Barbiturate overdose

Barbiturates increase the time that the chloride pore of the GABA_A 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.{{cite journal|title=Barbiturate Toxicity: Pathophysiology|date=14 January 2017|access-date=26 August 2017|publisher=WebMD|website=eMedicine|editor1=Tarabar, A |editor2=VanDeVoort, JT |editor3=Burns, MJ |author1=Lafferty, KA |author2=Bonhomme, K |author3=Kopinski, P |author4=Lee, DC |author5=Abdel-Kariem, R |location=New York, USA|url=http://emedicine.medscape.com/article/813155-overview#a5|url-status=live|archive-url=https://web.archive.org/web/20170826235157/http://emedicine.medscape.com/article/813155-overview#a5|archive-date=26 August 2017}}

Treatment involves supporting a person's breathing and blood pressure.{{cite book |last1=Carroll |first1=Robert G. |url=https://books.google.com/books?id=cXDO8XRrph0C&pg=PA99 |title=Problem-based Physiology |date=2010 |publisher=Elsevier Health Sciences |isbn=978-1416042174 |page=99 |language=en |archive-url=https://web.archive.org/web/20161104001404/https://books.google.ca/books?id=cXDO8XRrph0C&pg=PA99 |archive-date=4 November 2016 |url-status=live}} While there is no antidote, activated charcoal may be useful.{{cite journal |last1=Roberts |first1=DM |last2=Buckley |first2=NA |date=January 2011 |title=Enhanced elimination in acute barbiturate poisoning – a systematic review. |journal=Clinical Toxicology |volume=49 |issue=1 |pages=2–12 |doi=10.3109/15563650.2010.550582 |pmid=21288146 |s2cid=41375480}} Multiple doses of charcoal may be required. Hemodialysis may occasionally be considered. 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.{{cite book | last=Singh | first=Omender | last2=Juneja | first2=Deven | title=Principles and Practice of Critical Care Toxicology | publisher=Jaypee Brothers Medical Publishers Pvt. Limited | year=2019 | isbn=978-93-5270-674-7 | url=https://books.google.com/books?id=m3KSDwAAQBAJ&pg=PA79 |quote=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.}}

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 include Stefan Zweig,{{cite news |title="Stefan Zweig, Wife End Lives In Brazil"|quote=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|url=https://www.nytimes.com/1942/02/24/archives/stefan-zweig-wife-end-lives-in-brazil-austrianborn-author-left-a.html |work=New York Times |date=February 23, 1942 |access-date=February 23, 2012 }}{{cite magazine|title=Died|url=http://www.time.com/time/magazine/article/0,9171,773116,00.html|archive-url=https://web.archive.org/web/20101014145959/http://www.time.com/time/magazine/article/0,9171,773116,00.html|url-status=dead|archive-date=October 14, 2010|magazine=Time|date= March 2, 1942|access-date=June 30, 2010}} Gillian Bennett,{{Cite web|title=DeadAtNoon|url=http://deadatnoon.com/|access-date=23 June 2020|website=deadatnoon.com}} Charles Boyer, Ruan Lingyu, Victor Folke Nelson,City of Boston Registry, Certificate of Death record for Victor Folke Nelson, No. 10407, filed 14 December 1939."Dr. Brickley Says Nelson Took Poison." The Boston Globe. 11 December 1939. Dalida,{{cite news |title=Dalida|url=https://www.nytimes.com/1987/05/05/obituaries/dalida.html |work=New York Times |date=5 May 1987 |access-date=28 February 2008 |url-status=live |archive-url=https://archive.today/20120526070524/http://www.nytimes.com/1987/05/05/obituaries/dalida.html |archive-date=26 May 2012 }}{{cite book |title=v |first=Jeremy |last=Simmonds |url=https://books.google.com/books?id=S3y7tocgPzgC |publisher=Chicago Review Press |year=2008 |isbn=978-1-55652-754-8 |page=225 |url-status=live |archive-url=https://web.archive.org/web/20160518103005/https://books.google.com/books?id=S3y7tocgPzgC |archive-date=18 May 2016 }} 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 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.

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.{{Citation|last1=Suddock|first1=Jolee T.|title=Barbiturate Toxicity|date=2020|url=http://www.ncbi.nlm.nih.gov/books/NBK499875/|work=StatPearls|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=29763050|access-date=5 August 2020|last2=Cain|first2=Matthew D.}}

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{{Medical condition classification and resources

| DiseasesDB =

| ICD10 = {{ICD10|F|13||f|10}}.0, {{ICD10|T|42|3|t|36}}

| ICD9 = {{ICD9|969}}

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| OMIM =

| MedlinePlus =

| eMedicineSubj = article

| eMedicineTopic = 813155

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{{Psychoactive substance use}}

{{Poisoning and toxicity}}

Category:Causes of death

Category:Poisoning by drugs, medicaments and biological substances

Category:Barbiturates

Category:Drug overdose

Category:Suicide by poison

Category:Wikipedia medicine articles ready to translate

Category:Wikipedia emergency medicine articles ready to translate