Poisoning with barbiturates
Barbiturates are called a group of drugs, derivatives of barbituric acid, depressing effect on the central nervous system. The therapeutic effect is determined by the dose taken - from mild sedation to the surgical stages of anesthesia.
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Previously, barbiturates were widely used as hypnotics, sedatives and anticonvulsants, but due to the narrowness of the therapeutic effect, as well as due to the ability to quickly induce drug dependence, their use is currently limited.
How does barbiturate poisoning occur?
Barbiturate poisoning occurs deliberately (when attempting to kill or commit suicide) or accidentally when the therapeutic dose of the drug is exceeded.
After entering the body in toxic doses, barbiturates inhibit the functions of the cerebral cortex and the brain stem. This leads to loss of consciousness up to the development of coma and severe breathing problems. Tendon, tactile and pain reflexes disappear.
The toxic effect of barbiturates on the vasomotor center causes a decrease in the tone of blood vessels and a deterioration in myocardial contractility. As a result, the victim has severe hemodynamic disturbances:
- a sharp decrease in venous and blood pressure;
- decreased cardiac output;
- a decrease in the volume of circulating blood;
- significant tissue hypoxia.
Severe poisoning with barbiturates leads to paralysis of the vasomotor and respiratory center, as a result of which death occurs against the background of severe respiratory and heart failure.
Hemodynamic disturbances cause metabolic disorders, an increase in heat transfer and, as a result, a decrease in body temperature. However, in children with barbiturate poisoning, the body temperature, on the contrary, may increase, which is associated with severe hypoxia of the subcortical centers of the brain, including the center of thermoregulation, as well as dehydration of the body.
High doses of barbiturates have a toxic effect on the hypothalamic-pituitary system. The result is a significant decrease in urine output, up to the development of anuria (cessation of urination) and an increase in the concentration of residual nitrogen in the blood.
Poisoning symptoms
The clinical picture of barbiturate poisoning includes several stages. With the exception of the first stage, the rest may have a complicated or uncomplicated course.
Falling asleep stage
The first stage is characterized by:
- drowsiness;
- apathy;
- muscle weakness;
- ataxia;
- blurred speech;
- slight constriction of the pupils while maintaining their reaction to light;
- increased salivation.
Respiratory and cardiovascular disorders are not detected, reflex activity is preserved.
Superficial coma stage
The victim loses consciousness and falls into deep sleep. The pupils are constricted. Tendon, pupillary and corneal reflexes are weakened. At this stage of poisoning, there may be a slight stiffness of the occipital muscles, as well as the appearance of pathological reflexes of Rossolimo and Babinsky.
The frequency of respiratory movements decreases, which is accompanied by recurrent cyanosis. Blood pressure is within normal limits, the pulse is somewhat quickened, but its rhythm and filling correspond to the norm.
Deep coma stage
If the victim is not provided with medical care in the previous stages of barbiturate poisoning, a deep coma develops, which is manifested by the following symptoms:
- areflexia;
- lack of muscle tone;
- a sharp narrowing of the pupils, which, with severe hypoxia, is replaced by expansion;
- cyanosis of the mucous membranes and skin;
- cooling of the skin of the extremities;
- slow shallow breathing (in the terminal stage of poisoning, the development of noisy breathing like Cheyne-Stokes is possible);
- bradycardia;
- hypotension;
- decrease in body temperature.
Postcomatous period
After coming out of a coma, the patient has the following symptoms for some time (the duration depends on the severity of the intoxication):
- violation of coordination of movements;
- diplopia;
- nystagmus;
- ptosis of the eyelids;
- convergence of the eyes;
- transient neurological disorders;
- emotional lability;
- mental stunnedness;
- motor restlessness.
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First aid for barbiturate poisoning
First aid for poisoning with barbiturates, provided that the victim is conscious, should begin with gastric lavage. The patient is given about a liter of warm water to drink, and then, pressing on the root of the tongue, induce vomiting.
After gastric lavage, you should take an aqueous suspension of Activated Carbon, Smecta, Filtrum STI or any other intestinal sorbent.
Then the victim should be put to bed, covered with a warm blanket and given sweet tea.
If poisoning with barbiturates is accompanied by loss of consciousness, then rinsing the stomach at home is strictly prohibited. The victim should be put to bed under a warm blanket, always lying on his side - this will prevent the occurrence of mechanical asphyxia associated with retraction of the tongue or aspiration of vomit.
When is medical attention needed?
In case of poisoning with barbiturates, specialized medical care is needed in any case, even if the poisoning seems mild at first glance. Therefore, you must first call the ambulance team, and then proceed to provide first aid.
Treatment of patients with barbiturate poisoning is carried out in the toxicology department of the hospital, and in serious condition - in the intensive care unit.
In order to remove the poison from the body, the stomach is washed through a gastric tube, followed by the introduction of a suspension of activated carbon and a saline laxative through it. The use of methods of extracorporeal detoxification (forced diuresis, hemosorption, plasmapheresis, hemodialysis) is also shown.
To stimulate the respiratory center, respiratory analeptics (Bemegrid, Ephedrine, Cordiamine, Caffeine) are administered. If necessary, the question of transferring the patient to artificial lung ventilation is resolved.
Measures are being taken to eliminate hemodynamic disorders. For this purpose, the patient is given infusion therapy, if necessary, pressor amines (Dopamine, Norepinephrine, Adrenaline) and corticosteroids are used.
Possible complications
Poisoning with barbiturates is often accompanied by the development of complications. The most common:
- bronchopneumonia;
- pulmonary edema;
- swelling of the brain;
- mechanical asphyxia;
- bedsores;
- mental disorders.
Prevention
To prevent poisoning with barbiturates, you must carefully follow the dosage prescribed by your doctor. It is unacceptable to use barbiturates without a doctor's prescription!
Store medicines at home out of the reach of children. It is desirable that the first aid kit is locked with a key.
Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
