THE APPLICATION OF HEMODIALYSIS TO THE TREATMENT OF BARBITURATE POISONING 1

Abstract

Current methods of treatment of barbiturate poisoning, which consist of supportive measures aimed towards maintenance of life until the drug can be excreted or metabolized, have occasioned considerable dissatisfaction because of their lack of specificity. Ideal therapy must be directed to-ward either more rapid removal or accelerated de-toxification of the barbiturate preparation. The closest approach to this goal has been the use of massive intravenous infusions to initiate diuresis with consequently more rapid urinary excretion of the drug. Morbidity and mortality in a significant number of patients with barbiturate toxicity are not directly related to the primary depressant effect of the drug. Many patients, especially in the older age group, die because of respiratory difficulties. Mor-bidity at all ages is often increased by such com-plications. The number and severity of these could be reduced if the drug were removed from the body more rapidly, thus shortening the period of coma. The application of massive hydration (1) or cross-circulation of a poisoned dog with a large untreated animal (2) has been shown to permit survival of narcotized dogs given doses of barbitu-rate that ordinarily prove fatal. These studies in-dicated that permanent fixation of barbiturate to tissues is not the major factor in mortality and strongly suggested that beneficial effect might re-sult from lowering of the blood barbiturate level, irrespective of the total amount of barbiturate con-tained within the body. Hemodialysis will not remove substances that are firmly attached to protein. Brodie and his as-sociates (3) have presented evidence that only a certain portion of the circulating barbiturate is so