Barbiturate intoxication and overdose
Key points
- Barbiturates are a type of depressant drug that causes relaxation and sleepiness.
- Barbiturate abuse is still a major addiction problem in the population, although it has been partly replaced by addiction to other depressant drugs more commonly prescribed, such as benzodiazepines.
- Symptoms of acute barbiturate intoxication include sluggishness, incoordination, difficulty in thinking, slowness of speech, faulty judgment, drowsiness or coma, shallow breathing, and ataxic gait (staggering).
- Physical exam and clinical history are usually sufficient to make the diagnosis.
Alternative names
Intoxication - barbiturates
Definition
Barbiturates are a type of depressant drug that causes relaxation and sleepiness. In relatively low doses, barbiturates and alcohol have very similar clinical syndromes of intoxication.
However, excessive and prolonged dosages of barbiturate drugs, such as phenobarbital, may produce the following chronic symptoms: memory loss, irritability, changes in alertness, and decreased interpersonal functioning. Barbiturates may also cause an acute overdose syndrome, which is life-threatening.
Causes, incidence, and risk factors
Barbiturate abuse is still a major addiction problem in the population, although it has been partly replaced by addiction to other depressant drugs more commonly prescribed, such as benzodiazepines.
Though most people who take these medications for seizure disorders or pain syndromes do not abuse them, many abusers start by abusing medication prescribed for them or for other family members.
Symptoms
Symptoms of acute barbiturate intoxication include sluggishness, incoordination, difficulty in thinking, slowness of speech, faulty judgment, drowsiness or coma, shallow breathing, and ataxic gait (staggering).
Signs and tests
Physical exam and clinical history are usually sufficient to make the diagnosis. Drug screens, both urine and serum, can detect barbiturates for up to 5 days after ingestion. Additional blood tests may detect the level of respiratory depression.
Treatment
Most overdoses of depressant medications are mixtures of drugs, commonly alcohol and barbiturates, benzodiazepines or barbiturates and opiates (heroin or Oxycontin).
Some users use a combination of all 4 drugs. Those who take such combinations tend to be either new users who don't know that such combinations are a recipe for coma or death, or experienced users who want to entirely blot out consciousness. This second group is among the most difficult to treat.
Because mixtures are the most common cause of death, an opiate-blocking drug called naloxone (Narcan) is often used to treat overdose when an opiate was part of the mix. If opiates are involved, naloxone will often rapidly restore consciousness and breathing.
There is no direct antidote to barbiturates or alcohol overdose. In such overdoses, respiration must be maintained by artificial means until the drugs are removed from the system. Some drugs may help speed the excretion of the barbiturate.
Expectations (prognosis)
Written and revised by
Gerald Hurowitz, M.D.
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