Dialysis v. Poison

TV Engineer Alan Adair, 30, unhappily divorced and tired of life, parked his car alongside Los Angeles' Ballona Creek one evening and washed down a handful of barbiturate sleeping pills with milk. Then he made notes: "7:26. Now I wonder how long it will take ... 7:31. Everyone wonders what it is like to die. I'm going to find out. 7:39. I can barely see." When police spotted the car at 2:45 a.m., Adair was in a deep coma. Fortunately, his record told doctors at Santa Monica Hospital how much barbiturate he had taken, and the empty pill bottle told what kind. It was too late for stomach pumping to do any good. He was promptly put on the standard treatment for such cases: an injection of picrotoxin to stimulate the nervous system, and oxygen by mask.

About 90% of barbiturate poisoning victims recover with no more medication than this: their systems gradually remove the poison from the blood. But Adair's was a stubborn case. After 24 hours he remained in coma. Alarmed, hospital doctors got Adair transferred to U.C.L.A. Medical Center, where researchers had been experimenting on dogs with a fluid-exchange method called peritoneal dialysis, originally devised to tide patients over a kidney shutdown.

Adair was the first human subject so treated for barbiturate poisoning. Punching a hole through the muscle wall of his abdomen 2 in. below the navel, doctors inserted a plastic tube in his peritoneal cavity and hooked this up with a quart flask containing mineral salts in the same concentration as they occur in the blood, plus antibiotics to check infection. The solution drained into the peritoneal cavity. There it picked up some of the barbiturates by osmosis through the peritoneum. The doctors then drained the fluid, now mixed with barbiturates, back into the flask. They repeated the process with fresh fluid about once an hour for 36 hours, using some 60 qt. of fluid.

Within five hours, Adair's reflexes returned. After about 30 hours he regained partial consciousness and this week was well on the way to recovery. Analyses of the fluid will show how much barbiturate was removed by dialysis: similar trials with artificial kidneys have shown that removal of only 10% to 15% might be enough to get a patient over the hump.

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