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Title: | The Use of Peritoneal Dialysis in Phenobarbitone Toxicity in a Critically Unwell Neonate. | Authors: | Graudins A. ;Le Page A.K.;Stewart A.E.;Roehr C.C.;Johnstone L.M. | Institution: | (Le Page, Johnstone) Department of Nephrology, 246 Clayton Road, Clayton, VIC 3168, Australia (Stewart, Roehr) Department of Monash Newborn, Monash Children's Hospital, Australia (Le Page, Stewart, Johnstone) Women's and Children's Programme, Australia (Graudins) Clinical Sciences at Monash Health, Faculty of Medicine Nursing and Health Sciences, Monash University, Australia (Graudins) Clinical Toxicology Service, Clayton, VIC, Australia | Issue Date: | 12-Feb-2018 | Copyright year: | 2018 | Publisher: | S. Karger AG | Place of publication: | Switzerland | Publication information: | Neonatology. 113 (2) (pp 117-121), 2018. Date of Publication: 01 Feb 2018. | Journal: | Neonatology | Abstract: | Background: Phenobarbitone (PB) is the first-line anti-convulsant for neonatal seizures. The use of peritoneal dialysis (PD) to enhance drug elimination in cases of neonatal PB overdose has not been reported. Objective(s): To report a case of neonatal severe PB toxicity and review the elimination of PB by PD. Method(s): Assessment of PD drug clearance. Result(s): A neonate with prolonged seizures was administered PB. Encephalopathy and myocardial failure developed, which were initially suspected to be secondary to hypoxia. At 42 h of age, the serum PB concentration was in the toxic range at 131 mg/L. Despite supportive care, the infant's condition deteriorated with escalating inotropes and the need for CPR. Enhanced PB elimination via multiple-dose activated charcoal and exchange transfusion were considered too risky. Hourly PD cycles via Tenckhoff catheter were commenced, based on reports suggesting that PD enhances PB clearance. The clinical state of the infant then improved. PD administration was continued for 60 h, recovering 20% of the estimated total PB body load. The infant survived and there were no PD complications. Conclusion(s): PD increased PB clearance in this neonate, correlating with clinical recovery. Where other techniques are not possible, PD may have a role to play in enhancing PB elimination.Copyright © 2017 S. Karger AG, Basel. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1159/000481879 | ORCID: | Le Page, Amelia K.; ORCID: http://orcid.org/0000-0002-1336-5696 Roehr, Charles C.; ORCID: http://orcid.org/0000-0001-7965-4637 | Link to associated publication: | Click here for full text options | PubMed URL: | 29169160 [http://www.ncbi.nlm.nih.gov/pubmed/?term=29169160] | ISSN: | 1661-7800 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/36968 | Type: | Article | Subjects: | *peritoneal dialysis resuscitation Tenckhoff catheter treatment outcome dobutamine/dt [Drug Therapy] dopamine/dt [Drug Therapy] epinephrine/dt [Drug Therapy] *phenobarbital/ae [Adverse Drug Reaction] *phenobarbital/cr [Drug Concentration] *phenobarbital/dt [Drug Therapy] *phenobarbital/to [Drug Toxicity] *phenobarbital/pk [Pharmacokinetics] dialysate priority journal article brain disease/si [Side Effect] case report clinical article *critically ill patient drug blood level drug clearance drug elimination *drug intoxication/th [Therapy] drug overdose female heart failure/si [Side Effect] human hypotension/dt [Drug Therapy] hypoxia/si [Side Effect] infant infantile spasm/dt [Drug Therapy] hypotension / drug therapy hypoxia / side effect infant infantile spasm / drug therapy *peritoneal dialysis priority journal resuscitation Tenckhoff catheter treatment outcome *critically ill patient case report brain disease / side effect Article clinical article drug blood level drug clearance drug elimination *drug intoxication / *therapy drug overdose female heart failure / side effect human |
Type of Clinical Study or Trial: | Case series or case report |
Appears in Collections: | Articles |
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