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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Phenobarbital is a long-acting barbiturate that remains an important antiepileptic agent in resource-limited settings. It has a molecular weight of 232 Da, volume of distribution of 0.7 L/kg, protein binding of 40-50%, and partial renal excretion, making it amenable to extracorporeal removal. Acute overdose can cause altered mental status, respiratory depression, circulatory collapse, and death, with toxicity at doses >1g and potential fatality at >2g or serum concentrations >345 µmol/L. Given the absence of a specific antidote, management relies on supportive measures such as multiple-dose activated charcoal and urinary alkalinization. Hemodialysis (HD) and hemoperfusion (HP) have been shown individually to enhance phenobarbital clearance; however, early combined use in severe toxicity has not been previously reported. The purpose of the study is to present a case of acute severe phenobarbital overdose successfully treated with early combined HD and HP.
This is a case report of a 22-year-old female with epilepsy who arrived at the emergency department comatose five hours after ingesting 3.78g of phenobarbital tablets. She was tachycardic (heart rate 119 beats/min) and tachypneic (respiratory rate 27 breaths/min) but maintained normal blood pressure, oxygenation, and temperature. The rest of her physical and neurologic examinations were unremarkable. Intubation was performed due to profound neurologic depression and respiratory distress. Initial laboratory findings showed serum phenobarbital level of 668 µmol/L (therapeutic range: 50-130 µmol/L), urine pH 6.5, and metabolic acidosis. Emergent combined HD and HP was initiated due to the life-threatening toxicity with phenobarbital level five times the upper therapeutic limit and nearly twice the potentially fatal threshold.
After a single session of combined HD and HP, serum phenobarbital level decreased to 38.3 µmol/L, representing a 94% reduction from baseline. The patient exhibited rapid clinical improvement, regaining consciousness within an hour. She was able to communicate non-verbally and follow commands. She was successfully extubated on hospital day two and discharged in stable condition on hospital day four without neurologic sequelae. No adverse events from the extracorporeal therapy were observed.
Early combined use of HD and HP enabled rapid phenobarbital clearance with fast neurologic recovery, early extubation, and shortened hospitalization in this case of acute severe poisoning. This demonstrates the value of combined HD and HP as an effective, safe, and resource-efficient intervention for life-threatening phenobarbital overdose.
This abstract was previously submitted to the 23rd Asian Pacific Congress of Nephrology and re-submission is permitted by the organizers of the original meeting.
