The place of plasma and urinary alkalinization in the treatment of acute barbiturate poisoning

Abstract

SummaryThe authors summarize their experimental work on the dog, explain how they alkalinize the body fluids and give their results in clinical application.Alkalinization of the plasma prevents penetration of phenobarbital into the cells and increases the plasma concentration of the toxic substance. Elevation of the urinary pH hinders tubular reabsorption of barbiturate and increases markedly their renal clearance.In clinical application, alkalinization may be obtained by two different methods : 1) isotonic bicarbonate perfusion or 2) hypertonic bicarbonate perfusion. In the latter case, treatment must be given under forced breathing, with precise controls of arterial pH. If the first method can thus be applied on a large scale, the second one requires intubation or tracheotomy and must be applied in a well-organized center.The authors have submitted 121 cases of barbiturate coma to that treatment. Death rate was 1,6 %(2 deaths). Duration of the coma appears significantly reduced.Alkalinization of the pla...