What Are the Signs of a Barbiturate Overdose?

Acute barbiturosis

Acute barbiturate poisoning is an acute poisoning caused by a single overdose of barbiturates. This class of drugs includes phenobarbital, isoprenebital, scopolamine, thiopental sodium, etc. These drugs have sedative hypnosis, antiepileptic effects, and toxic effects for the central nervous system.

Name of Acute Barbiturate Poisoning Disease

Acute barbiturosis

Overview of Acute Barbiturate Poisoning

Diagnosis: 1. The patient has a history of overdose of barbiturates, or there are residual drugs and medicine bottles on site. 2. Symptoms can be manifested to varying degrees due to differences in the amount of medication taken. Starts drowsiness, unresponsiveness, and slurred speech; gradually appears lethargy, coma, muscles in the limbs, and tendon reflexes weaken or disappear; in severe cases, shallow and irregular breathing, decreased urine output, decreased blood pressure, shock, may be due to breathing, circulation failure Death; severe poisoning shows dilated pupils and may dilate before death. 3. The auxiliary examination of vomitus, urine, and blood barbiturate concentrations can help confirm the diagnosis.

Treatment: 1. General treatment Immediately wash the stomach with a 1: 5000 potassium permanganate solution, and strive to wash it thoroughly. After gastric lavage, inject 20-30 grams of sodium sulfate to induce diarrhea and inhale oxygen. Disable magnesium sulfate to avoid aggravating central nervous system depression. 2. Promote drug excretion and infusion; use 250 ml of 20% mannitol, or 40-60 mg of furosemide; 200 ml of 5% sodium bicarbonate can be used for alkalinized urine, intravenously; severe hemorrhage can be treated with hemodialysis, and the effect is exact. 3. Respiratory stimulants are used to treat patients in a coma state. Central stimulants can be applied when the breathing is irregular and irregular, such as mesotherapy 50 mg, intravenous injection or intravenous drip; Nicoxam (Kolamin) 0.375 per hour ~ 0.75 g, intravenous injection; imprintin 3 mg, intravenous injection. These drugs are not used for routine treatment.

Classification of acute barbiturate poisoning diseases

Emergency Department

Signs and symptoms of acute barbiturosis

Poisoning manifestations: disturbance of consciousness can be from drowsiness to coma, severe poisoning can occur muscle relaxation, weakened or disappeared tendon reflexes, shallow breathing, narrowed or dilated pupils, cyanosis, decreased urine output, weak pulse, decreased blood pressure, shock.

Causes of Acute Barbiturate Poisoning

Have a history of taking barbiturates. This class of drugs includes barbiturate, phenobarbital, isoprene barbiturate, scorcomber, and thiopental sodium. Know the dose. Barbiturates that are more than 10 times their hypnotic dose are considered lethal.

Diagnostic tests for acute barbiturate poisoning

Analysis of blood, stomach contents and urine.

Treatment options for acute barbiturate poisoning

1, gastric lavage and catharsis

For those who take a large amount of medicine but do not exceed 4-6 hours, apply 1: 5000 potassium permanganate solution or water for gastric lavage. After washing, infuse 20-30 g of sodium sulfate to prevent diarrhea (do not use magnesium sulfate, because the absorption of magnesium ions will aggravate the central nervous system), or 20% medicinal charcoal suspension.

2. Central stimulant application

For deep coma, shallow breathing or irregularities, the following drugs can be considered.

(1) Beauty sleep: 50mg diluted in 20ml of glucose solution intravenously for 3 ~ 5min, or 200 ~ 300mg diluted in 5% glucose solution and 250ml slowly intravenously after intravenous injection, such as nausea, vomiting, muscle tremor and other poisoning symptoms Need to reduce or discontinue.

(2) Nikosa: 0.375 ~ 0.75g / h. Intravenously, until corneal reflex and muscle tremor appear.

(3) Naloxone: 0.4 ~ 0.8mg / 5 ~ 10min intravenously, 2 ~ 4mg can be added to 500ml of glucose solution intravenously until the breathing or (and) consciousness is significantly improved. Excessive central excitatory doses can cause convulsions or arrhythmias, aggravate breathing and circulatory failure, and should be reduced or discontinued when muscle tension and reflex recovery or muscle tremor occur.

3. Application of diuretics

Barbituric sodium and phenobarbital are mainly excreted from the kidneys. After replenishing blood volume, 250ml of 20% mannitol is given intravenously, once every 812h. It is especially suitable for patients with intracranial hypertension, and intermittent infusion of fast urine 20 ~ 40mg, intravenous infusion of 5% sodium bicarbonate 200ml alkalized urine can promote drug excretion.

4.Blood purification

Hemodialysis is an effective method. It should be implemented as soon as possible for cases with large doses, deep coma, and incomplete gastric lavage. Hemoperfusion is feasible under conditions. If the patient should not move, peritoneal dialysis can be used.

5.General processing

Conventional oxygen inhalation, intravenous fluid replacement to maintain water, electrolyte and acid-base balance, vascular active drugs can be used for unstable circulation; respiratory failure can be tracheal intubation and mechanical ventilation. Pay attention to prevention and treatment of complications such as pulmonary infection, cerebral edema, shock, etc., and strengthen nursing and supportive treatment.

Safety of Acute Barbiturate Poisoning

1. Patients with oral poisoning should perform gastric lavage as soon as possible, and use warm water or saline to lavage the stomach. For those who take a large amount of medicine, they can still perform gastric lavage, even if it exceeds 4-6 hours. Gastric lavage should be thorough, and activated carbon can be repeatedly infused by nasal feeding.

2. Immediately inhale oxygen and intubate or artificial respiration if necessary. The catharsis can be injected into the gastric tube with 250 ~ 500ml of 20% mannitol. Magnesium sulfate is forbidden. After absorption of magnesium ions, it can inhibit the central nervous system.

3. The rescue of patients with barbiturate salt poisoning focuses on maintaining respiratory, circulatory and urinary system functions. Those who have severe poisoning should be sent to the hospital for further rescue in time after simple treatment, such as diuresis and dialysis therapy. Consider using wakefulness or central stimulants when necessary.

4, mild poisoning: 2 to 5 times the oral hypnotic dose, the patient fell asleep, but he could wake up, when he woke, his performance was slow, his speech was unclear, and he had mild conscious disturbances such as judgment and orientation.

5. Moderate poisoning: When swallowing a hypnotic dose of 5 to 10 times, the patient appears to fall asleep or enter a shallow coma. Strong stimuli can awaken, but can not speak, immediately drowsiness, shallow breathing, and tremor in the eyeballs.

6. Severe poisoning: When swallowing a hypnotic dose of 10-20 times, the patient shows coma, the reflection disappears, the pupils diminish or dilate, and the breathing is shallow and slow, sometimes showing Chen Yishi's breathing, the pulse is fine, and the blood pressure drops. Rescued and died from respiratory and circulatory failure.