[Metabolism of carbromal during detoxication with combined hemoperfusion and hemodialysis (author's transl)]

Abstract

Combined charcoal hemoperfusion and hemodialysis was performed on three occasions in two patients with severe carbromal intoxication. The concentration of carbromal, its organic metabolites and of bromide was determined in arterial blood before and after passage of the charcoal column and behind the dialyzer cartridge. Results show a rapid metabolic degradation of carbromal including cleavage of bromide. Besides carbromal and its main metabolite 2-brome-2-ethylbutyramide (=carbromide) debromised organic metabolites appear to be responsible for the severity of the intoxication. Bromide plays no role in the pathogenesis of acute intoxication. Carbromal and its organic metabolites are eliminated through a large surface dialyzer almost as effectively as with charcoal hemoperfusion. The effectivity of detoxication is enhanced by the combination of both procedures. Free bromide is not adsorbed at charcoal but is readily dialyzable. Values of carbromal, calculated out of bromide levels, do not correspond to directly measured blood levels. Treatment of carbromal intoxication with combined hemoperfusion-hemodialysis should be performed early in all severe, risky or otherwise complicated cases until the patients awakens.