Management of Barbiturate Poisoning

In this article, we will discuss the Management of Barbiturate Poisoning. So, let’s get started.

Management

1. To remove the unabsorbed drug from the stomach by gastric lavage, activated charcoal 50 g every four to six hours.

2. To excrete the drug through stool by catharsis.

Each cycle consists of 1000 ml of dextrose saline + 10 ml of KCl and 100 ml of NaHCO3 followed by 1000 ml of 5% dextrose + 10 ml of KCl and 350 ml of mannitol in 60 kg adults. About 3-6 cycles are required depending on the severity. Urine output is to be measured, if it does not match with intake, a bolus dose of mg furosemide may be given I.V. CVP line should be put and fluid balance is maintained.

3. To enhance urinary excretion by forced alkaline diuresis in cycles. It is useful for long acting barbiturate poisoning. Complications of forced-alkaline diuresis include circulatory overload, pulmonary edema, electrolyte disturbance and mannitol induced acute tubular necrosis.

4. Removal of drug by extracorporeal means, e.g. peritoneal or hemodialysis. Hemodialysis is useful in poisoning due to long and short acting barbiturates and hemoperfusion in short acting one. Indications of dialysis are given below:

Deep coma with areflexia, hypotension and respiratory depression.

Blood levels e.g. >9 mg/dl of long-acting and >3.5 mg/dl for short-acting barbiturates.

Presence of renal failure and pulmonary edema

5. Respiratory support: Maintain a patent airway. Intubate if assisted ventilation is required.

6. Other measures: Maintain electrolyte balance, temperature and blood pressure.

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