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To the Editor:—
The article on peritoneal dialysis by Loeser et al (JAMA192:809-812 [May 31] 1965) made one comment which is not only unclear but could prove dangerous. In one place the author states that deep coma with areflexia, shock, or apnea is an indication for dialysis. He gives several examples of drug intoxication effectively treated with dialysis. He fails to mention, however, that not all drugs are dialyzable; a good example is the phenothiazines. With certain drugs, the renal route of excretion with hydration and osmotic diuresis with mannitol has proved even more effective in eliminating the offending agent than has dialysis. This may be the case with barbiturates. Aspirin is an example of a drug more effectively cleared by urinary excretion than by dialysis. Other serious intoxicants which do not cause central nervous system depression are not effectively cleared by peritoneal dialysis; digoxin (Lanoxin) is a
Samson JH. Peritoneal Dialysis. JAMA. 1965;193(8):687-688. doi:10.1001/jama.1965.03090080049022