{"title":"Severe pentobarbital poisoning treated after two sessions of intermittent hemodialysis: A case report","authors":"Sohma Miyamoto , Shutaro Isokawa , Norio Otani , Masatoshi Miyamoto , Yoshito Kamijo","doi":"10.1016/j.jemrpt.2025.100174","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Pentobarbital is a short-acting barbiturate that can cause life-threatening central nervous system, respiratory, and cardiovascular depression if massively overdosed.</div></div><div><h3>Case report</h3><div>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.</div></div><div><h3>Why should an emergency physician should be aware of this?</h3><div>In severe pentobarbital poisoning, hemodialysis may be effective to enhance drug clearance.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100174"},"PeriodicalIF":0.0000,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JEM reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2773232025000380","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
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Abstract
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.
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