Ethchlorvynol poisoning: gas liquid chromatography in management.
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Adult↗
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Resin hemoperfusion for ethchlorvynol.
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Adult↗
Pathophysiologic effects of intravenous ethchlorvynol (Placidyl) in man following acute pulmonary edema.
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Acute Disease↗
Resin hemoperfusion in dogs intoxicated with ethychlorvynol (Placidyl).
Kinetic parameters were studied to determine the effectiveness of hemoperfusion in removing ethychlorvynol from the plasma and red blood cells (RBC) of intoxicated dogs. Perfusion columns contained polystyrene/divinyl benzene resin (XAD-4 Amberlite. Column clearances of ethchlorvynol averaged 96.5 +/- 0.4% of the plasma flow rate (mean +/- SEM, 9 dogs). Plasma ethchlorvynol t 1/2's during preperfusion periods averaged 94.1 hr. During hemoperfusion, t 1/2's averaged 3.8 hr, or 90.3 hr shorter than at the endogenous rate of detoxication. There was no significant difference between preperfusion and postperfusion half lives. An estimate based on plasma column clearance suggests that 1.5 +/- 0.1 g ethchlorvynol, or 19.0 +/- 2.8% of the dose, was removed by hemoperfusion. The amount eluted from the resin was 2.9 +/- 0.3 g (37.2 +/- 5.8% of the dose), or about twice the amount apparent from plasma clearance alone. Further, the volume of distribution of ethchlorvynol was 2.3 +/- 0.2 liters/kg, suggesting significant distribution to intracellular and extravascular compartments. The results show that resin hemoperfusion removes a large fraction of ethchlorvynol from intoxicated dogs, and greatly adds to endogenous mechanisms for elimination. Ethchlorvynol was removed from RBC directly, and ultimately from extravascular sites as well.
Animals↗
A CLINICAL EVALUATION OF FOUR HYPNOTIC AGENTS, USING A LATIN-SQUARE DESIGN.
A double-blind study with a Latin-square design was undertaken on 25 elderly patients, using a placebo and four hypnotic drugs: ethchlorvynol 500 mg., glutethimide 500 mg., chloral hydrate 500 mg., and secobarbital sodium 100 mg. The trial lasted for five weeks. The drugs were all effective compared with the placebo, differences in sleeping time being statistically significant. Differences between these four drugs were not statistically significant. Sleep was induced soonest by secobarbital and ethchlorvynol. Ethchlorvynol and glutethimide had a relatively somewhat longer period of activity than the others. Glutethimide produced most side effects, especially morning drowsiness. Ethchlorvynol and chloral hydrate produced relatively few cases of drowsiness.
Aged↗
The reduction of coma time in lipophilic drug overdose using castor oil.
A clinical trial of castor oil in overdoses of lipophilic drugs gave a strong clinical impression that it was effective in speeding up recovery. Therefore, animal experiments were undertaken to confirm that castor oil acts as a ligand in Ethchlorvynol poisoning and that its use reduces coma time. Serial serum levels of Ethchlorvynol were obtained from dogs given Ethchlorvynol 150 mg/kg alone, and the same dose dissolved in castor oil 15 ml/kg in a crossover fashion. The result was a reduction of peak serum levels and of the half-life of the drug when the castor oil solution was used. In order to mimic the clinical situation more closely, a further crossover study was undertaken using Ethchlorvynol 300 mg/kg alone and the same dose followed by castor oil 15 ml/kg repeated q12h. This showed no delay in reaching peak serum concentration and no reduction of peak levels. However, it did show a 31 per cent reduction in the half-life of the drug. This change is statistically significant, and supports the continued use of castor oil in lipophilic drug overdose.
Animals↗
Bronchoalveolar lavage in an animal model of acute lung injury. Relationship between enhanced membrane permeability and transvascular neutrophil flux.
Results of studies utilizing bronchoalveolar lavage (BAL) have led workers to propose that the neutrophil serves as the pivotal cellular element responsible for promoting enhanced alveolar capillary membrane (ACM) permeability in certain forms of acute lung injury. The authors performed BAL on anesthetized, intubated, instrumented sheep before and after the administration of 15 mg/kg ethchlorvynol, a known pulmonary edemagenic agent. Bronchoalveolar lavage fluid (BALF) protein content increased from 0.62 +/- 0.05 to 1.5 +/- 0.15 mg/ml, and the percentage of neutrophils recovered from 2% +/- 1% at baseline to 35% +/- 7% (P less than 0.01) 60 minutes after infusion of ethchlorvynol. After ethchlorvynol infusion into neutropenic sheep (less than 500 cells/microliter), BALF protein content increased from 0.35 +/- 0.08 to 1.5 +/- 0.69 mg/ml (P less than 0.01) with no increase in BALF neutrophil count. In 3 non-neutropenic sheep BAL was performed at 15 and 30 minutes after ethchlorvynol infusion. BALF protein content increased significantly within 15 minutes, whereas the percentage of neutrophils did not change. These findings suggest coexistent ACM injury as reflected by increases in BALF protein content and increased number of neutrophils in BALF does not necessarily imply a cause-and-effect relationship in certain forms of acute lung injury.
Acute Disease↗
Production of leukotrienes in phorbol ester-induced acute lung injury.
Leukotrienes, when administered into the pulmonary circulation of intact animals or isolated perfused lungs, have been associated with the formation of pulmonary edema. In addition, leukotrienes were identified in edema fluid and in bronchoalveolar lavage fluid (BALF) both from patients with the adult respiratory distress syndrome (ARDS) and from dogs with ethchlorvynol-induced acute lung injury (ALI). To determine whether the identification of leukotrienes in BALF was a finding common to ALI, etiology notwithstanding, we produced acute lung injury in dogs with phorbol myristate acetate (PMA). PMA produces a model of ALI thought to differ mechanistically from ethchlorvynol-induced ALI. Leukotriene C4 (LTC4), D4 (LTD4) and B4 (LTB4) were measured in BALF before and after PMA administration in intact pentobarbital-anesthetized dogs. The intravenous administration of 20 or 30 micrograms/kg of PMA produced increases in pulmonary vascular resistance (PVR) and extravascular lung water (EVLW), whereas, 10 or 15 micrograms/kg caused only a modest increase in PVR with no increase in EVLW. LTD4 and LTB4 were increased in BALF solely in those animals that developed increases in EVLW. These results, when viewed together with those reported in humans with ARDS and in dogs with ethchlorvynol-induced ALI, support the hypothesis that leukotriene detection in BALF is a feature common to ALI, etiology notwithstanding.
Animals↗
Comparative clinical study of two hypnotic drugs.
The comparative sleep-inducing and sleep-sustaining effects of glutethimide, 0.5 g., and ethchlorvynol, 0.5 g., were studied in 20 patients hospitalized for a considerable time (average: 21 years; minimum nine years and maximum 32 years) and not receiving psychotropic agents. Assessment of sleep and para-sleep parameters (pre-sleep tension; frequency of awakening at night; post-sleep activity) revealed that patients fell asleep faster (P>.001) and slept for a longer time with ethchlorvynol than with glutethimide.
Ethchlorvynol↗
Lipid solubility is correlated with hypnotic and hypothermic responses of long-sleep (LS) and short-sleep (SS) mice to various depressant drugs.
The long-sleep (LS) and short-sleep (SS) lines of mice have been selected for a difference in duration of ethanol-induced sleep time. In our previous study, recent generations of the two lines were found to exhibit differential hypnotic and hypothermic responses to pentobarbital which appear to be explained by differences in elimination. Casual observation that the LS mice were fatter than the SS suggested that this discrepancy may influence the responses of these animals to sedative-hypnotic drugs which differ in lipid solubility. The present study was designed to determine whether the LS and SS mice differ in hypnotic and hypothermic responses to two barbiturates which differ in lipid solubility; to the highly lipid soluble tertiary alcohol, ethchlorvynol; and to the water soluble depressant, methyprylon. Mice of the SS line were more responsive to the lipid soluble depressants than were LS mice, and increasing the lipid solubility of the barbiturates resulted in a greater difference between the lines. LS mice were more responsive to the water soluble depressant, apparently due to differential central nervous system sensitivity rather than to differences in elimination. The whole-body lipid content of the LS mice is double that of the SS mice. The influence of body lipid content on drug disposition may accentuate the elimination differences that result in the lesser responsivity of LS mice to barbiturates and possibly ethchlorvynol. This study indicates that sedative-hypnotic drugs of varying lipid solubilities may not share common mechanisms of action.
Animals↗
Effects of some volatile sedative-hypnotics on punished behavior.
Lever-press responses of rats were established under a schedule in which punished and unpunished responding alternated. Every 30th response produced food (unpunished responding) during an alternate schedule component, while every tenth response produced both food and shock (punished responding) during an alternate schedule component. Each schedule component was correlated with a different visual stimulus. Unpunished behavior was characterized by high sustained rates which followed brief pauses after food delivery. Punished behavior occurred at less than 10% the rate of unpunished behavior. Oral administration of diazepam, ethchlorvynol, chloral hydrate, tertiary-butanol, and ethanol all produced marked dose-related increases in punished behavior at doses that decreased or had little effect on unpunished responding. Potency estimates for increasing punished responding varied over a 400-fold range. The potency ranking was diazepam greater than ethchlorvynol greater than chloral hydrate greater than tertiary-butanol greater than ethanol. Higher doses of all drugs decreased unpunished responding with relative potencies comparable to those found for doses producing maximal increases in punished responding. Increases in punished behavior appear to be a characteristic feature of drugs with sedative-hypnotic properties.
Animals↗
Rapid method for screening toxic drugs in serum with liquid chromatography.
We present a method for the simultaneous analysis of a variety of commonly abused drugs (acetaminophen, theophylline, salicylate, primidone, methyprylon, phenobarbital, butabarbital, ethchlorvynol, butalbital, chlordiazepoxide, pentobarbital, amobarbital, phenytoin, glutethimide, secobarbital, flurazepam, nitrazepam, methaqualone, N-desmethyldiazepam, and diazepam) in serum or plasma. Serum proteins are precipitated with an acetonitrile solution containing hexobarbital, the internal standard. The drugs are eluted from a reversed-phase column with a mobile phase consisting of acetonitrile/phosphate buffer (pH 3.2), using a two-step linear gradient, at a flow rate of 3.0 mL/min. The eluted drugs are detected by their absorption at 210 nm; their quantities are estimated from their peak heights. A complete analysis requires no longer than 45 minutes at the optimum column temperature of 50 degree C. A sensitivity of 2 mg/L of serum is attained routinely for most of the hypnotic and analgesic drugs; while methaqualone, chlordiazepoxide, diazepam, and N-desmethyldiazepam can be detected at a concentration of 0.2 mg/L. Analytical recoveries for the twenty drugs varied from 93-112%, with good reproducibility. Of more than forty drugs tested for possible interference, desmethyldoxepin, procainamide, phenylpropanolamine, mesantoin, and phenacetin interfere with the analysis of flurazepam, acetaminophen, ethchlorvynol, and phenobarbital, respectively.
Chromatography, Liquid↗
Experimental drug intoxication: treatment with charcoal haemoperfusion.
Dogs were given large doses of barbiturates, glutethimide, ethanol, methaqualone, ethchlorvynol, meprobamate, chloral hydrate, paracetamol and aspirin. These were treated by haemoperfusion using a column packed with charcoal coated with an acrylic hydrogel. Clearances for most drugs were significantly higher than those reported for haemodialysis. Minimal clearances of common biochemical entities were observed and although leucocyte and platelet counts were diminished, no deleterious effects attributable to this were encountered. Careful histological examination of tissues derived from perfused dogs revealed no evidence of charcoal emboli.
Acetaminophen↗
Titrimetric determination of acetylenic hyponotics using organic brominating agents.
A titrimetric method is described for the determination of three acetylenic hypnotics, namely ethchlorvynol, ethinamate, and methylpentynol carbamate, in bulk and in dosage forms. The method involves the use of either 1,3-dibromo-5,5-dimethylhydantoin (DBH), N-bromosuccinimide (NBS) or N-bromophthalimide (NBP) as titrants. A known excess volume of the reagent is added and, after the specified time, the residual reagent is determined iodometrically. This procedure permits semimicro determination (1-15 mg) of the drug. The procedure has been successfully applied to pharmaceutical dosage forms; the results agree well with those given by compendial methods. The stoichiometry of the reaction has been assessed and an explanation of the reaction pathway is presented.
Bromosuccinimide↗
Resin hemoperfusion in ethychlorvynol overdose.
An 18-yr-old male with a severe ethchlorvynol (ECV) overdose was treated with Amberlite XAD-4 resin hemoperfusion. Plasma ECV concentration declined 33% during a 3.5-hr hemoperfusion, but rebounded substantially, peaking 6 hr later. It was estimated that 16% of ECV in the body was removed. Following hemoperfusion, plasma ECV concentrations declined linearly at a rate of 13 mg/1/day. Hemoperfusion clearance was estimated by both the traditional method, using extraction ratios across the column and column blood flow (Cl = 270 ml/min), and an alternative method, using blood concentrations during hemoperfusion and recovery of drug from the resin (Cl = 184 ml/min). The latter may provide a better estimate of hemoperfusion clearance because it is not subject to error (which can be substantial) in measurement of column blood flow. The resin completely extracted ECV from plasma, resulting in a rate of elimination 10 times that expected from endogenous processes. To aid in kinetic analysis, blood:plasma partition and protein binding of ECV in 3 normal subjects were also examined. Blood:plasma ratio averaged 0.88 +/- 0.04 and fraction free in plasma, 0.38 +/- 0.02; neither changed as a function of blood concentration between 27 and 108 mg/1. Our data indicate that removal of ECV from the overdosed patient by hemoperfusion is limited by extensive distribution in and slow redistribution from body tissues, but because of the extremely slow rate of removal by the body and the severe nature of the ECV overdose, Amberlite XAD-4 hemoperfusion may be clinically useful.
Adolescent↗
Placidyl abuse: a dimorphic picture.
Eleven patients with documented intoxication with ethchlorvynol were evaluated for clinical and laboratory manifestations. All of the 7 patients who ingested the drug were severity neurologically depressed; 3 were hemodynamically unstable and 1 developed pulmonary edema documented to be noncardiogenic 40 h after admission. All of the remaining patients (including 1 who also ingested a small amount) presented with pulmonary edema in the absence of neurological changes, soon after injection of 2--3 capsules iv; hemodynamic measurements in one of these demonstrated a noncardiogenic etiology. The clinical manifestations in these 2 groups of patients seem to be clearly separable, depending on the dose and route of administration.
Adult↗
Reduced venous admixture in hemorrhagic hypovolemia: maintenance of arterial oxygenation by selective pulmonary vascular collapse.
In nine anesthetized and ventilated swine, a microcomputer calculated cardiac output, venous admixture (Qsp/Qt) and physiologic deadspace (VD/VT) every 20 sec, utilizing dual oximetry and a gas exchange analyzer. After lung injury with ethchlorvynol (ECV), animals were bled 40% blood volume over 40 min. Mean cardiac output decreased 7.0 to 2.2 L/min (p less than .05) accompanied by a decrease in mean Qsp/Qt from 0.28 to 0.14 (p less than .05) and an increase in mean VD/VT from 0.39 to 0.54 (p less than .05). Arterial Hgb saturation (Sao2) increased from 88 +/- 7% to 90 +/- 6%. On regression of all data points for each variable, Qsp/Qt had a positive correlation with cardiac output (r = .90), mean arterial pressure (MAP, r = .87), mean pulmonary artery pressure (MPAP, r = .86), and mixed venous Hgb saturation (Svo2, r = .89, p less than .001). VD/VT had an inverse correlation with cardiac output (r = -.90), MAP (r = -.82), Qsp/Qt (r = -.83), MPAP (r = -.77), and Svo2 (r = -.92, p less than .001). The decreasing Qsp/Qt and increasing VD/VT, with decreasing pulmonary perfusion pressures, were attributed to selective loss of perfusion to alveoli with low ventilation/perfusion ratios.
Animals↗
Experience with cellulose acetate-coated activated charcoal haemoperfusion in the treatment of severe hypnotic drug intoxication.
A haemoperfusion column containing activated charcoal coated with cellulose acetate was used to treat 7 patients with barbiturate or ethchlorvynol poisoning. Six of the patients showed marked lightening of coma and all showed a significant fall in plasma drug concentration. Plasma drug clearance and platelet loss were similar to those reported for other coated charcoal columns. Cellulose acetate-coated charcoal haemoperfusion may reduce the period of coma in severe poisoning with barbiturates and other hypnotic drugs and thus the morbidity and mortality.
Adult↗