:59-66.
8. Hung HT, Du NT, Hojer J. The first poison control center in Vietnam: experiences of its initial years. Southeast Asian J Trop Med Public Health 2008; 39:310-318.
9. Thompson TM, Aks SE. Case files of the toxikon medical toxicology fellowship in Chicago: the poisoned anesthesiologist. J Med Toxicol 2007; 3:31-36.
10. Koyama K, Suzuki R, Yoshida T, Kikuno T. Usefulness of serum concentration measurement for acute pentobarbital intoxication in patients. Chudoku Kenkyu 2007; 20:45-53.
11. Srinivas S, Karanth S, Nayyar V. Does it matter how we treat phenobarbitone overdose of moderate severity? Indian J Crit Care Med 2004; 8:153-156.
12. Bronstein AC, Spyker DA, Cantilena LR Jr., Green JL, Rumack BH, Giffin SL. 2008 annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 26th annual report. Clin Toxicol 2009; 47:911-1084.
13. Heller AJ, Chesterman P, Elwes RD, Crawford P, Chadwick D, Johnson AL, et al. Phenobarbitone, phenytoin, carbamazepine, or sodium valproate for newly diagnosed adult epilepsy: a randomized comparative monotherapy trial. J Neurol Neurosurg Psychiatry 1995; 58:44-50.
14. Pal DK. Phenobarbital for childhood epilepsy: systematic review. Paediatr Perinat Drug Ther 2006; 7:31-42.
15. Setter JG, Maher JF, Schreiner GE. Barbiturate intoxication. Evaluation of therapy including dialysis in a large series selectively referred because of severity. Arch Intern Med 1966; 117:224-236.
16. Cordato DJ, Herkes GK, Mather LE, Morgan MK. Barbiturates for acute neurological and neurosurgical emergencies - do they still have a role? J Clin Neurosci 2003; 10:283-288.
17. Ferguson MJ, Grace WJ. The conservative management of barbiturate intoxication: experience with 95 unconscious patients. Ann Intern Med 1961; 54:726-733.
18. Wax PM. Analeptic use in clinical toxicology: a historical appraisal. J Toxicol Clin Toxicol 1997; 35:203-209.
19. Wieth JO. Hemodialysis in barbiturate poisoning. Int Anesthesiol Clin 1966; 4:359-371.
20. Pond S, Rosenberg J, Benowitz NL, Takki S. Pharmacokinetics of haemoperfusion for drug overdose. Clin Pharmacokinet 1979; 4:329-354.
21. Bismuth C, Fournier PE. Biological evaluation of hemoperfusion in acute poisoning. Dev Toxicol Environ Sci 1980; 8:377-385.
22. Roberts DM, Buckley NA. Pharmacokinetic considerations in clinical toxicology: clinical applications. Clin Pharmacokinet 2007; 46:897-939.
23. Pond SM. Extracorporeal techniques in the treatment of poisoned patients. Med J Aust 1991; 154:617-622.
24. Breimer DD. Clinical Pharmacokinetics of hypnotics. Clin Pharmacokinet 1977; 2:93-109.
25. Wermeling DP, Blouin RA, Porter WH, Rapp RP, Tibbs PA. Pentobarbital pharmacokinetics in patients with severe head injury. Drug Intell Clin Pharm 1987; 21:459-463.
26. Bayliff CD, Schwartz ML, Hardy BG. Pharmacokinetics of highdose pentobarbital in severe head trauma. Clin Pharmacol Ther 1985; 38:457-461.
27. Reidenberg MM, Lowenthal DT, Briggs W, Gasparo M. Pentobarbital elimination in patients with poor renal function. Clin Pharmacol Ther 1976; 20:67-71.
28. Barbiturates-Short Acting & Barbiturates-Long Acting in POISINDEX1 System [intranet database]. Version 5.1. Greenwood Village, CO: Thomson Reuters (Healthcare) Inc. http://proxy1.use.hcn.com.au/hcs/librarian/. Accessed 12 December 2010.
29. Cutler RE, Forland SC, Hammond PG, Evans JR. Extracorporeal removal of drugs and poisons by hemodialysis and hemoperfusion. Annu Rev Pharmacol Toxicol 1987; 27:169-191.
30. Ebid AIM, Abdul-Rahman HM. Pharmacokinetics of Phenobarbital during certain enhanced elimination modalities to evaluate their clinical efficacy in management of drug overdose. Ther Drug Monitor 2001; 23:209-216.
31. Pond SM, Olson KR, Osterloh JD, Tong TG. Randomized study of the treatment of phenobarbital overdose with repeated doses of activated charcoal. JAMA 1984; 251:3104-3108.
32. Bloomer HA. Limited usefulness of alkaline diuresis and peritoneal dialysis in pentobarbital intoxication. N Engl J Med 1965; 272:1309-1313.
33. Wermeling D, Record K, Bell R, Porter W, Bloiun R. Hemodialysis clearance of pentobarbital during continuous infusion. Ther Drug Monit 1985; 7:485-487.
34. Gelfand MC, Winchester JF, Knepshield JH, Hanson KM, Cohan SL, Strauch BS, et al. Treatment of severe drug overdosage with charcoal hemoperfusion. Trans Am Soc Artif Intern Organs 1977; 23:599-605.
35. Bironneau E, Garrec F, Kergueris MF, Testa A, Nicolas F. Hemodialfiltration in pentobarbital poisoning. Renal Failure 1996; 18:299-303.
36. Vale JA, Rees AJ, Widdop B, Goulding R. Use of charcoal haemoperfusion in the management of severely poisoned patients. Br Med J 1975; 1:5-9.
37. Koffler A, Bernstein M, LaSette A, Massry SG. Fixed-bed charcoal hemoperfusion. Treatment of drug overdose. Arch Intern Med 1978; 138:1691-1694.
38. Iversen BM, Willassen Y, Bakke OM, Wallem G. Assessment of barbiturate removal by charcoal hemoperfusion in overdose cases. Clin Toxicol 1979; 15:139-149.
39. Ehrnebo M. Pharmacokinetics and distribution properties of pentobarbital in humans following oral and intravenous administration. J Pharm Sci 1974; 63:1114-1118.
40. Baselt RC. Disposition of Toxic Drugs and Chemicals in Man. 5th ed. Foster City, CA: Chemical Toxicology Institute; 2000.
41. de Wolff FA, Smit ND, Grunewald EJ, Schicht IM. Evaluation of haemoperfusion by column analysis. Dev Toxicol Environ Sci 1980; 8:405-409.
42. Bloomer HA. A critical evaluation of diuresis in the treatment of barbiturate intoxication. J Lab Clin Med 1966; 67:898-905.
43. Setter JG, Freeman RB, Maher JF, Schreiner GE. Factors influencing the dialysis of barbiturates. Trans Am Soc Artif Intern Organs 1964; 10:340-344.
44. De Groot G, Maes RA, van Heijst AN. A toxicological evaluation of different adsorbents in hemoperfusion. Clin Toxicol 1981; 18:1199-1211.
45. De Groot G, Maes RA, van Heyst AN. The use of haemoperfusion in the elimination of absorbed drug mixtures in acute intoxications. Neth J Med 1977; 20:142-148.
46. De Waele M, Heyndrickx A, De Broe M. Gas chromatographic determination of drug levels for the evaluation of a combined hemoperfusion-hemodialysis treatment. J Anal Toxicol 1982; 6:282-285.
47. Verpooten GA, De Broe ME. Prediction of the efficacy of hemoperfusion and hemodialysis in severe poisoning. Arch Toxicol Suppl 1982; 5:304-306.
48. De Broe ME, Verpooten GA, Christiaens MA, Rutsaert RJ, Holvoet J, Nagler J, Heyndrickx A. Clinical experience with prolonged combined hemoperfusion-hemodialysis treatment of severe poisoning. Artif Organs 1981; 5:59-66.
49. Musson VJ. Nursing care study: haemoperfusion in the treatment of severe barbiturate poisoning. Nurs Times 1976; 72:1956-1958.
50. Verpooten GA, De Broe ME. Combined hemoperfusion-hemodialysis in severe poisoning: kinetics of drug extraction. Resuscitation 1984; 11:275-289.
51. Bunn HF, Lubash GD. A controlled study of induced diuresis in barbiturate intoxication. Ann Intern Med 1965; 62:246-251.
52. Cirksena WJ, Bastian RC, Malloy JP, Barry KG. Use of mannitol in exogenous and endogenous intoxications. N Engl J Med 1964; 270:161-166.
53. Hampel G, Crome P, Widdop B, Goulding R. Experience with fixedbed charcoal haemoperfusion in the treatment of severe drug intoxication. Arch Toxicol 1980; 45:133-141.
54. Goulding R. Experience with hemoperfusion in drug abuse. Kidney Int Suppl 1976; S338-S340.
55. Crome P, Hampel G, Widdop B, Goulding R. Experience with cellulose acetate-coated activated charcoal haemoperfusion in the treatment of severe hypnotic drug intoxication. Postgrad Med J 1980; 56:763-766.
56. Fantozzi R, Martinelli F, Masini E, Sodi A, Amaducci L, Mannaioni P. Use of haemoperfusion with uncoated charcoal in the management of acute intoxications with barbiturate and salicylate. Subst Alcohol Actions Misuse 1981; 2:55-62.
57. Myschetzky A, Lassen NA. Urea-induced, osmotic diuresis and alkalinization of urine in acute barbiturate intoxication. JAMA 1963; 185:936-942.
58. De Groot G, Maes RA, van Heijst AN. An evaluation of the use of hemoperfusion in acute poisoning. Vet Hum Toxicol 1979; 21 Suppl:8-11.
59. Lous P. Plasma levels and urinary excretion of three barbituric acids after oral administration to man. Acta Pharmacol Toxicol (Copenh) 1954; 10:147-165.
60. De Groot G, Maes RA, van Heijst AN. A toxicological evaluation of hemoperfusion using pharmacokinetic principles. Dev Toxicol Environ Sci 1980; 8:387-395.
61. Lassen NA. Treatment of severe acute barbiturate poisoning by forced diuresis and alkalinisation of the urine. Lancet 1960; 276:338-342.
62. Yatzidis H, Voudiclari S, Oreopolos D, Voudiclari S, Tsaparas N, Gavras C, Stavroulaki A. Treatment of severe barbiturate poisoning. Lancet 1965; 265:216-217.
63. Balme RH, Lloyd-Thomas HG, Shead GV. Severe barbitone poisoning treated by haemodialysis. Br Med J 1962; 1:231-232.
64. Johnson CA, Simmons WD. Dialysis of Drugs. Verona, WI: Nephrology Pharmacy Associates; 2000.
65. Matzke GR, Cloyd JC, Sawchuk RJ. Acute phenytoin and primidone intoxication: a pharmacokinetic analysis. J Clin Pharmacol 1981; 21:92-99.
66. van Heijst AN, de Jong W, Seldenrijk R, van Dijk A. Coma and crystalluria: a massive primidone intoxication treated with haemoperfusion. J Toxicol Clin Toxicol 1983; 20:307-318.
67. Bismuth C, Conso F, Wattel F, Gosselin B, Lambert H, Genestal M. Coated activated charcoal hemoperfusion: experience of French antipoison centers about 60 cases. Vet Hum Toxicol 1979; 21 Suppl:2-4. (Pubitemid 10199781)
68. Lal R, Faiz S, Garg RK, Baweja KS, Guntupalli J, Finkel KW. Use of continuous venovenous hemodiafiltration in a case of severe phenobarbital poisoning. Am J Kidney Dis 2006; 48:e13-e15.
69. Quan DJ, Winter ME. Extracorporeal removal of phenobarbital by high-flux hemodialysis. J Appl Ther Res 1998; 2:75-79.
70. Palmer BF. Effectiveness of hemodialysis in the extracorporeal therapy of phenobarbital overdose. Am J Kidney Dis 2000; 36:640-643.
71. Lin JL, Jeng LB. Critical, acutely poisoned patients treated with continuous arteriovenous hemoperfusion in the emergency department. Ann Emerg Med 1995; 25:75-80.
72. Lin JL, Lim PS. Continuous arteriovenous hemoperfusion in acute poisoning. Blood Purif 1994; 12:121-127.
73. Jacobsen D, Wiik-Larsen E, Dahl T, Enger E, Lunde PK. Pharmacokinetic evaluation of haemoperfusion in Phenobarbital poisoning. Eur J Clin Pharmacol 1984; 26:109-112.
74. Zawada ET Jr., Nappi J, Done G, Rollins D. Advances in the hemodialysis management of phenobarbital overdose.South Med J 1983; 76:6-8.
75. Raper S, Crome P, Vale A, Helliwell M, Widdop B. Experience with activated carbon-bead haemoperfusion columns in the treatment of severe drug intoxication. A preliminary report. Arch Toxicol 1982; 49:303-310.
76. de Wolff FA, Smit ND. Analysis of haemoperfusion columns for evaluation of treatment of phenobarbital overdosage. Arch Toxicol 1980; 43:233-235.
77. de Torrente A, Rumack BH, Blair DT, Anderson RJ. Fixed-bed uncoated charcoal hemoperfusion in the treatment of intoxications: animal and patient studies. Nephron 1979; 24:71-77.
78. Bentley C, Kjellstrand CM. The treatment of severe drug intoxication with charcoal hemoperfusion in series with hemodialysis. J Dial 1979; 3:337-348.
79. Bosl R, Shideman JR, Meyer RM, Buselmeier TJ, von Hartitzsch B, Kjellstrand CM. Effects and complications of high efficiency dialysis. Nephron 1975; 15:151-160.
80. Balagot RC, Tsuji H, Sadove MS. Use of an osmotic diuretic-THAMin treatment of barbiturate poisoning. Alkalinizing action of drug and its ability to increase elimination of electrolytes in urine appears to facilitate clearance of barbiturates. JAMA 1961; 178:1000-1004.
81. Chang TM. Hemoperfusion alone and in series with ultrafiltration or dialysis for uremia, poisoning and liver failure. Kidney Int Suppl 1976; S305-S311.
82. Roberts DM, Chau AMT, Nair P. Enhanced elimination of phenobarbital using charcoal haemoperfusion in a patient with severe poisoning. Nephrology 2010; 15:87.
83. Borkan SC. Extracorporeal therapies for acute intoxications. Crit Care Clin 2002; 18:393-420.
84. Watson WA, Litovitz TL, Rodgers GC, Jr., Klein-Schwartz W, Reid N, Youniss J, et al. 2002 annual report of the American Association of Poison Control Centres Toxic Exposure Surveillance System. Am J Emerg Med 2003; 21:353-421.
85. Heinemeyer G, Roots I, Dennhardt R. Monitoring of pentobarbital plasma levels in critical care patients suffering from increased intracranial pressure. Ther Drug Monit 1986; 8:145-150.
86. Hadden J, Johnson K, Smith S, Price L, Giardina E. Acute barbiturate intoxication. Concepts of management. JAMA 1969; 209: 893-900.
87. Proudfoot AT, Krenzelok EP, Vale JA. AACT/EAPCCT position paper on urinary alkalinisation. J Toxicol Clin Toxicol 2004; 42:1-26.
88. Vale JA, Krenzelok EP, Barceloux GD. Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol 1999; 37:731-751.
89. Day EA, Morgan EB. Accidental hypothermia: report of a case following alcohol and barbiturate overdose. Anaesth Intensive Care 1974; 11:73-76.
90. Reed CE, Driggs MF, Foote CC. Acute barbiturate intoxication: a study of 300 cases based on a physiological system of classification of severity of intoxication. Ann Intern Med 1952; 37:290-300.
91. Arieff AI, Friedman EA. Coma following nonnarcotic drug overdosage: management of 208 adult patients. Am J Med Sci 1973; 266:405-426.
92. Greenblatt DJ, Allen MD, Harmatz JS, Noel BJ, Shader RI. Overdosage with pentobarbital and secobarbital: assessment of factors related to outcome. J Clin Pharmacol 1979; 19:758-768.
93. Cordell WH, Curry SC, Furbee RB, Mitchell-Flynn DL. Veterinary euthanasia drugs as suicide agents. Ann Emerg Med 1986; 15:939-943.
94. Schiebel N, Vicas I. Barbiturates. In: Ford MD, Delaney KA, Ling LJ, Erickson T, eds. Clinical Toxicology. 1st ed. New York: W.B. Saunders Company; 2001. pp. 569-574.
95. Kozlowski KH, Szaykowski A, Danysz A. Dependence of pentobarbital kinetics upon the dose of the drug and its pharmacodynamic effects. Pol J Pharmacol Pharm 1977; 29:497-508.
96. Vlasses PH, Rocci MJ, Jr., Koffer H, Ferguson RK. Combined phenytoin and phenobarbital overdose. Drug Intell Clin Pharm 1982; 16:487-488.
97. Lins G. [Lethal aqueous pericardium-tamponade after overtreatment by forced diuresis]. Z Rechtsmed 1980; 85:241-246.
98. Gil HW, Kim SJ, Yang JO, Lee EY, Hong SY. Clinical outcome of hemoperfusion in poisoned patients. Blood Purif 2010; 30:84-88.
99. Lous P. Elimination of barbiturates. Int Anesthesiol Clin 1966; 4:341-350.
100. Cohan SL, Winchester JF, Gelfand MC. Treatment of intoxication with charcoal hemadsorption. Drug Metab Rev 1982; 13:681-693.
101. Spear PW, Protass LM. Barbiturate poisoning - an endemic disease. Five years' experience in a municipal hospital. Med Clin North Am 1973; 57:1471-1479.
102. McCarron MM, Schulze BW, Walberg CB, Thompson GA, Ansari A. Short-acting barbiturate overdosage. Correlation of intoxication score with serum barbiturate concentration. JAMA 1982; 248:55-61.
103. Parker KD, Elliott HW, Wright JA, Nomof N, Hine CH. Blood and urine concentrations of subjects receiving barbiturates, meprobamate, glutethimide, or diphenylhydantoin. Clin Toxicol 1970; 3:131-145.
104. Brown TJ, Bauer LA, Miyoshi HR. Phenobarbital overdose: a kinetic approach. Drug Intell Clin Pharm 1982; 16:613-614.
105. Buckley NA, Foy A. Barbiturate withdrawal - a nomogram for supplementary dosing after the phenobarbitone loading technique. Drug Alcohol Rev 1995; 14:385-388.
106. Janecek E, Kapur BM, Devenyi P. Oral phenobarbital loading: a safe method of barbiturate and nonbarbiturate hypnosedative withdrawal. CMAJ 1987; 137:410-412.
107. Kamijo Y, Soma K, Kondo R, Ohwada T. Transient diffuse cerebral hypoperfusion in Tc-99m HMPAO SPECT of the brain during withdrawal syndrome following acute barbiturate poisoning. Vet Hum Toxicol 2002; 44:348-350.