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Does it matter how we treat phenobarbitone overdose of moderate severity?

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Author(s): Srinivas S | Karanth Sunil | Nayyar V

Journal: Indian Journal of Critical Care Medicine
ISSN 0972-5229

Volume: 8;
Issue: 3;
Start page: 153;
Date: 2004;
Original page

Keywords: Overdose; phenobarbitone; alkaline diuresis

ABSTRACT
AIM: To study if the routine use of combined Forced Alkaline Diuresis (FAD) and Hemodialysis (HD), confers any advantage in terms of quicker drug elimination, reduced ICU stay or lower costs, among patients with moderate Phenobarbitone overdose. MATERIALS AND METHODS: A retrospective analysis of all available records of patients admitted with phenobarbitone overdose between March 1995 and September 2002, was carried out. RESULTS: 42 records could be analysed. Fourteen patients each had drug levels above 100 mg/L and between 60 -100 mg/L. Out of the fourteen with drug levels between 60-100 mg/L, 9 were treated with FAD alone and the rest with combined FAD + HD. The parameter, which influenced the modality of drug elimination, was the GCS, which correlated neither with the dose consumed, nor the drug levels at admission. Those treated with FAD alone stayed in the ICU a shorter while needed fewer cycles of FAD for detoxification and ultimately spent significantly less for their treatment. CONCLUSIONS: Routine use of combined FAD and HD confers no advantage when used among patients with moderate phenobarbitone overdose whose GCS is more than 8 and are hemodynamically stable.
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