Barbiturate intoxication. Evaluation of therapy including dialysis in a large series selectively referred because of severity

Setter, John G.

doi:10.1001/archinte.117.2.224

Cited by 29 publications

(4 citation statements)

References 22 publications

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“…Toxicity varies within the barbiturate class largely in terms of onset and duration of action. Short‐acting barbiturates induce a rapid onset of coma, but further complications may not develop, and recovery is fairly quick 28 …”

Section: Gamma‐aminobutyric Acid Gaba Receptor Types and Drug Actionsmentioning

confidence: 99%

“…General treatment guidelines for intoxication by nonopioid CNS depressants include stabilization of airway, breathing, and circulation; toxidrome identification based on physical exam findings; individualized laboratory evaluation to identify or exclude coingestion; and provision of basic supportive care 71 . Significant poisoning by long‐acting agents such as phenobarbital may often require ventilatory support and intensive care 28 . Escalation of care may be warranted with depressed levels of consciousness, endotracheal intubation and mechanical ventilation, refractory hypotension or hypertensive emergency, cardiovascular compromise requiring advanced cardiac life support protocols, status epilepticus, metabolic acidosis, end‐organ dysfunction, or those requiring extracorporeal membrane oxygenation 71 .…”

Section: Treatment Considerationsmentioning

confidence: 99%

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Sedative‐Hypnotic Agents That Impact Gamma‐Aminobutyric Acid Receptors: Focus on Flunitrazepam, Gamma‐Hydroxybutyric Acid, Phenibut, and Selank

Doyno

White

2021

The Journal of Clinical Pharma

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There are many nonopioid central nervous system depressant substances that share a gamma‐aminobutyric acid (GABA) receptor–related mechanism of action. These sedatives‐hypnotics can be indicated to treat anxiety, seizures, depression, and insomnia but are also used as substances of abuse and used to facilitate sexual assault. Barbiturates, methaqualone, and glutethimide were among the first type A GABA receptor–mediated sedative‐hypnotics. Their clinical use was limited for most indications by serious adverse events and strong abuse potential but continue to be used illicitly around the world. The benzodiazepines supplanted barbiturates for most indications because they were less likely to cause severe adverse events in monotherapy. Flunitrazepam is a newer benzodiazepine that is preferentially used recreationally and to facilitate sexual assault. Flunitrazepam has greater potency and higher affinity for the type A GABA receptor than most benzodiazepines. Gamma‐hydroxybutyric acid is sought illicitly for its hypnotic, euphoric and anabolic effects as well as to facilitate sexual assault. When any of these GABAergic drugs are used in high doses or with other sedative hypnotic agents, respiratory depression, coma, and death have occurred. Chronic use of these GABAergic drugs can lead to significant withdrawal syndromes. Phenibut and selank are poorly studied Russian drugs with GABAergic mechanisms that are inexplicably sold to US consumers as dietary supplements. Poison control center calls regarding phenibut have increased substantially over the past 5 years. Desired euphoriant effects account for the recreational and illicit use of many GABA‐modulating agents. However, illicit use can lead to significant toxicities related to abuse, dependence, and subsequent withdrawal syndromes. Significant evaluation of developing agents with GABA properties should be conducted to determine abuse potential before public access ensues.

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Section: Gamma‐aminobutyric Acid Gaba Receptor Types and Drug Actionsmentioning

confidence: 99%

Section: Treatment Considerationsmentioning

confidence: 99%

Sedative‐Hypnotic Agents That Impact Gamma‐Aminobutyric Acid Receptors: Focus on Flunitrazepam, Gamma‐Hydroxybutyric Acid, Phenibut, and Selank

Doyno

White

2021

The Journal of Clinical Pharma

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“…Although it is many years since haemodialysis (Setter et al, 1966) and haemoperfusion over uncoated (Yatzidis, 1964) and later coated (Vale et al, 1975) charcoal columns have been used for the treatment of intoxicated patients, the clinical efficacy of these extracorporeal techniques in the treatment of severely poisoned patients remains a matter of debate (Chang, 1982). Reports varying from enthusiasm (Hampel et al, 1979) to papers considering this difficult pharmacokinetic model to study, since several parameters are unknown.…”

mentioning

confidence: 99%

“…Information concerning the dose and time of drug intake is often not reliable. The amount of drug removed by gastric lavage and oral administration of activated charcoal is difficult to estimate (Setter et al 1966). Moreover, unlike a pharmacokinetic experiment, the volume of distribution and the absorption kinetics cannot be measured directly.…”

mentioning

confidence: 99%

Haemoperfusion: a Useful Therapy for a Severely Poisoned Patient?

et al. 1986

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Although it is many years since a haemodialysis and haemoperfusion over uncoated and later coated charcoal columns have been used for the treatment of intoxicated patients, the clinical efficacy of these extracorporeal techniques in the treatment of severely poisoned patients remains a matter of debate. Some of the reasons for this controversy may be the indiscriminate use of haemoperfusion in any form of intoxication, the lack of well-controlled studies and the wrong interpretation of the high haemoperfusion clearance values sometimes obtained. Simple pharmacokinetic principles are applied to this type of treatment and some practical guidelines as to how and when haemoperfusion should be applied or presented are reviewed. The limited place of haemoperfusion in the treatment of severe poisoning, its further declining use in the future, at least in its present design, and some promising new treatments are emphasized.

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