<prompt> A 34-year-old man is brought to the emergency room by his family because of extreme lethargy. After further questioning, he admits to taking a large number of phenobarbital tablets. Which of the following is the most appropriate next step in management?acidification of urine to pH 3.0repetitive administration of activated charcoalipecac to induce vomitinghemoperfusion  <response>: Activated charcoal absorbs barbiturates very effectively and is useful in decontamination of the GI tract. Renal elimination of phenobarbital is enhanced by alkalinization of the urine to a pH of 8 with sodium bicarbonate and fluids. Hemodialysis and hemoperfusion are reserved for extreme cases with refracting hypotension. Short-acting barbiturates are metabolized in the liver, so fluid administration and alkalinization are not helpful. 