Barbiturate withdrawal

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Background

  • Presentation similar to alcohol withdrawal
  • Tolerance and dependence on barbiturates develops rapidly

Clinical Features

  • Onset of minor symptoms within 24h of abrupt cessation
  • Major, life-threatening symptoms occur ~2-8 days after stopping drug
  • Symptoms more severe with higher dose, longer duration of use, and use of short-acting barbiturates
  • Autonomic hyperactivity (e.g., diaphoresis, HR>100, hyperthermia)
  • Nausea/vomiting, abdominal cramping
  • Tremulousness, psychomotor agitation, muscle twitching
  • Anxiety, insomnia, irritability agitation
  • Psychosis (more common than in ETOH withdrawal)
  • Seizure

Differential Diagnosis

Sedative/hypnotic withdrawal

Seizure

Altered mental status

Diffuse brain dysfunction

Primary CNS disease or trauma

Psychiatric

Evaluation

Management

  • Ensure patient and staff safety, airway protection if acutely agitated or seizing
  • Seizures can be treated with benzodiazepines, but management with barbiturates (e.g. phenobarbital) generally more effective
  • Generally need gradual detox as inpatient

Disposition

  • Admit for gradual detoxification

See Also

External Links

References

Authors:

Claire