Enhanced elimination in acute barbiturate poisoning – A systematic review

@article{Roberts2011EnhancedEI,
  title={Enhanced elimination in acute barbiturate poisoning – A systematic review},
  author={Darren M. Roberts and Nick A. Buckley},
  journal={Clinical Toxicology},
  year={2011},
  volume={49},
  pages={12 - 2}
}
Context. Despite a worldwide decline in barbiturate use, cases of acute poisoning with severe toxicity are still noted, particularly in developing countries. Severe poisonings often require prolonged admission to an intensive care unit, so enhanced elimination might be useful to hasten recovery. Information regarding the efficacy of these techniques for individual barbiturates is not available in standard textbooks. Objective. To determine the evidence supporting the effect of enhanced… 
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References

SHOWING 1-10 OF 126 REFERENCES
Barbiturate intoxication. Evaluation of therapy including dialysis in a large series selectively referred because of severity.
TLDR
Information gained from the study of severe barbiturate poisoning is presented, particularly valuable because all patients were studied in depth by the Renal and Electrolyte Division of Georgetown University Hospital, rather than reviewed in a record room series.
Overdosage with Pentobarbital and Secobarbital: Assessment of Factors Related to Outcome
TLDR
It is suggested that measurement of plasma barbiturate concentrations is of value in identifying patients at risk of developing serious intoxication after overdosage with pentobarbital or secobarbitals.
Hemodialysis, an effective therapy for acute barbiturate poisoning.
TLDR
Hemodialysis appears to be a rational and highly effective treatment of acute barbiturate poisoning and the efficiency of the hemodialysis improved as the patient's clinical condition improved.
Activated charcoal in the treatment of acute poisoning.
TLDR
The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based.
An evaluation of the use of hemoperfusion in acute poisoning.
TLDR
It has been proven that for an adapted evaluation of hemoperfusion, in most cases it is not sufficient to determine merely the pre- and post-perfusion plasma levels, but also plasma levels have to be monitored during perfusion at the in- and out-let of the hem operfusion column.
Acute barbiturate intoxication. Concepts of management.
TLDR
Supportive care alone appears to be the best method of reducing morbidity and mortality in patients with barbiturate overdose and using length of coma, the slope of disappearance of serum Barbiturate value, and clearance data as indicators of the effectiveness of treatment found that the three treatment forms did not differ.
An evaluation of the use of hemoperfusion in acute poisoning.
TLDR
From the obtained results, it has been proven that for an adapted evaluation of hemoperfusion, in most cases it is not sufficient to determine merely the pre- and post-perfusion plasma levels, but also plasma levels have to be monitored during perfusion at the in- and out-let of the hemoperFusion column.
Analeptic use in clinical toxicology: a historical appraisal.
  • P. Wax
  • Medicine
    Journal of toxicology. Clinical toxicology
  • 1997
TLDR
While analeptic therapies for the treatment of drug overdose have now been abandoned, one of these analeptics, methylphenidate, currently enjoys wide use in the treatmentof attention deficit hyperactivity disorder.
Severe Barbitone Poisoning Treated by Haemodialysis
TLDR
A similar clinical picture could result theoretically from cryptococcal toxaemia, torulosis of the central nervous system, or a coincident disease of Landry's paralysis type, if one considers its recognized effects on other vital tissues.
Pharmacokinetics of Phenobarbital During Certain Enhanced Elimination Modalities to Evaluate Their Clinical Efficacy in Management of Drug Overdose
TLDR
The authors conclude that the management of drug overdose in the case of weak acidic drugs that have small volumes of distribution should include the sole use of MDAC and supportive care, without urinary alkalinization.
...
1
2
3
4
5
...