Use Of Activated Charcoal To Reduce Elevated Serum Phenobarbital Concentration In A Neonate

Abstract

The course of a neonate administered activated charcoal orally for elevated phenobarbital concentration is described. The neonate required a serum concentration of phenobarbital eventually exceeding 80 μg/mL for seizure control. However, due to the severe CNS injury as a result of the asphyxia at birth, a diagnosis of cerebral death by electroencephalogram and apnea test was pursued. This required the phenobarbital concentration to be less than 30 μg/mL. Serial phenobarbital concentrations during this time indicated a 250 hour half-life, which would require two weeks for the phenobarbital to drop below 30 μg/mL. With the administration of six doses of activated charcoal at 0.7 g/kg/dose, the phenobarbital serum concentration decreased to 22 μg/mL, giving an estimated phenobarbital half-life of 22 hours. This, and two other subsequent cases, indicates repeated doses of activated charcoal are effective in augmenting the clearance of certain drugs in the neonatal age group.

KEY WORDS:

• Phenobarbital
• pharmacokinetics
• charcoal
• human
• infant