Severe pentobarbital poisoning treated after two sessions of intermittent hemodialysis: A case report
Background: Pentobarbital is a short-acting barbiturate that can cause life-threatening central nervous system, respiratory, and cardiovascular depression if massively overdosed. Case report: This case report describes a 38-year-old female who entered a deep coma after ingesting 2.45 g of pentobarbi...
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Elsevier
2025-06-01
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| Series: | JEM Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2773232025000380 |
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| author | Sohma Miyamoto Shutaro Isokawa Norio Otani Masatoshi Miyamoto Yoshito Kamijo |
| author_facet | Sohma Miyamoto Shutaro Isokawa Norio Otani Masatoshi Miyamoto Yoshito Kamijo |
| author_sort | Sohma Miyamoto |
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| description | Background: Pentobarbital is a short-acting barbiturate that can cause life-threatening central nervous system, respiratory, and cardiovascular depression if massively overdosed. Case report: This case report describes a 38-year-old female who entered a deep coma after ingesting 2.45 g of pentobarbital. She had severe respiratory depression and hypotension refractory to fluid administration. The patient was intubated, placed under mechanical ventilation, and given continuous intravenous administration of norepinephrine. She then underwent 2 sessions of intermittent hemodialysis (IHD) lasting 4 h each, after which her clinical condition rapidly improved. The serum pentobarbital concentration determined using liquid chromatography-tandem mass spectrometry (LD/MS/MS) decreased rapidly from 60.61 to 23.75 μg/ml after the first session and from 26.16 to 9.34 μg/ml after the second session. The half-lives of pentobarbital were estimated to be 3.8 and 4.1 h during the first and second sessions, respectively, 157.5 h between the two sessions, and 20.4 h after the second session. The case highlights the potential benefit of IHD in managing pentobarbital toxicity, where enhanced drug clearance may shorten intubation and intensive care unit stay. Why should an emergency physician should be aware of this?: In severe pentobarbital poisoning, hemodialysis may be effective to enhance drug clearance. |
| format | Article |
| id | doaj-art-5ee1099812e54137afc2db8e75a9e678 |
| institution | Kabale University |
| issn | 2773-2320 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
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| spelling | doaj-art-5ee1099812e54137afc2db8e75a9e6782025-08-20T03:30:39ZengElsevierJEM Reports2773-23202025-06-014210017410.1016/j.jemrpt.2025.100174Severe pentobarbital poisoning treated after two sessions of intermittent hemodialysis: A case reportSohma Miyamoto0Shutaro Isokawa1Norio Otani2Masatoshi Miyamoto3Yoshito Kamijo4Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Japan; Corresponding author. 9-1 Akashicho, Chuo-ku, Tokyo, Japan.Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, JapanDepartment of Emergency and Critical Care Medicine, St. Luke's International Hospital, JapanClinical Toxicology Center, Saitama Medical University Hospital, JapanClinical Toxicology Center, Saitama Medical University Hospital, JapanBackground: Pentobarbital is a short-acting barbiturate that can cause life-threatening central nervous system, respiratory, and cardiovascular depression if massively overdosed. Case report: This case report describes a 38-year-old female who entered a deep coma after ingesting 2.45 g of pentobarbital. She had severe respiratory depression and hypotension refractory to fluid administration. The patient was intubated, placed under mechanical ventilation, and given continuous intravenous administration of norepinephrine. She then underwent 2 sessions of intermittent hemodialysis (IHD) lasting 4 h each, after which her clinical condition rapidly improved. The serum pentobarbital concentration determined using liquid chromatography-tandem mass spectrometry (LD/MS/MS) decreased rapidly from 60.61 to 23.75 μg/ml after the first session and from 26.16 to 9.34 μg/ml after the second session. The half-lives of pentobarbital were estimated to be 3.8 and 4.1 h during the first and second sessions, respectively, 157.5 h between the two sessions, and 20.4 h after the second session. The case highlights the potential benefit of IHD in managing pentobarbital toxicity, where enhanced drug clearance may shorten intubation and intensive care unit stay. Why should an emergency physician should be aware of this?: In severe pentobarbital poisoning, hemodialysis may be effective to enhance drug clearance.http://www.sciencedirect.com/science/article/pii/S2773232025000380PentobarbitalRenal replacement therapy (RRT)Intermittent hemodialysis (IHD)Suicide attemptLiquid chromatography-tandem mass spectrometry (LD/MS/MS) |
| spellingShingle | Sohma Miyamoto Shutaro Isokawa Norio Otani Masatoshi Miyamoto Yoshito Kamijo Severe pentobarbital poisoning treated after two sessions of intermittent hemodialysis: A case report JEM Reports Pentobarbital Renal replacement therapy (RRT) Intermittent hemodialysis (IHD) Suicide attempt Liquid chromatography-tandem mass spectrometry (LD/MS/MS) |
| title | Severe pentobarbital poisoning treated after two sessions of intermittent hemodialysis: A case report |
| title_full | Severe pentobarbital poisoning treated after two sessions of intermittent hemodialysis: A case report |
| title_fullStr | Severe pentobarbital poisoning treated after two sessions of intermittent hemodialysis: A case report |
| title_full_unstemmed | Severe pentobarbital poisoning treated after two sessions of intermittent hemodialysis: A case report |
| title_short | Severe pentobarbital poisoning treated after two sessions of intermittent hemodialysis: A case report |
| title_sort | severe pentobarbital poisoning treated after two sessions of intermittent hemodialysis a case report |
| topic | Pentobarbital Renal replacement therapy (RRT) Intermittent hemodialysis (IHD) Suicide attempt Liquid chromatography-tandem mass spectrometry (LD/MS/MS) |
| url | http://www.sciencedirect.com/science/article/pii/S2773232025000380 |
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