A 34-year-old man is brought to the emergency room by his family because of extreme lethargy. After further questioning, he admits to taking a large number of phenobarbital tablets. Which of the following is the most appropriate next step in management?
Activated charcoal absorbs barbiturates very effectively and is useful in decontamination of the GI tract. Renal elimination of phenobarbital is enhanced by alkalinization of the urine to a pH of 8 with sodium bicarbonate and fluids. Hemodialysis and hemoperfusion are reserved for extreme cases with refracting hypotension. Short-acting barbiturates are metabolized in the liver, so fluid administration and alkalinization are not helpful.
acidification of urine to pH 3.0
repetitive administration of activated charcoal
ipecac to induce vomiting
hemoperfusion
Miscellaneous