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?
Correct Answer: repetitive administration of activated charcoal
Description: 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.
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