Article

The Artificial Kidney for Acute Glutethimide (Doriden*) and Barbiturate Poisoning

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Abstract

THE artificial kidney has been used successfully in acute poisoning in a number of patients.1–5 Hemodialysis appears to be a rational and effective treatment of acute toxicity caused by ingestion of excessive amounts of barbiturate, glutethimide, salicylate, bromide, diphenylhydantoin sodium, bichloride of mercury, or mushroom poisons.

In treating poisoning from hypnotic drugs the goal of dialysis is twofold: to eliminate the poison and to shorten coma. Patients can be allowed to sleep out their barbiturate effects as long as respiration, blood pressure, and temperature are under control. In a light case of barbiturate poisoning, we let the patient sleep, but observe him closely so as to be able to ward off complications. The clinical intervention with hemodialysis is justified in two conditions: (1) when the amount of poison ingested or the initial concentration of poison in the blood is unquestionably in the fatal range, and (2) when the underlying physical state of the patient dangerously heightens the risk of prolonged sleep or coma. The time required to assemble a Kolff twin-coil artificial kidney6,7 and the risk of hemodialysis to the patient are negligible when the procedure is performed by an experienced team. The reduction of morbidity is as legitimate an indication for the use of the artificial kidney as is the reduction of mortality.

Our report concerns four representative cases of acute poisoning from hypnotic drugs that do not cause much direct damage to the kidneys. Two of the patients had glutethimide poisoning and two of the patients had barbiturate . . .


 

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