Barbiturate overdose

Short description: Medical condition

"Barbiturate poisoning" and "Barbiturate toxicity" redirect here. For other uses, see barbiturate.

Barbiturate overdose

Other names| Barbiturate poisoning, barbiturate toxicity
Molecular diagram of phenobarbital
Specialty| Emergency medicine
Symptoms| 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| medical 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, it 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]

While once a common cause of overdose, barbiturates are now a rare cause.[7]

## Contents

* 1 Mechanism
* 2 Treatment
* 3 Notable cases
* 4 Differential diagnosis
* 5 References
* 6 External 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

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] Urinary alkalinization with sodium bicarbonate may be useful for barbiturate poisoning, targeting a urinary pH greater than 7.5 and ensuring urine output surpasses 2 mL/kg/min.[10]

If a 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. Psychiatric consult is generally recommended.

## Notable cases

People who are known to have died by suicide from barbiturate overdose include Stefan Zweig,[11][12] Gillian Bennett,[13] Charles Boyer, Ruan Lingyu, Victor Folke Nelson,[14][15] Dalida,[16][17] Jeannine "The Singing Nun" Deckers, Felix Hausdorff, Abbie Hoffman, Phyllis Hyman, Marilyn Monroe, Cesare Pavese, C. P. Ramanujam, George Sanders, Carole Landis, Jean Seberg, Lupe Vélez and the members of the Heaven's Gate cult. Others who have died as a result of accidental barbiturate overdose include Pier Angeli, Brian Epstein, Judy Garland, Jimi Hendrix, Inger Stevens, Dinah Washington, Ellen Wilkinson, and Alan Wilson; in some cases these have been speculated to be suicides as well. Those who died of a combination of barbiturates and other drugs include Rainer Werner Fassbinder, Dorothy Kilgallen, Malcolm Lowry, Edie Sedgwick and Kenneth Williams. Dorothy Dandridge died of either an overdose or an unrelated embolism. Ingeborg Bachmann may have died of the consequences of barbiturate withdrawal (she was hospitalized with burns, the doctors treating her not being aware of her barbiturate addiction). Maurice Chevalier attempted suicide in March 1971 by swallowing a large amount of barbiturates and slitting his wrists. While he lived, he suffered severe organ damage as a result and died from multiple organ failure nine months later.

## Differential diagnosis

The differential diagnosis should include intoxication by other substances with sedative effects, such as benzodiazepines, anticonvulsants (carbamazepine), alcohols (ethanol, ethylene glycol, methanol), opioids, carbon monoxide, sleep aids, and gamma-Hydroxybutyric acid (GHB). Natural disease that can result in disorientation may be in the differential, including hypoglycemia and myxedema coma. In the right setting, hypothermia should be ruled out.[18]

## References

1. ↑ 1.0 1.1 Weaver, MF (3 September 2015). "Prescription Sedative Misuse and Abuse.". The Yale Journal of Biology and Medicine 88 (3): 247–56. PMID 26339207.
2. ↑ 2.0 2.1 2.2 2.3 2.4 Marx, 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.
3. ↑ 3.0 3.1 3.2 3.3 3.4 Sadock, Benjamin J.; Sadock, Virginia A. (2008) (in en). Kaplan & Sadock's Concise Textbook of Clinical Psychiatry. Lippincott Williams & Wilkins. p. 149. ISBN 9780781787468. https://books.google.com/books?id=ubG51n2NgfwC&pg=PA149.
4. ↑ 4.0 4.1 Baren, Jill M. (2008) (in en). Pediatric Emergency Medicine. Elsevier Health Sciences. p. 955. ISBN 978-1416000877. https://books.google.com/books?id=wpvux6RS-jsC&pg=PA955.
5. ↑ 5.0 5.1 5.2 Carroll, Robert G. (2010) (in en). Problem-based Physiology. Elsevier Health Sciences. p. 99. ISBN 978-1416042174. https://books.google.com/books?id=cXDO8XRrph0C&pg=PA99.
6. ↑ 6.0 6.1 6.2 Roberts, 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.
7. ↑ 7.0 7.1 7.2 Müller, D; Desel, H (October 2013). "Common causes of poisoning: etiology, diagnosis and treatment.". Deutsches Ärzteblatt International 110 (41): 690–9; quiz 700. doi:10.3238/arztebl.2013.0690. PMID 24194796.
8. ↑ (in en) Dictionary of Medical Terms. Bloomsbury Publishing. 2009. p. 37. ISBN 9781408102091. https://books.google.com/books?id=yAZCBAAAQBAJ&pg=PA37.
9. ↑ Lafferty, KA; Bonhomme, K; Kopinski, P; Lee, DC; Abdel-Kariem, R (14 January 2017). Barbiturate Toxicity: Pathophysiology. New York, USA: WebMD. http://emedicine.medscape.com/article/813155-overview#a5. Retrieved 26 August 2017.
10. ↑ Singh, Omender; Juneja, Deven (2019). Principles and Practice of Critical Care Toxicology. Jaypee Brothers Medical Publishers Pvt. Limited. ISBN 978-93-5270-674-7. https://books.google.com/books?id=m3KSDwAAQBAJ&pg=PA79. "For barbiturate overdose, urinary alkalinization with sodium bicarbonate may be beneficial. The optimum urinary pH which needs to be achieved is >7.5 and urine output should be more than 2 mL/kg/min."
11. ↑ ""Stefan Zweig, Wife End Lives In Brazil"". New York Times. February 23, 1942. https://www.nytimes.com/1942/02/24/archives/stefan-zweig-wife-end-lives-in-brazil-austrianborn-author-left-a.html. "Stefan Zweig, Wife End Lives In Brazil; Austrian-Born Author Left a Note Saying He Lacked the Strength to Go on – Author and Wife Die in Compact: Zweig and Wife Commit Suicide"
12. ↑ "Died". Time. March 2, 1942. http://www.time.com/time/magazine/article/0,9171,773116,00.html. Retrieved June 30, 2010.
13. ↑ "DeadAtNoon". http://deadatnoon.com/.
14. ↑ City of Boston Registry, Certificate of Death record for Victor Folke Nelson, No. 10407, filed 14 December 1939.
15. ↑ "Dr. Brickley Says Nelson Took Poison." The Boston Globe. 11 December 1939.
16. ↑ "Dalida". New York Times. 5 May 1987. https://www.nytimes.com/1987/05/05/obituaries/dalida.html.
17. ↑ Simmonds, Jeremy (2008). v. Chicago Review Press. p. 225. ISBN 978-1-55652-754-8. https://books.google.com/books?id=S3y7tocgPzgC.
18. ↑ Suddock, Jolee T.; Cain, Matthew D. (2020), "Barbiturate Toxicity", StatPearls (Treasure Island (FL): StatPearls Publishing), PMID 29763050, https://www.ncbi.nlm.nih.gov/books/NBK499875/, retrieved 5 August 2020

## External links

Classification|

* ICD-10: F13.0, T42.3
* ICD-9-CM: 969

|

External resources|

* eMedicine: article/813155

* v
* t
* e

Psychoactive substance-related disorder (F10–F19, 291–292; 303–305)

General|

* SID
* Substance intoxication / Drug overdose
* Substance-induced psychosis
* Withdrawal:
* Craving
* Neonatal withdrawal
* Post-acute-withdrawal syndrome (PAWS)
* SUD
* Substance abuse / Substance-related disorders
* Physical dependence / Psychological dependence / Substance dependence

Combined
substance use|

* SUD
* Polysubstance dependence
* SID
* Combined drug intoxication (CDI)

Alcohol|

| SID|

| Cardiovascular diseases|

* Alcoholic cardiomyopathy
* Alcohol flush reaction

|

Gastrointestinal diseases|

* Alcoholic liver disease (ALD):
* Alcoholic hepatitis
* Auto-brewery syndrome

Endocrine diseases|

* Alcoholic ketoacidosis (AKA)

Nervous
system diseases|

* Alcohol-related dementia (ARD)
* Alcohol intoxication
* Hangover

Neurological
disorders|

* Alcoholic hallucinosis
* Alcoholic polyneuropathy
* Alcohol-related brain damage
* Alcohol withdrawal syndrome:
* Alcoholic hallucinosis
* Delirium tremens (DTs)
* Fetal alcohol spectrum disorder (FASD)
* Fetal alcohol syndrome (FAS)
* Korsakoff syndrome
* Korsakoff psychosis
* Positional alcohol nystagmus (PAN)
* Wernicke–Korsakoff syndrome (WKS)
* Wernicke encephalopathy (WE)

Respiratory tract diseases|

* Alcohol-induced respiratory reactions
* Alcoholic lung disease

SUD|

* Alcoholism (alcohol use disorder (AUD))
* Binge drinking

Caffeine|

* SID
* Caffeine-induced anxiety disorder
* Caffeine-induced sleep disorder
* Caffeinism
* SUD
* Caffeine dependence

Cannabis|

* SID
* Cannabinoid hyperemesis syndrome (CHS)
* SUD
* Amotivational syndrome
* Cannabis use disorder (CUD)
* Synthetic cannabinoid use disorder

Cocaine|

* SID
* Cocaine intoxication
* Prenatal cocaine exposure (PCE)
* SUD
* Cocaine dependence

Hallucinogen|

* SID
* Acute intoxication from hallucinogens (bad trip)
* Hallucinogen persisting perception disorder (HPPD)

Nicotine|

* SID
* Nicotine poisoning
* Nicotine withdrawal
* SUD
* Nicotine dependence

Opioids|

* SID
* Opioid overdose
* SUD
* Opioid use disorder (OUD)

Sedative /
hypnotic|

* SID
* Kindling (sedative–hypnotic withdrawal)
* benzodiazepine: SID
* Benzodiazepine overdose
* Benzodiazepine withdrawal
* SUD
* Benzodiazepine use disorder (BUD)
* Benzodiazepine dependence
* barbiturate: SID
* Barbiturate overdose
* SUD
* Barbiturate dependence

Stimulants|

* SID
* Stimulant psychosis
* amphetamine: SUD
* Amphetamine dependence

Volatile
solvent|

* SID
* Sudden sniffing death syndrome (SSDS)
* Toluene toxicity
* SUD
* Inhalant abuse

* v
* t
* e

* Poisoning
* Toxicity
* Overdose (T36–T65, 960–989)

History of poison

Inorganic|

| Metals|

| Toxic metals|

* Beryllium
* Cadmium
* Lead
* Mercury
* Nickel
* Silver
* Thallium
* Tin

|

Dietary minerals|

* Chromium
* Cobalt
* Copper
* Iron
* Manganese
* Zinc

Metalloids|

* Arsenic

Nonmetals|

* Sulfuric acid
* Selenium
* Chlorine
* Fluoride

Organic|

| Phosphorus|

* Pesticides
* Aluminium phosphide
* Organophosphates

|

Nitrogen|

* Cyanide
* Nicotine
* Nitrogen dioxide poisoning

CHO|

* alcohol
* Ethanol
* Ethylene glycol
* Methanol
* Carbon monoxide
* Oxygen
* Toluene

Pharmaceutical|

| Drug overdoses|

| Nervous|

* Anticholinesterase
* Aspirin
* Barbiturates
* Benzodiazepines
* Cocaine
* Lithium
* Opioids
* Paracetamol
* Tricyclic antidepressants

|

Cardiovascular|

* Digoxin
* Dipyridamole

Vitamin poisoning|

* Vitamin A
* Vitamin D
* Vitamin E
* Megavitamin-B6 syndrome

Biological1|

| Fish / seafood|

* Ciguatera
* Haff disease
* Ichthyoallyeinotoxism
* Scombroid
* Shellfish poisoning
* Amnesic
* Diarrhetic
* Neurotoxic
* Paralytic

|

Other vertebrates|

* amphibian venom
* Batrachotoxin
* Bombesin
* Bufotenin
* Physalaemin
* birds / quail
* Coturnism
* snake venom
* Alpha-Bungarotoxin
* Ancrod
* Batroxobin

Arthropods|

* Arthropod bites and stings
* bee sting / bee venom
* Apamin
* Melittin
* scorpion venom
* Charybdotoxin
* spider venom
* Latrotoxin / Latrodectism
* Loxoscelism
* tick paralysis

Plants / fungi|

* Cinchonism
* Ergotism
* Lathyrism
* Locoism
* Mushrooms
* Strychnine

1 including venoms, toxins, foodborne illnesses.

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