Skip to main content
Journal of Medical Toxicology logoLink to Journal of Medical Toxicology
. 2007 Mar;3(1):31–36. doi: 10.1007/BF03161036

Case files of the Toxikon Medical Toxicology Fellowship in Chicago: The poisoned anesthesiologist

Trevonne M Thompson 1,, Steven E Aks 2
PMCID: PMC3550125  PMID: 18072156

Conclusion

Suicide attempts by health care workers are very serious because these patients have the knowledge of and access to potentially lethal substances. Our patient presented with hypotension and hemodynamic instablility. He was treated with multiple-dose activated charcoal and 2 rounds of hemodialysis. While there was rapid toxicokinetic improvement and extubation on day 2 of his hospital stay, he had prolonged altered mental status, illustrating the long-acting effects of phenobarbital. It remains unclear exactly how our medical treatment regimens alter the clinical course of phenobarbital poisoning. We are indebted to Clemmesen and Nilsson for their description of the Scandinavian Method and the resulting reduction in morbidity from sedative-hypnotic poisoning. Further research is needed to define the precise clinical benefit achieved from additional therapeutic modalities in treating such poisonings.

Keywords: phenobarbital, overdose, poisoning

Full Text

The Full Text of this article is available as a PDF (117.8 KB).

Footnotes

There was no outside funding of any kind used for this study.

References

  • 1.Lindeman S, Laara E, Vuori E, Lonnqvist J. Suicides among physicians, engineers and teachers: the prevalence of reported depression, admissions to hospital and contributory causes of death. Acta Psychiatr Scand. 1997;96:68–71. doi: 10.1111/j.1600-0447.1997.tb09907.x. [DOI] [PubMed] [Google Scholar]
  • 2.Hawton K, Clements A, Sakarovitch C, Simkin S, Deeks JJ. Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979–1995. J Epidemiol Community Health. 2001;55:296–300. doi: 10.1136/jech.55.5.296. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Frank E, Biola H, Burnett CA. Mortality rates and causes among U.S. physicians. Am J Prev Med. 2000;19:155–159. doi: 10.1016/S0749-3797(00)00201-4. [DOI] [PubMed] [Google Scholar]
  • 4.Alexander BH, Checkoway H, Nagahama SI, Domino KB. Cause-specific mortality risks of anesthesiologists. Anesthesiology. 2000;93:922–930. doi: 10.1097/00000542-200010000-00008. [DOI] [PubMed] [Google Scholar]
  • 5.Swanson SP, Roberts LJ, Chapman MD. Are anaesthetists prone to suicide? A review of rates and risk factors. Anaesth Intensive Care. 2003;31:434–445. doi: 10.1177/0310057X0303100413. [DOI] [PubMed] [Google Scholar]
  • 6.Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis) Am J Psychiatry. 2004;161:2295–2302. doi: 10.1176/appi.ajp.161.12.2295. [DOI] [PubMed] [Google Scholar]
  • 7.Tondo L, Albert MJ, Baldessarini RJ. Suicide rates in relation to health care access in the United States: an ecological study. J Clin Psychiatry. 2006;67:517–523. doi: 10.4088/JCP.v67n0402. [DOI] [PubMed] [Google Scholar]
  • 8.Schernhammer E. Taking their own lives—the high rate of physician suicide. N Engl J Med. 2005;352:2473–2476. doi: 10.1056/NEJMp058014. [DOI] [PubMed] [Google Scholar]
  • 9.Binder L, Fredrickson L. Poisonings in laboratory personnel and health care professionals. Am J Emerg Med. 1991;9:11–15. doi: 10.1016/0735-6757(91)90004-4. [DOI] [PubMed] [Google Scholar]
  • 10.Clemmensen C, Nilsson E. Therapeutic trends in the treatment of barbiturate poisoning. The Scandinavian method. Clin Pharmacol Ther. 1961;2:220–229. doi: 10.1002/cpt196122220. [DOI] [PubMed] [Google Scholar]
  • 11.Buckley NA, McManus PR. Changes in fatalities due to overdose of anxiolytic and sedative drugs in the UK (1983–1999) Drug Saf. 2004;27:135–141. doi: 10.2165/00002018-200427020-00004. [DOI] [PubMed] [Google Scholar]
  • 12.Johns MW. Self-poisoning with barbiturates in England and Wales during 1959–74. Br Med J. 1977;1:1128–1130. doi: 10.1136/bmj.1.6069.1128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Osselton MD, Blackmore RC, King LA, Moffat AC. Poisoning-associated deaths for England and Wales between 1973 and 1980. Hum Toxicol. 1984;3:201–221. doi: 10.1177/096032718400300305. [DOI] [PubMed] [Google Scholar]
  • 14.Watson WA, Litovitz TL, Rodgers GCJ, Klein-Schwartz W, Reid N, Youniss J, Flanagan A, Wruk KM. 2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 2005;23:589–666. doi: 10.1016/j.ajem.2005.05.001. [DOI] [PubMed] [Google Scholar]
  • 15.Bloomer HA. A critical evaluation of diuresis in the treatment of barbiturate intoxication. J Lab Clin Med. 1966;67:898–905. [PubMed] [Google Scholar]
  • 16.Waddell WJ, Butler TC. The distribution and excretion of phenobarbital. J Clin Invest. 1957;36:1217–1226. doi: 10.1172/JCI103518. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Lassen NA, Copenhgen MD. Treatment of severe acute barbiturate poisoning by forced diuresis and alkalinisation of the urine. Lancet. 1960;2:338–342. doi: 10.1016/S0140-6736(60)91482-3. [DOI] [Google Scholar]
  • 18.Myschetzky A, Lassen NA. Urea-Induced, Osmotic Diuresis and Alkinization of Urine in Acute Barbiturate Intoxication. JAMA. 1963;185:936–942. doi: 10.1001/jama.1963.03060120046020. [DOI] [PubMed] [Google Scholar]
  • 19.Linton AL, Luke RG, Briggs JD. Methods of forced diuresis and its application in barbiturate poisoning. Lancet. 1967;2:377–379. doi: 10.1016/S0140-6736(67)92003-X. [DOI] [PubMed] [Google Scholar]
  • 20.Mawer GE, Lee HA. Value of forced diuresis in acute barbiturate poisoning. Br Med J. 1968;2:790–793. doi: 10.1136/bmj.2.5608.790. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Neuvonen PJ, Elonen E. Effect of activated charcoal on absorption and elimination of phenobarbitone, carbamazepine and phenylbutazone in man. Eur J Clin Pharmacol. 1980;17:51–57. doi: 10.1007/BF00561677. [DOI] [PubMed] [Google Scholar]
  • 22.Goldberg MJ, Berlinger WG. Treatment of phenobarbital overdose with activated charcoal. JAMA. 1982;247:2400–2401. doi: 10.1001/jama.247.17.2400. [DOI] [PubMed] [Google Scholar]
  • 23.Berg MJ, Berlinger WG, Goldberg MJ, Spector R, Johnson GF. Acceleration of the body clearance of phenobarbital by oral activated charcoal. N Engl J Med. 1982;307:642–644. doi: 10.1056/NEJM198209093071102. [DOI] [PubMed] [Google Scholar]
  • 24.Levy G. Gastrointestinal clearance of drugs with activated charcoal. N Engl J Med. 1982;307:676–678. doi: 10.1056/NEJM198209093071109. [DOI] [PubMed] [Google Scholar]
  • 25.Pond SM, Olson KR, Osterloh JD, Tong TG. Randomized study of the treatment of phenobarbital overdose with repeated doses of activated charcoal. JAMA. 1984;251:3104–3108. doi: 10.1001/jama.251.23.3104. [DOI] [PubMed] [Google Scholar]
  • 26.Boldy DA, Vale JA, Prescott LF. Treatment of phenobarbitone poisoning with repeated oral administration of activated charcoal. QJ Med. 1986;61:997–1002. [PubMed] [Google Scholar]
  • 27.Frenia ML, Schauben JL, Wears RL, Karlix JL, Tucker CA, Kunisaki TA. Multiple-dose activated charcoal compared to urinary alkalinization for the enhancement of phenobarbital elimination. J Toxicol Clin Toxicol. 1996;34:169–175. doi: 10.3109/15563659609013766. [DOI] [PubMed] [Google Scholar]
  • 28.Mohammed Ebid AH, Abdel-Rahman HM. Pharmacokinetics of phenobarbital during certain enhanced elimination modalities to evaluate their clinical efficacy in management of drug overdose. Ther Drug Monit. 2001;23:209–216. doi: 10.1097/00007691-200106000-00005. [DOI] [PubMed] [Google Scholar]
  • 29.Setter JG, Maher JF, Schreiner GE. Barbiturate intoxication. Evaluation of therapy including dialysis in a large series selectively referred because of severity. Arch Intern Med. 1966;117:224–236. doi: 10.1001/archinte.117.2.224. [DOI] [PubMed] [Google Scholar]
  • 30.Jacobsen D, Wiik-Larsen E, Dahl T, Enger E, Lunde PK. Pharmacokinetic evaluation of haemoperfusion in phenobarbital poisoning. Eur J Clin Pharmacol. 1984;26:109–112. doi: 10.1007/BF00546717. [DOI] [PubMed] [Google Scholar]
  • 31.Palmer BF. Effectiveness of hemodialysis in the extra-corporeal therapy of phenobarbital overdose. Am J Kidney Dis. 2000;36:640–643. doi: 10.1053/ajkd.2000.16207. [DOI] [PubMed] [Google Scholar]
  • 32.Jacobs F, Brivet FG. Conventional haemodialysis significantly lowers toxic levels of phenobarbital. Nephrol Dial Transplant. 2004;19:1663–1664. doi: 10.1093/ndt/gfh221. [DOI] [PubMed] [Google Scholar]
  • 33.Lin JL, Jeng LB. Critical, acutely poisoned patients treated with continuous arteriovenous hemoperfusion in the emergency department. Ann Emerg Med. 1995;25:75–80. doi: 10.1016/S0196-0644(95)70359-4. [DOI] [PubMed] [Google Scholar]
  • 34.Lal R, Faiz S, Garg RK, Baweja KS, Guntupalli J, Finkel KW. Use of continuous venovenous hemodiafiltration in a case of severe phenobarbital poisoning. Am J Kidney Dis. 2006;48:e13–5. doi: 10.1053/j.ajkd.2006.04.081. [DOI] [PubMed] [Google Scholar]
  • 35.Winchester JF. Extracorporeal removal of toxic substances. In: Brent J, Wallace KL, Burkhart KK, Phillips SD, Donovan JW, editors. Critical Care Toxicology. Philadelphia: Elsevier Mosby; 2005. [Google Scholar]

Articles from Journal of Medical Toxicology are provided here courtesy of Springer

RESOURCES