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

Sayandeep Jana1, Chandrashish Chakravarty1, Abhijit Taraphder2

  • 1Department of Critical Care, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine
|August 20, 2014
PubMed

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.

Keywords:
Barbituratehemodialysisphenobarbitalpoisoningsustained low efficiency dialysis

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