Supraventricular tachycardia in infants: Use of the diving reflex

seen when subcutaneous sutures were used despite the treatment group. The authors point out that this may reflect a more serious injury and a propensity for infection. The findings in this study are similar to those of previous studies, and the authors conclude that prophylactic oral antibiotics do not decrease the incidence of infection in patients with suture closure of simple lacerations. [Editor's n o t e : This is another in a series of studies that proves there is no efficacy for prophylactic antibiotics in the care of most lacerations. There is a paucity of hard data as to whether prophylactic antibiotics are of benefit in the groups excluded from this study. There is no substitute for meticulous cleansing and debridement.] W. Peter Vellman, MD

DIVING REFLEX, SUPRAVENTRICULAR TACHYCARDIA

dren. Due to the nature of battery contents, this does not necessarily represent a benign type of foreign body. One reason for this is liquefaction necrosis of tissues caused by alkali contained in the batteries, some of which contain a 40% to 45% solution of sodium hydroxide. Others contain up to 21 g mercuric oxide, a dose high enough to cause severe morbidity or death. In addition to morbidity from mercury poisoning and corrosive burns, tissue electrolysis can occur from the potential difference established in tissues between the two battery terminals. Leakage of toxic contents can occur from faulty battery seals or as a result of stomach acid corrosion. Thus actual rupture of the battery need not occur. The authors recommend an aggressive approach to removal of these batteries, including early endoscopy or surgery to prevent these complications. To improve home safety and to encourage early medical consultation, parental education about these dangers is also stressed. Ted W. Larremore, MD

Supraventricular tachycardia in infants: Use of the diving reflex

CHARCOAL, ACTIVATED, AND PHENOBARBITAL

Sperandeo V, Pieri D, Palazzolo P, et al Am J Cardiol 51:286-287 Jan 1983

Acceleration of the body clearance of phenobarbital by oral activated charcoal

The authors studied the effectiveness of the diving reflex in 10 infants with paroxysmal supraventricular tachycardias (PSVT). The patients ranged from 14 days to 5 months, and all patients had features of congestive heart failure at presentation. Ventricular rates varied from 270 to 320 beats/ min. Five patients had type A and one type B WolffParkinson White syndrome, two had normal electrocardiograms, and one had Lown-Ganong-Levine pattern. All patients failed to convert with conventional maneuvers, including carotid sinus massage, unilateral eyeball pressure and induction of vomiting. All patients converted immediately with the use of the diving reflex. The maneuver employed involved immersion of the infant's face in ice water at 4 to 5 C for 6 to 7 seconds while manually occluding the nostrils to prevent aspiration. All patients were subsequently placed on digitalis (digoxin 10 to 15 mg/kg/day orally) for prophylaxis. The authors suggest consideration of the diving reflex as a first therapeutic measure in infants under 6 months of age with PSVT. Pete Vellman, MD

BATTERY INGESTION; INGESTION, BATTERY

Hazards of battery ingestion Temple DM, McNeese MC Pediatrics 71:100-103 Jan 1983

In recent years, "button-size" batteries have been widely used in watches, cameras, hearing aids, and calculators. The potential thus exists for these items to be ingested by chil12:7 July 1983

Annals of

Berg MJ, Berlinger WG, Goldberg MJ, et al N Engl J Med 307:642-644 Sep 1982

The authors investigated the effect of multiple doses of activated charcoal on the pharmacokinetics of intravenously administered phenobarbital. Six healthy men were given 200 mg phenobarbital sodium per 70 kg of body weight intravenously on two separate occasions (one week apart) in a randomized crossover trial. Each subject received 180 g activated charcoal in eight divided doses over three days on one occasion and no charcoal on the other. Serum phenobarbital levels were measured at several intervals up to 90 hours after the infusion. Urinary excretion of phenobarbital was also measured in two individuals. The serum half-life of phenobarbital was reduced from 110 + 8 to 45 + 6 hours (P < .01) in the charcoal treated patients, and the total body clearance of phenobarbital was increased from 4.4 -+ 0.2 to 12.0 + 1.6 mL/kg/h (P < .01). The nonrenal clearance was increased from 52% to 80% of the total body clearance based on urinary excretion measurements. The authors postulate that phenobarbital is absorbed to the activated charcoal from gastrointestinal fluids, setting up a concentration gradient between the blood and the fluids in the bowel. Phenobarbital diffuses from the blood into the fluids and is subsequently absorbed by the charcoal, thereby enhancing the nomenal excretion of the drug./Editor's note: Pulse charcoal administration has proven to be efficacious for phenobarbital overdose. It m a y be as effective in enhancing the clearance of other drugs that have no enterohepatic circulation. It is certainly a benign (yet aesthetically unpleasing) procedure which m a y be recommended therapy for m a n y overdoses in the future.] James Berner, MD

EmergencyMedicine

460/83