Advances in the hemodialysis management of phenobarbital overdose.

When a comatose man requiring ventilatory support for acute ingestion of phenobarbital was admitted to the University of Utah Hospital, he was managed by a multispecialty team, which included a nephrologist and a clinical pharmacologist. Since the patient could not be moved to the dialysis unit, a mobile dialysis machine was used. A negative-pressure adapter was used in conjunction with a batch-type dialysis machine to create a single-pass dialysate delivery system. Blood was delivered to the dialyzer and returned to the patient through bilateral femoral catheters that had been placed percutaneously. Pharmacokinetic studies were performed and compared to the disappearance of phenobarbital by conservative measures alone after the patient had awakened and dialysis was discontinued.