Related Experiment Video
Updated: Jan 9, 2026
06:59
A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
31.1K
Loading phenobarbital in paediatric home-based terminal care: A case series
Jo-Anne J Kelly1, Karen Aisling Griffin1,2, Sidharth Vemuri3,4,5,6
1Palliative Care South East, Narre Warren, VIC, Australia.
Palliative Medicine
|December 2, 2025
Summary
A weight-based loading dose of phenobarbital improved symptom management in three pediatric palliative care cases. This approach, unlike adult guidelines or no loading dose, offers better relief for refractory symptoms at home.
Area of Science:
- Palliative Care
- Pharmacology
- Pediatrics
Background:
- Limited evidence exists for phenobarbital administration in pediatric palliative home care for refractory symptoms.
- Refractory symptoms cause significant distress to children and families during the terminal phase.
Purpose of the Study:
- To evaluate phenobarbital administration for refractory symptom management in pediatric palliative home care.
- To compare different phenobarbital dosing strategies in terminal pediatric cases.
Main Methods:
- Case study of three pediatric patients with refractory symptoms in home-based palliative care.
- Review of medication adjustments prior to phenobarbital administration.
- Comparison of phenobarbital loading doses: adult guideline-based, none, and weight-based.
Main Results:
- A weight-based loading dose of phenobarbital, followed by continuous infusion, enhanced symptom management.
- This approach was more effective than using adult guidelines or omitting a loading dose.
- All three cases involved prior medication adjustments.
Conclusions:
- A weight-based loading dose of phenobarbital appears beneficial for managing terminal refractory symptoms in pediatric palliative care.
- Further research is required to establish evidence-based guidelines for phenobarbital use in this population.
- Establishing guidelines will ensure appropriate relief and support peaceful death at home.
Related Concept Videos
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
176
In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
176
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
231
Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
231
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
244
Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
244
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
195
In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
195
01:29Drug Dosing: Infants and Children
234
Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
234
01:20Sedatives and Hypnotics Drugs: Barbiturates
907
Sedatives and hypnotics encompass a drug class that acts on the central nervous system (CNS) to alleviate anxiety, promote relaxation and induce sleep.These drugs function by amplifying the actions of the neurotransmitter γ-aminobutyric acid (GABA), resulting in reduced neuronal activity. Barbiturates, a subset of sedatives and hypnotics first synthesized in the late 1800s, are categorized into ultra-short, short, intermediate, and long-acting groups based on their duration of effect. A...
907