BARBITURATE POISONING

Barbiturates are used in the treatment of epilepsy and convulsions (e.g. phenobarbital).

Clinical features

  • Confusion, irritability, combativeness
  • Drowsiness, lethargy
  • Hypotension, bradycardia or tachycardia, until shock
  • Respiratory depression, until coma

Management

Supportive care
  • Oxygen therapy
  • IV fluids for hypotension
  • Charcoal may be useful but only if given within 1 hour from ingestion and if the patient is not drowsy (risk of inhalation)
  • Refer for ventilatory support if necessary
  • Alkalinisation to increase renal excretion
    • Sodium bicarbonate 1 mEq/kg bolus followed by infusion (specialist only)