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HelpTest Code PENTS Pentobarbital, Serum
Reporting Name
Pentobarbital, SUseful For
Monitoring of pentobarbital therapy treatment
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
Serum RedSpecimen Required
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube: Red top (Serum gel/SST are not acceptable)
Submission Container/Tube: Plastic vial
Specimen Volume: 2 mL
Collection Instructions:
1. Draw blood immediately before next scheduled dose.
2. Centrifuge and aliquot serum in plastic vial within 2 hours of collection.
Specimen Minimum Volume
0.7 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum Red | Refrigerated (preferred) | 14 days | |
| Ambient | 14 days | ||
| Frozen | 14 days |
Reference Values
Therapeutic range
Hypnotic: 1-5 mcg/mL
Therapeutic coma: 20-50 mcg/mL
Reducing intracranial pressure: 30-40 mcg/mL
This degree of sedation requires artificial respiratory support.
Toxic concentration: >10 mcg/mL
Day(s) Performed
Thursday
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
80299
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| PENTS | Pentobarbital, S | 3924-8 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 8239 | Pentobarbital, S | 3924-8 |
Clinical Information
Pentobarbital is a short-acting barbiturate with anticonvulsant and sedative-hypnotic properties. Uses include sedation induction, relief of preoperative anxiety, control of status epilepticus or seizures resulting from meningitis, tetanus, alcohol withdrawal, poisons, chorea, or eclampsia, and induction of coma in the management of cerebral ischemia and increased intracranial pressure that may follow stroke or head trauma.(1,2)
Pentobarbital is administered orally, parenterally, and rectally. The duration of hypnotic effect is about 1 to 4 hours. The drug distributes throughout the body with about 35% to 45% of a dose bound to plasma proteins in the blood. Metabolism takes place in the liver via oxidation to the inactive metabolite, hydroxypentobarbital. Elimination is biphasic; half-life is about 4 hours in the first phase, and 35 to 50 hours in the second phase. Excretion occurs through the urine, mainly as glucuronide conjugates of metabolites, with only about 1% excreted as unchanged drug.(1,2) Tolerance to the hypnotic effects of pentobarbital occurs after about 2 weeks of continuous dosing.
Interpretation
Pentobarbital concentrations above 10 mcg/mL have been associated with toxicity.
Clinical Reference
1. NEMBUTAL Sodium Solution (pentobarbital sodium injection). Package insert: Ovation Pharmaceuticals Inc; October 2007
2. Langman LJ, Bechtel LK, Holstege CP. Clinical toxicology. In: Rifai N, Chiu RWK, Young I, Burnham C-AD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:454-454.e484
3. Baselt RC. Disposition of toxic drugs and chemical in man. 12th ed. Biomedical Publications; 2020
4. Milone MC, Shaw LM. Therapeutic drugs and their management. In: Rifai N, Chiu RWK, Young I, Burnham C-AD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:420-453
5. Mihic SJ, Mayfield J. Hypnotics and sedatives. In: Brunton LL, Knollmann BC, eds. Goodman and Gilman's: The Pharmacological Basis of Therapeutics. 14th ed. McGraw-Hill Education; 2023
Method Description
Barbiturates are extracted from serum using solid-phase extraction techniques. The serum is buffered and eluted with organic solvent. The organic phase is dried, reconstituted, and analysis performed by gas chromatography-mass spectrometry using selected ion monitoring. The assay utilizes deuterated barbiturates as internal standards.(Unpublished Mayo method)
Report Available
3 to 9 daysSpecimen Retention Time
14 daysReject Due To
| Gross hemolysis | Reject |
| Gross lipemia | OK |
| Gross icterus | OK |
Method Name
Gas Chromatography Mass Spectrometry (GC-MS)
Cautions
The concentration at which toxicity occurs varies and results should be interpreted in light of clinical situation.
Specimens collected in serum gel tubes are not acceptable because the drug can absorb on the gel and lead to falsely decreased concentrations.
Forms
If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.