Effective Role of CVVH in Fatal Phenobarbital Overdose Clearance: A Case Report

Abstract

We report affective utilization of continuous veno-venous hemofiltration for removal of phenobarbital in a patient who took twice amount of fatal dose and was hemodynamically stable. Historically treatment includes supportive care, activated charcoal and urinary alkalinisation along with the application of extracorporeal treatments such as charcoal haem perfusion or hemodialysis and continuous veno-venous hemodiafiltration are affective treatment for removal of drug. Early initiation of extracorporeal treatment and increasing blood flow rate effectively reduced half life of drug and improved patient outcome with fatal poisoning. known time. He was brought unconscious had GCS of 3 blood pressure 120/75 pulse 85 per minutes’ respiratory rate 12 per minutes’ and temperature of 36.5 °C was intubated and ventilated and transferred to intensive care unit. His medical background history includes bipolar disorder, deliberate self harm. His initial investigation showed positive blood and urine toxicology screen for barbiturates only and phenobarbital level of 160.5 mg/L, others investigation including full blood count, renal profile, liver function, arterial blood gases, calcium, phosphate, amylase, creatinine kinase and coagulation screen within normal limits (Table 1). His electrocardiogram showed prolonged QT. He remained hemodynamically stable without any inotropic support was started on supportive management with intravenous fluid and activated charcoal in intensive care unit as renal profile and acid base status remained within fair range with no evidence of renal failure. His repeat phenobarbital level after 48 hours was 221.8 mg/L likely due to redistribution of drug.