The Use of the Artificial Kidney in Acute Intoxication by Hypnotic Drugs
IN the last few years the artificial kidney has been used successfully in the treatment of acute poisoning by the hypnotic drugs, glutethimide (Doriden†), barbiturates, and bromides.1,2 In 1958, Schreiner1 outlined the basic conditions in acute poisoning which are necessary for effective hemodialysis. The poison molecule must be readily diffusible from plasma water and well distributed within accessible body-fluid compartments. The toxicity of the molecule must be proportional to the concentration of the drug in the serum and to the duration of bodily exposure. Furthermore, the amount of poison removable by dialysis must be a significant addition to the amount that can be successfully removed by the slower physiologic mechanisms.
In practice, we adhere to the principle that the patient who has taken an overdose of hypnotics should be given conservative treatment if the coma is light and if he is observed closely for a gradual improvement as judged from the vital signs and the neurologic examination. However, hemodialysis is justified in any one of three conditions:2 (1) when the amount of poison ingested or the initial concentration of poison in the blood is unquestionably known to be in the fatal range, (2) when the patient's condition is deteriorating, and (3) when prolonged coma would be harmful as in the debilitated or elderly patient. Therefore, the acceleration, by dialysis, of recovery from coma is justifiable since a reduction in morbidity in turn reduces the mortality rate.
Eight patients with hypnotic drug intoxication have been dialyzed at Cleveland Clinic Hospital since . . .