| Barbiturate overdose | |
|---|---|
| Other names | Barbiturate poisoning, barbiturate toxicity |
 | |
| Molecular diagram ofphenobarbital | |
| Specialty | Emergency medicine |
| Symptoms | Decreased breathing, decreasedlevel 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 ispoisoning due to excessive doses ofbarbiturates.[8] Symptoms typically include difficulty thinking, poor coordination, decreasedlevel of consciousness, and a decreased effort to breathe (respiratory depression).[1] Complications ofoverdose can includenoncardiogenic 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 anattempt to cause death.[3] The toxic effects are additive to those ofalcohol andbenzodiazepines.[3] The lethal dose varies with a person'stolerance and how the drug is taken.[3] The effects of barbiturates occur via theGABA 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]
Barbiturates increase the time that thechloride pore of theGABAA 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 involves supporting a person's breathing andblood pressure.[2][5] While there is noantidote,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.
People who are known to have died by suicide from barbiturate overdose includeStefan 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 theHeaven's Gate cult. Others who have died as a result of accidental barbiturate overdose includePier Angeli,Brian Epstein,Judy Garland,Jimi Hendrix,Inger Stevens,Dinah Washington,Ellen Wilkinson, andAlan Wilson; in some cases these have been speculated to be suicides as well. Those who died of a combination of barbiturates and other drugs includeRainer Werner Fassbinder,Dorothy Kilgallen,Malcolm Lowry,Edie Sedgwick andKenneth Williams.Dorothy Dandridge died of either an overdose or an unrelatedembolism.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.
Thedifferential diagnosis should include intoxication by other substances withsedative effects, such as benzodiazepines,anticonvulsants (carbamazepine), alcohols (ethanol,ethylene glycol,methanol),opioids,carbon monoxide, sleep aids, andgamma-Hydroxybutyric acid (GHB). Natural disease that can result in disorientation may be in the differential, includinghypoglycemia andmyxedema coma. In the right setting,hypothermia should be ruled out.[18]
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.
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
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