Barbiturate toxicity

Background

• Death most commonly due to respiratory arrest and CV collapse
• Assume severe poisoning if >10x hypnotic dose has been ingested

Clinical Features

1. Mild-moderate toxicity
   1. Resembles ETOH intoxication
2. Severe toxicity
   1. Respiratory depression
   2. Hypothermia
   3. Hypotension (decreased vascular tone)
   4. Coma, absence of corneal reflex

Treatment

1. Airway assessment and stabilization
   1. Mechanical ventilation often required
2. Hypotension
   1. IVF
   2. Dopamime or norepi
3. Hypothermia
   1. Rewarming measures
4. GI Decontamination
   1. Activated charcoal x1 if present w/in 1hr of ingestion
   2. Multi-dose activated charcoal
      1. Consider only if pt has ingested life-threatening amount of phenobarbital
      2. Give 50-100gm PO initially; follow by 12.5-25gm PO q4hr
5. Urinary alkalinization
   1. Less effective than multi-dose activated charcoal
6. Dialysis
   1. Only effective for phenobarbital (long-acting barb)
   2. Reserved for pts who are deteriorating despite aggressive supportive care

Disposition

1. Consider discharge if improvement in neuro status / VS over 6-8hr
2. Evidence of toxicity after 6hr requires admission

Source

• Tintinalli