Barbiturate toxicity: Difference between revisions
| Line 17: | Line 17: | ||
#Hypotension | #Hypotension | ||
#*IVF | #*IVF | ||
#*Dopamime or | #*[[Dopamime]] or [[norepinepherine]] | ||
#Hypothermia | #Hypothermia | ||
#*Rewarming measures | #*Rewarming measures | ||
#GI Decontamination | #GI Decontamination | ||
#*Activated charcoal x1 if present w/in 1hr of ingestion | #*[[Activated charcoal]] x1 if present w/in 1hr of ingestion | ||
#*Multi-dose activated charcoal | #*[[Multi-dose activated charcoal]] | ||
#**Consider only if pt has ingested life-threatening amount of phenobarbital | #**Consider only if pt has ingested life-threatening amount of phenobarbital | ||
#**Give 50-100gm PO initially; follow by 12.5-25gm PO q4hr | #**Give 50-100gm PO initially; follow by 12.5-25gm PO q4hr | ||
#Urinary alkalinization | #[[Urinary alkalinization]] | ||
#*Less effective than multi-dose activated charcoal | #*Less effective than multi-dose activated charcoal | ||
#Dialysis | #Dialysis | ||
#*Only effective for phenobarbital (long-acting barb) | #*Only effective for phenobarbital (long-acting barb) | ||
#*Reserved for | #*Reserved for patients who are deteriorating despite aggressive supportive care | ||
==Disposition== | ==Disposition== | ||
Revision as of 18:58, 8 March 2015
Background
- Death most commonly due to respiratory arrest and CV collapse
- Assume severe poisoning if >10x hypnotic dose has been ingested
Clinical Features
- Mild-moderate toxicity
- Resembles ETOH intoxication
- Severe toxicity
- Respiratory depression
- Hypothermia
- Hypotension (decreased vascular tone)
- Coma, absence of corneal reflex
Treatment
- Airway assessment and stabilization
- Mechanical ventilation often required
- Hypotension
- IVF
- Dopamime or norepinepherine
- Hypothermia
- Rewarming measures
- GI Decontamination
- Activated charcoal x1 if present w/in 1hr of ingestion
- Multi-dose activated charcoal
- Consider only if pt has ingested life-threatening amount of phenobarbital
- Give 50-100gm PO initially; follow by 12.5-25gm PO q4hr
- Urinary alkalinization
- Less effective than multi-dose activated charcoal
- Dialysis
- Only effective for phenobarbital (long-acting barb)
- Reserved for patients who are deteriorating despite aggressive supportive care
Disposition
- Consider discharge if improvement in neuro status / VS over 6-8hr
- Evidence of toxicity after 6hr requires admission
See Also
Source
- Tintinalli