To the Editor.
—The case report in the June 1981 Archives (141:938-940) concerning the use of dopamine hydrochloride to support an alkaline diuresis in the treatment of phenobarbital overdose is most disturbing. This patient, with a lethal plasma concentration of phenobarbital, was allowed to remain comatose for five days and intubated for six days, while the drug was slowly excreted via forced alkaline diuresis. The authors are to be commended on the excellent intensive care they gave this patient. It is unfortunate that a more efficient method of removing the drug was not used.The case report indicates that "dialysis was considered, but because of the clinical situation and practical considerations" was not used. Our extensive experience, and the extensive reports in the literature, indicate that these patients are rarely too sick to tolerate hemodialysis or hemoperfusion. Phenobarbital can be readily dialyzed, but a more modern approach would be to
Walker PJ, Farmer CD, Chandler JT, Diaz-Buxo JA. In Support of Hemodialysis and Hemoperfusion. Arch Intern Med. 1982;142(3):646. doi:10.1001/archinte.1982.00340160226049