Abstract
Effective Role of CVVH in Fatal Phenobarbital Overdose Clearance: A Case Report
Highlights
Phenobarbital is a long-acting barbiturate in use reported since 1912 with a wide interindividual difference in rate of its metabolism and a narrow therapeutic index
We report affective utilization of continuous veno-venous hemofiltration for removal of phenobarbital in a patient who took twice amount of fatal dose and was hemodynamically stable
Historical treatment of a barbiturate overdose is based on supportive care, activated charcoal and urinary alkalinisation [1,2] along with the application of extracorporeal treatments such as charcoal haem perfusion or hemodialysis and continuous veno-venous hemodiafiltration [3,4,5] are affective treatment for removal of drug
Summary
Phenobarbital is a long-acting barbiturate in use reported since 1912 with a wide interindividual difference in rate of its metabolism and a narrow therapeutic index. It was decided to commence on CVVH (Plasma flex system Gambro) with initial blood flow of 200 ml/min and dialysate flow 2000 ml/hour and Gambro FX100 filter size in intensive care unit in view to improve clearance for phenobarbital level and recovery from coma. His phenol barbital level was measured after 48 hours from arterial port 80.4 mg/L venous port 79 mg/L and level in effluent fluid 58.5 mg/L. He was discharged from intensive care unit after mechanical ventilation of 5 days for duration of his coma and CVVH for 72 hours, specialist psychiatric team was involved in his care before discharge from hospital
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