Enhanced elimination

Multiple-dose activated charcoal

Evidence for the use of multiple-dose activated charcoal for barbiturate poisoning varies with the drug and dose ingested. Mild to moderate poisonings with sedation, but no haemodynamic or respiratory compromise, do not require multiple-dose activated charcoal. Large phenobarbital or primidone ingestions with coma, respiratory depression or haemodynamic instability may benefit from multiple-dose activated charcoal.

If considering the use of multiple-dose activated charcoal, seek advice from a clinical toxicologist. Patients must be alert, cooperative and able to protect their airway to drink a dose of activated charcoal, or be intubated and receive activated charcoal via a nasogastric or orogastric tube—confirm correct placement of the nasogastric or orogastric tube beforehand.

Extracorporeal elimination

Following life-threatening ingestions of barbiturates, particularly involving long-acting drugs, after the use of multiple-dose activated charcoal, consider haemodialysis in consultation with a clinical toxicologist. In particular, consider haemodialysis in patients who have ingested long-acting drugs to shorten the duration of coma.

Patients who ingested short-acting drugs are unlikely to benefit from haemodialysis unless they have haemodynamic instability.

For more information on extracorporeal enhanced elimination techniques, such as haemodialysis, see here.