Decreased breathing, decreased level of consciousness[1]
Complications
Noncardiogenic pulmonary edema[2]
Duration
6-12 hours[2]
Causes
Accidental, suicide[3]
Diagnostic method
Blood or urine tests[4]
Treatment
Breathing support, activated charcoal[5][6]
Frequency
Uncommon[7]
Barbiturate overdose is poisoning due to excessive doses of barbiturates.[8] Symptoms typically include difficulty thinking, poor coordination, decreased level of consciousness, and a decreased effort to breathe (respiratory depression).[1] Complications of overdose can include noncardiogenic pulmonary edema.[2] If death occurs this is typically due to a lack of breathing.[3]
Barbiturate overdose may occur by accident or purposefully in an attempt to cause death.[3] The toxic effects are additive to those of alcohol and benzodiazepines.[3] The lethal dose varies with a person's tolerance and how the drug is taken.[3] The effects of barbiturates occur via the GABA neurotransmitter.[2] Exposure may be verified by testing the urine or blood.[4]
Treatment involves supporting a person's breathing and blood pressure.[2][5] While there is no antidote, activated charcoal may be useful.[5][6] Multiple doses of charcoal may be required.[7] Hemodialysis may occasionally be considered.[6] Urine alkalinisation has not been found to be useful.[6] While once a common cause of overdose, barbiturates are now a rare cause.[7]
Contents
1Mechanism
2Treatment
3Notable cases
4See also
5References
6External links
Mechanism
Barbiturates increase the time that the chloride pore of the GABAA receptor is opened, thereby increasing the efficacy of GABA. In contrast, benzodiazepines increase the frequency with which the chloride pore is opened, thereby increasing GABA's potency.[9]
Treatment
The treatment of barbiturate abuse or overdose is generally supportive. The amount of support required depends on the person's symptoms. If the person is drowsy but awake and can swallow and breathe without difficulty, the treatment can be as simple as monitoring the person closely. If the person is not breathing, it may involve mechanical ventilation until the drug has worn off.
Supportive treatment often includes the following:
Activated charcoal may be given via nasogastric tube.
Intravenous administration of saline, naloxone, thiamine, and/or glucose.
Intubation and bemegride, or a hand-breather where these are not available until the person can breathe under their own power.
Observation in the Emergency Department for a number of hours or admission to the hospital for several days of observation if symptoms are severe.
Advise the person about drug misuse or refer for psychiatric consult.
Notable cases
In famous cases, Marilyn Monroe, Dalida,[10][11] Judy Garland, Chester Morris, George Sanders, Pier Angeli, Jimi Hendrix, Scott Newman, Brian Epstein, Alan Wilson, Scotty Beckett, Helen Palmer, Edie Sedgwick, Dominick Elwes, Dinah Washington, Leila Pahlavi, and Carole Landis died from a barbiturate overdose.
See also
Bemegride, an analeptic used to treat acute barbiturate overdose
References
^ abWeaver, MF (3 September 2015). "Prescription Sedative Misuse and Abuse". The Yale Journal of Biology and Medicine. 88 (3): 247–56. PMC 4553644. PMID 26339207.
^ abcdeMarx, John A. Marx (2014). "165". Rosen's emergency medicine : concepts and clinical practice (8th ed.). Philadelphia, PA: Elsevier/Saunders. pp. Sedative Hypnotics. ISBN 978-1455706051.
^ abcdeSadock, Benjamin J.; Sadock, Virginia A. (2008). Kaplan & Sadock's Concise Textbook of Clinical Psychiatry. Lippincott Williams & Wilkins. p. 149. ISBN 9780781787468. Archived from the original on 2016-11-04.
^ abBaren, Jill M. (2008). Pediatric Emergency Medicine. Elsevier Health Sciences. p. 955. ISBN 978-1416000877. Archived from the original on 2016-11-04.
^ abcCarroll, Robert G. (2010). Problem-based Physiology. Elsevier Health Sciences. p. 99. ISBN 978-1416042174. Archived from the original on 2016-11-04.
^ abcdRoberts, DM; Buckley, NA (January 2011). "Enhanced elimination in acute barbiturate poisoning - a systematic review". Clinical Toxicology. 49 (1): 2–12. doi:10.3109/15563650.2010.550582. PMID 21288146.
^ abcMüller, D; Desel, H (October 2013). "Common causes of poisoning: etiology, diagnosis and treatment". Deutsches Arzteblatt International. 110 (41): 690–9, quiz 700. doi:10.3238/arztebl.2013.0690. PMC 3813891. PMID 24194796.
^Publishing, Bloomsbury (2009). Dictionary of Medical Terms. Bloomsbury Publishing. p. 37. ISBN 9781408102091. Archived from the original on 2016-11-04.
^Lafferty, KA; Bonhomme, K; Kopinski, P; Lee, DC; Abdel-Kariem, R (14 January 2017). Tarabar, A; VanDeVoort, JT; Burns, MJ (eds.). "Barbiturate Toxicity: Pathophysiology". eMedicine. New York, USA: WebMD. Archived from the original on 26 August 2017. Retrieved 26 August 2017.
^"Dalida". New York Times. 5 May 1987. Archived from the original on 26 May 2012. Retrieved 28 February 2008.
^Simmonds, Jeremy (2008). v. Chicago Review Press. p. 225. ISBN 978-1-55652-754-8. Archived from the original on 2016-05-18.
… Thiopental (Pentothal) and methohexital (Brevital) are barbiturates that are occasionally used to sedate critically ill patients. Barbiturates produce sedation by binding to the gamma aminobutyric acid …
…opioids, the United States DOD DOA screen includes: Four most commonly used barbiturates (amobarbital, pentobarbital, phenobarbital, secobarbital) Benzodiazepines; Certain amphetamine derivatives: Methamphetamine …
…ferase (UGT)-glucuronidation The oral dose of phenobarbital is 1 to 5 mg/kg per day; it may also be administered intravenously (IV). Serum phenobarbital concentrations should be checked three to four …
…psychosis is not recommended . Barbiturates have similarly been used to treat insomnia. However, all have potentially significant adverse effects. Routine use of barbiturates to treat insomnia is not recommended …
…depression and oversedation. Barbiturates, such as pentobarbital and phenobarbital, can also be used. Propofol has been used successfully in cases of refractory withdrawal. Barbiturates and propofol pose a greater …
English Journal
Case 13-2019: A 54-Year-Old Man with Alcohol Withdrawal and Altered Mental Status.
Fenves AZ, Mojtahed A, Nisavic M, Massoth LR.
The New England journal of medicine. 2019 Apr;380(17)1657-1665.
Suicide by Fatal Pentobarbital Intoxication in Ontario, Canada, from 2012 to 2015.
Solbeck P, Snowdon V, Rajagopalan A, Jhirad R.
Journal of forensic sciences. 2019 Jan;64(1)309-313.
A fatal concentration of pentobarbital found in a coroner's case where the history had not indicated use of this drug prompted a review of fatalities in Ontario from 2012 to 2015. Coroner's case files, including police and toxicology reports, were reviewed in twenty deaths, in which pentobarbital wa
Deliberate Self-poisoning with a Lethal Dose of Pentobarbital with Confirmatory Serum Drug Concentrations: Survival After Cardiac Arrest with Supportive Care.
Druda DF, Gone S, Graudins A.
Journal of medical toxicology : official journal of the American College of Medical Toxicology. 2019 Jan;15(1)45-48.
Pentobarbital (PB) is a euthanasia drug in doses of 2 to 10 grams, causing death within 15-30 minutes. We report a case of recovery from lethal pentobarbital deliberate self-poisoning with confirmatory serum drug concentrations. A 45-year-old male purchased 20 grams of PB powder over the Internet
… With the revision of the medical treatment fees in FY2014, facilities that can be calculated in those case that could identify the drugs responsible for acute drug poisoning of a patient by instrumental analysis, including HPLC analysis, were expanded from only advanced emergency medical care centers (30 facilities nationwide) to emergency medical care centers (263 facilities nationwide). …
Method for Screening and Quantitative Determination of Serum Levels of Salicylic Acid, Acetaminophen, Theophylline, Phenobarbital, Bromvalerylurea, Pentobarbital, and Amobarbital Using Liquid Chromatography/Electrospray Mass Spectrometry
Hori Yasushi,Fujisawa Manami,Shimada Kenji [他],HIROSE Yasuo,YOSHIOKA Toshiharu
… We investigated a method for the simultaneous screening, identification, and quantitative determination of salicylic acid, acetaminophen, theophylline, barbiturates, and bromvalerylurea, drugs that frequently cause acute poisoning in Japan and therefore require rapid analysis for effective treatment in the clinical setting. …
… Head injuries, alcoholism, cerebral vascular accidents and barbituratepoisoning may be complicated within a few days by a severe pulmonary infection apparently caused by organisms aspirated from the nose, throat and mouth.<br>The present investigation was conducted to clarify the pathophysiology of aspiration pneumonia in anesthetized mongrel dogs. …
TREATMENT OF BARBITURATE POISONING 535 thol anaesthesia and the effects of a new convul-sant drug, picrotoxin, were described by Maloney and others (1931). In 1936 Grabfield recommended nikethamide and especially ...
Barbiturates are drugs that cause relaxation and sleepiness. A barbiturate overdose occurs when someone takes more than the normal or recommended amount of this medicine. This can be by accident or on
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