Barbiturate Toxicity Medication

  • Author: Keith A Lafferty, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Jun 15, 2010
 

Medication Summary

GI decontamination with activated charcoal and urinary alkalinization may be beneficial in patient management. Also, pharmacologic support may be required in hypotensive patients with the use of pressor agents.

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GI decontaminants

Class Summary

These agents are used to minimize the amount of toxin absorbed from the GI tract into systemic circulation. Depending upon the amount of drug ingested and time from ingestion to treatment, gastric lavage may be used. Activated charcoal is beneficial in adsorbing the ingested agent and is considered safer than emetics.

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Activated charcoal (Liqui-Char)

 

Prevents absorption by adsorbing drug in the intestine. Multidose charcoal may interrupt enterohepatic recirculation and enhance elimination by enterocapillary exsorption. Theoretically, by constantly bathing the GI tract with charcoal, the intestinal lumen serves as a dialysis membrane for reverse-absorption of drug from intestinal villous capillary blood back into the intestine.

Supplied as an aqueous mixture or in combination with a cathartic (usually sorbitol 70%).

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Alkalinizing agent

Class Summary

Sodium bicarbonate is the primary agent used clinically to enhance elimination. The goal of use is to alkalinize the urine to promote renal excretion and decrease elimination half-life of the barbiturate.

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Sodium bicarbonate (Neut)

 

Goal is to maintain a urinary pH >7.5 and urine output >2 mL/kg/h. Monitor arterial or venous pH; a blood pH >7.55 may increase patient morbidity.

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Adrenergic Agonist Agents

Class Summary

These agents improve the hemodynamic status by increasing myocardial contractility and heart rate. This results in an increase in cardiac output. They also increase peripheral resistance by inducing vasoconstriction. Increased cardiac output and increased peripheral resistance lead to increased blood pressure.

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Norepinephrine (Levophed)

 

Stimulates beta1-adrenergic and alpha-adrenergic receptors, which, in turn, increases cardiac muscle contractility, heart rate, and vasoconstriction. As a result, systemic blood pressure and coronary blood flow increase.

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Contributor Information and Disclosures
Author

Keith A Lafferty, MD  Adjunct Assistant Professor of Emergency Medicine, Temple University; Consulting Staff, Department of Emergency Medicine, South West Regional Medical Center

Keith A Lafferty, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Rehab Abdel-Kariem, MD  Resident Physician, Department of Emergency Medicine, Temple University Hospital

Rehab Abdel-Kariem, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physicians, American Medical Student Association/Foundation, Physicians for Human Rights, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David C Lee, MD  Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical School

David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael J Burns, MD  Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

  1. Harrison P. Barbiturates Still Drugs of Choice in Geriatric Suicide. Medscape Medical News. March 11, 2010;[Full Text].

  2. Wischmeyer PE, Johnson BR, Wilson JE, et al. A survey of propofol abuse in academic anesthesia programs. Anesth Analg. Oct 2007;105(4):1066-71, table of contents. [Medline].

  3. Kotani Y, Shimazawa M, Yoshimura S, Iwama T, Hara H. The experimental and clinical pharmacology of propofol, an anesthetic agent with neuroprotective properties. CNS Neurosci Ther. Summer 2008;14(2):95-106. [Medline].

  4. [Best Evidence] Miner JR, Danahy M, Moch A, Biros M. Randomized clinical trial of etomidate versus propofol for procedural sedation in the emergency department. Ann Emerg Med. Jan 2007;49(1):15-22. [Medline].

  5. Fudickar A, Bein B. Propofol infusion syndrome: update of clinical manifestation and pathophysiology. Minerva Anestesiol. May 2009;75(5):339-44. [Medline].

  6. Barbiturates. Clinical Toxicology. In: Ford. Chap 68.

  7. Barr J, Egan TD, Sandoval NF, et al. Propofol dosing regimens for ICU sedation based upon an integrated pharmacokinetic-pharmacodynamic model. Anesthesiology. Aug 2001;95(2):324-33. [Medline].

  8. Coupey SM. Barbiturates. Pediatr Rev. Aug 1997;18(8):260-4; quiz 265. [Medline].

  9. Devlin JW, Roberts RJ. Pharmacology of commonly used analgesics and sedatives in the ICU: benzodiazepines, propofol, and opioids. Crit Care Clin. Jul 2009;25(3):431-49, vii. [Medline].

  10. Fassoulaki A, Theodoraki K, Melemeni A. Pharmacology of sedation agents and reversal agents. Digestion. 2010;82(2):80-3. [Medline].

  11. Feiner JR, Bickler PE, Estrada S, Donohoe PH, Fahlman CS, Schuyler JA. Mild hypothermia, but not propofol, is neuroprotective in organotypic hippocampal cultures. Anesth Analg. Jan 2005;100(1):215-25. [Medline].

  12. Frank LR, Strote J, Hauff SR, Bigelow SK, Fay K. Propofol by infusion protocol for ED procedural sedation. Am J Emerg Med. Sep 2006;24(5):599-602. [Medline].

  13. Frazee BW, Park RS, Lowery D, Baire M. Propofol for deep procedural sedation in the ED. Am J Emerg Med. Mar 2005;23(2):190-5. [Medline].

  14. Frölich MA, Price DD, Robinson ME, Shuster JJ, Theriaque DW, Heft MW. The effect of propofol on thermal pain perception. Anesth Analg. Feb 2005;100(2):481-6. [Medline].

  15. Fujii Y, Uemura A. Effect of metoclopramide on pain on injection of propofol. Anaesth Intensive Care. Oct 2004;32(5):653-6. [Medline].

  16. Gary NE, Tresznewsky O. Clinical aspects of drug intoxication: barbiturates and a potpourri of other sedatives, hypnotics, and tranquilizers. Heart Lung. Mar 1983;12(2):122-7. [Medline].

  17. Goldfrank LR, Flomenbau NE. Prentice Hall. In: Sedative-hypnotic agents. Goldfrank's Toxicologic Emergencies. 5th ed. 1994:787-804.

  18. Hadden J, Johnson K, Smith S, Price L, Giardina E. Acute barbiturate intoxication. Concepts of management. JAMA. Aug 11 1969;209(6):893-900. [Medline].

  19. Inagawa G, Sato K, Kikuchi T. Chronic ethanol consumption does not affect action of propofol on rat hippocampal acetylcholine release in vivo. Br J Anaesth. 2002;93(5):737-9.

  20. Kanbak M, Saricaoglu F, Avci A, Ocal T, Koray Z, Aypar U. Propofol offers no advantage over isoflurane anesthesia for cerebral protection during cardiopulmonary bypass: a preliminary study of S-100beta protein levels. Can J Anaesth. Aug-Sep 2004;51(7):712-7. [Medline].

  21. Katzung BG. Sedative-hypnotics. In: Basic and Clinical Pharmacology. 6th ed. Appleton & Lange; 1995:333-49.

  22. Khantzian EJ, McKenna GJ. Acute toxic and withdrawal reactions associated with drug use and abuse. Ann Intern Med. Mar 1979;90(3):361-72. [Medline].

  23. Lowinson JH, Ruiz P, Millman RB, et al. Epidemiology. In: Substance Abuse: A Comprehensive Textbook. 3rd ed. Lippincott Williams & Wilkins; 1997:10-16.

  24. Lowinson JH, Ruiz P, Millman RB, et al. Sedative hypnotics and tricyclics. In: Substance Abuse: A Comprehensive Textbook. 3rd ed. Lippincott Williams & Wilkins; 1997:223-30.

  25. Miner JR, Danahy M, Moch A, Biros M. Randomized clinical trial of etomidate versus propofol for procedural sedation in the emergency department. Ann Emerg Med. Jan 2007;49(1):15-22. [Medline].

  26. Morgan CJ, Muetzelfeldt L, Curran HV. Consequences of chronic ketamine self-administration upon neurocognitive function and psychological wellbeing: a 1-year longitudinal study. Addiction. Jan 2010;105(1):121-33. [Medline].

  27. Motsch J, Roggenbach J. [Propofol infusion syndrome]. Anaesthesist. Oct 2004;53(10):1009-22; quiz 1023-4. [Medline].

  28. Nishiyama T, Misawa K, Yokoyama T, Hanaoka K. Effects of combining midazolam and barbiturate on the response to tracheal intubation: changes in autonomic nervous system. J Clin Anesth. Aug 2002;14(5):344-8. [Medline].

  29. Roberts I. Barbiturates for acute traumatic brain injury. Cochrane Database Syst Rev. 2000;CD000033. [Medline].

  30. Romero CE, Baron JD, Knox AP, Hinchey JA, Ropper AH. Barbiturate withdrawal following Internet purchase of Fioricet. Arch Neurol. Jul 2004;61(7):1111-2. [Medline].

  31. Solomon S. Butalbital-containing agents: should they be banned? No. Curr Pain Headache Rep. Apr 2002;6(2):147-50. [Medline].

  32. Subramaniam K, Gowda RM, Jani K, Zewedie W, Ute R. Propofol combined with lorazepam for severe poly substance misuse and withdrawal states in intensive care unit: a case series and review. Emerg Med J. Sep 2004;21(5):632-4. [Medline]. [Full Text].

  33. Young WB, Siow HC. Should butalbital-containing analgesics be banned? Yes. Curr Pain Headache Rep. Apr 2002;6(2):151-5. [Medline].

 
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