Abstract
Phenobarbitone levels in the blood do not always provide a reliable guide in the management of the poisoned patient. They may rise in response to active treatment though the patient may be improving clinically. Some reasons for this are considered, with illustrations from three cases. It is concluded that the poor correlation of phenobarbitone levels with a patient's condition is due not to inadequate analytical techniques but to the poor representation of the “whole body” situation by a single blood specimen. The usefulness of analysing such specimens is questioned.
References
1.
Bloomer
H. A.
A critical evaluation of diuresis in the treatment of barbiturate intoxication . J. Lab. clin. Med.
67 (1966 ) 899 .
2.
Emery
E. R. J.
Yates
A. K.
Moorhead
P. J.
in Principles of Intensive Care.
London , English Universities Press (1973 ).
3.
Greeley
R. H.
New approach to derivatization and gas-chromatographic analysis of barbiturates . Clin. Chem.
20 (1974 ) 192 .
4.
Hadden
J.
Johnson
K.
Smith
S.
Price
L.
Giardina
E.
Acute barbiturate intoxication. Concepts of management. J. Amer. med. Ass.
209 (1969 ) 893 .
5.
Hsiung
M-W.
Itiaba
K.
Crawhall
J. C.
A spectro-photofluorometric method for the estimation of barbiturates separated by instant T.L.C . Clin. Biochem.
7 (1974 ) 45 .
6.
Jamieson
A.
Frew
M. W.
Rapid, standardised blood barbiturate determination . Ann. clin. Biochem.
10 (1973 ) 37 .
7.
Jatlow
P.
Seligson
D.
Application of a digital computer to emergency toxicology . Clin. chim. Acta
50 (1974 ) 19 .
8.
Kennedy
A. C.
Briggs
J. D.
Young
N.
Lindsay
R. M.
Luke
R. G.
Campbell
D.
Successful treatment of three cases of very severe barbiturate poisoning . Lancet
1 (1969 ) 995 .
9.
Leach
H.
Toseland
P. A.
The determination of barbiturates and some related drugs by gas chroma-tography . Clin. chim. Acta
20 (1968 ) 195 .
10.
Matthew
H.
(1971a ). Ed. Acute Barbiturate Poisoning.
Amsterdam , Excerpta Medica (1971 ).
11.
Matthew
H.
(1971b ). Acute poisoning: Some myths and misconceptions . Brit. med. J.
1 (1971 ) 519 .
12.
Matthew
H.
Proudfoot
A. T.
Brown
S. S.
Aitken
R. C. B.
Acute poisoning: Organization and work-load of a treatment centre . Brit. med. J.
3 (1969 ) 489 .
13.
Mawer
G. E.
Lee
H. A.
Value of forced diuresis in acute barbiturate poisoning . Brit. med. J.
1 (1968 ) 790 .
14.
Mercaldo
D. E.
Pizzi
E. A.
Automated colorimetric method for phenobarbitone using autoanalysers . Ann. N.Y. Acad. Sei.
130 (1965 ) 550 .
15.
Robinson
R. R.
Gunnells
J. C.
Jr.
Clapp
J. R.
Treatment of acute barbiturate intoxication . Mod. Treat.
8 (1971 ) 561 .
16.
Stewart
M. J.
(1974 ) unpublished.
17.
Waddell
W. J.
Butler
T. C.
Distribution and excretion of phenobarbital . J. clin. Invest.
36 (1957 ) 1217 .
18.
Watson
D.
Dillon
G.
Use of the barbiturate-mercury reaction in clinical laboratory “screening” for barbiturate poisoning . Ann. clin. Biochem.
10 (1973 ) 31 .
19.
Wiltbank
T. B.
Sine
H. E.
Brody
B. B.
Are emergency toxicology measurements really used?
Clin. Chem.
20 (1974 ) 116 .
20.
Wright
J. T.
The Value of barbiturate estimations in the diagnosis and treatment of barbiturate intoxication . Quart. J. Med.
24 (1955 ) 95 .