[Long-term hemodialysis in acute barbiturate intoxication (author's transl)]

From 1975 to 1978, ten patients were on long-term hemodialysis due to acute barbiturate intoxication. Duration of hemodialysis varied from 16 to 40 hours (mean 23 +/- 9.4 hours). Phenobarbital was the most common type of barbiturate ingested (6 out of 10 patients), and diazepam the drug most frequently taken in association with barbiturates (3 out of 10 patients). All patients were in a state of deep unconsciousness (coma II: 1 case; coma III: 5 cases; coma IV: 4 cases), and all of them required endotracheal intubation. Seven patients needed the assistance of automatic intermittent positive-pressure respirator. Two patients presented hypothermia, and another a peripheral collapse. Long-term hemodialysis was well tolerated without major complications. Significant decreases of barbiturate levels were obtained in all cases (before hemodialysis: 7.3 +/- 1.9 mg/dl, after hemodialysis: 1.8 +/- 1.2 md/dl, corresponding to the pattern of secobarbital used to refer the results). No correlation was observed between initial levels of barbiturates and number of hours of long-term hemodialysis required. Neurologic symptoms improved in all cases. Eight patients were conscious after hemodialysis had been discontinued, and only two patients remained unconscious (coma I). Intratracheal tube could be removed in six patients, but positive-pressure respirator could be took away from all cases. Complete recovery was achieved in eight patients. Two patients died on the 2nd. and 8th. postdialysis days due to respiratory distress. Long-term hemodialysis has proven of value in the treatment of severe barbiturate intoxication, particularly better to conventional hemodialysis.