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Successful use of the two-tube approach for the treatment of phenobarbital poisoning without hemodialysis.

Authors:
Atsushi Tanikawa Satoshi Seki Takuya Yasuda Eiju Hasegawa

Am J Emerg Med 2019 09 21;37(9):1809.e1-1809.e3. Epub 2019 Jun 21.

Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa City, Tokyo 190-0014, Japan.

Half-life of the antipsychotic vegetamin is very long, partially due to the presence of phenobarbital, and mortality due to phenobarbital poisoning is high. Here, we present the case of a 22-year-old female admitted to the emergency department with disturbed consciousness due to vegetamin overdose. Her blood phenobarbital level was elevated to 123 μg/ml. Phenobarbital undergoes enterohepatic circulation, and its retention in the intestine causes its blood levels to remain sustained. The utility of hemodialysis for drug poisoning has been previously reported; however, its efficiency is not yet established and its efficacy is low for drugs with long half-lives such as phenobarbital. Therefore, we performed a two-tube approach to adsorb phenobarbital in the intestines with activated charcoal delivered via a gastric tube and to remove the phenobarbital-adsorbed activated charcoal using whole bowel irrigation via an ileus tube 2 h later. The patient successfully eliminated the charcoal via stool, the blood phenobarbital level decreased drastically without hemodialysis, and the clinical course improved. We propose that this two-tube approach is suitable for treatment of poisoning with drugs that undergo enterohepatic circulation and have long half-lives.

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http://dx.doi.org/10.1016/j.ajem.2019.06.036DOI Listing
September 2019

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Successful use of the two-tube approach for the treatment of phenobarbital poisoning without hemodialysis.

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Atsushi Tanikawa Satoshi Seki Takuya Yasuda Eiju Hasegawa

Am J Emerg Med 2019 09 21;37(9):1809.e1-1809.e3. Epub 2019 Jun 21.

Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa City, Tokyo 190-0014, Japan.

Half-life of the antipsychotic vegetamin is very long, partially due to the presence of phenobarbital, and mortality due to phenobarbital poisoning is high. Here, we present the case of a 22-year-old female admitted to the emergency department with disturbed consciousness due to vegetamin overdose. Her blood phenobarbital level was elevated to 123 μg/ml. Read More

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