• Hironori Katsuki, Yoshito Kamijo, Ryoko Kyan, and Hiroko Abe.
• Clinical Toxicology Center, Saitama Medical University Hospital, 38, Hongo, Moroyama-machi, Iruma-gun, Sitama 350-0495, Japan; Emergency and Critical Care Center, Iizuka Hospital, 3-38, Yoshiomachi, Iizukashi, Fukuoka 820-0018, Japan. Electronic address: hkatsukih1@aih-net.com.
• Am J Emerg Med. 2024 May 1; 79: 231.e1231.e2231.e1-231.e2.

AbstractBromvalerylurea (BVU) is a sedative-hypnotic drug with a high risk of acute poisoning. In the present case, hemodialysis (HD) was introduced in a patient with severe BVU poisoning who later demonstrated respiratory arrest, and then HD clearances (CLHD) were assessed in detail. A 20-year-old female was transported to the emergency department by ambulance, an estimated two to four hours after orally ingesting 144 tablets of Utto® (12,000 mg BVU) in a suicide attempt. The patient was comatose on arrival. After intratracheal intubation, 50 g of activated charcoal was administered through nasogastric tube. She was then transferred to the intensive care unit. Ten hours after arrival at the hospital, her light reflex, contralateral light reflex, corneal reflex, and spontaneous respiration disappeared, resulting in an introduction of HD 16 h after arrival. Eighteen hours after arrival, her light reflex, contralateral light reflex, and corneal reflexes had recovered. Twenty-one hours after arrival, her consciousness level improved and the patient was weaned from HD. During HD treatment, blood samples were collected pre-HD and post-HD every hour. Serum BVU concentrations were determined using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The median CLHD was 133.61 mL/min, and the systemic clearance (CLSYS) was 117.77 mL/min. Higher CLHD of BVUs over CLSYS suggests that HD may play an important role in the treatment of severe BVU poisoning.Copyright © 2024 Elsevier Inc. All rights reserved.

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