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Symptoms and effects of barbiturate poisoning. Poisoning and overdose with barbiturates Poisoning with barbituric acid derivatives

Poisoning with barbiturates - drugs that are derivatives of barbituric acid - can occur either by accidental overdose, or deliberately, in order to commit suicide.

Characteristic features of barbiturates

Barbiturates are medicines based on barbituric acid. Their main property is depression of the central nervous system. Barbiturates are characterized by powerful hypnotic, analgesic and sedative effects.

The effect of such drugs on the body is compared with the effect that alcohol has. Soon after taking them, a state of excitement and euphoria is noted, followed by a heavy sleep-forgetfulness, after which the person feels weak and depressed.

After taking drugs from the barbiturate group, there may be consequences such as unpredictable behavior, the inability to control emotions. Large doses of the drug help to reduce blood pressure, disrupt the activity of the cardiovascular system, and cause disruption of the functioning of the digestive tract. An overdose of barbiturates poses a particular threat not only to health, but also to human life, since in this case there is a high risk of death.

The use of drugs of this drug group causes:

violation of breathing and heart rhythm;
speech disorders (slowness, slurring);
depression;
clouding of consciousness;
hallucinations;
inability to navigate in space;
loss of balance;
drowsiness.

Long-term use of barbiturates makes a person dependent on these medications. This state can be compared to drug addiction. Due to their powerful effect on the central nervous system and the likelihood of dependence, barbituric acid preparations are almost never used for therapeutic purposes. They are rarely used to treat epilepsy or hypnotic effect. The most famous barbiturate drugs are Barbital, Barbamil, Nembutal, Talbutal. On the basis of barbiturates, such well-known products as Valocordin and Corvalol are made.

What happens with an overdose

Increased doses of barbiturates cause a number of changes in the functioning of organs and body systems. Under these conditions, the following happens:

blood circulation is disturbed;
the functions of the trunk and cortex of the cerebral hemispheres are inhibited;
the contractility of the heart muscle decreases;
decreased activity of the urinary system;
the tone of blood vessels is disturbed;
oxygen starvation of tissues develops;
the level of toxic compounds and decay products in the blood increases;
body temperature drops;
arterial pressure drops sharply.

Death in case of barbiturate poisoning occurs as a result of severe heart and respiratory failure, since large doses of drugs provoke paralysis of the respiratory and vasomotor centers.

Typical symptoms of intoxication with barbituric acid preparations

The severity of symptoms with excessive use of barbiturates depends on the dosage of the drug and the duration of the stay of toxic substances in the bloodstream. If the victim took quick-acting drugs, the manifestations of intoxication are eliminated quickly enough, since the drugs break down in the body in a short time. When the dosage of medium and long-acting barbiturates is exceeded, the clinical picture of intoxication is more pronounced.

Signs of barbiturate poisoning:

drowsiness and apathy;
feeling of pleasant relaxation;
pronounced salivation;
feeling of weakness in the muscles;
illegibility of speech;
slight constriction of the pupils.

These manifestations indicate a mild stage of intoxication. In this case, there is no violation of reflexes. If further the next dose of barbiturates does not enter the body and timely medical assistance is provided, there will be no serious consequences for the body.

A more severe stage (the so-called "superficial coma") is expressed in the following manifestations:

increased heart rate;
pallor of the skin;
weak motor reactions;
difficulty breathing;
constriction of the pupils;
decrease in the frequency of respiratory movements;
loss of consciousness - the poisoned person is in a state of deep sleep, attempts to wake him up are unsuccessful.

A characteristic feature of this stage of poisoning is the ability of the victim to respond to painful stimuli. The victim, who is in a state of superficial coma, may begin an attack of vomiting, which is fraught with the reflux of vomit into the esophagus and their entry into the respiratory tract. This can cause respiratory arrest.

Barbiturate poisoning is most dangerous in the stage of deep coma. In this case, changes occur associated with the complete absorption of toxic substances by tissues. With untimely medical care, the stage of deep coma ends in death.

This condition is characterized by:

pallor and dryness of the skin;
lack of reflexes;
slowness of breathing;
decrease in body temperature;
a sharp decrease in blood pressure;
pronounced constriction of the pupils;
lack of response to painful stimuli;
arrhythmia.

In a state of coma, the victim can be for a long time - from an hour to a day. The severe toxic effect of toxins provokes respiratory and cardiac arrest. In this case, death occurs. Each drug that is a derivative of barbituric acid has its own lethal dose when taken orally. For example, when using "Barbital" - 6-8 g, "Phenobarbital" - 4-6 g, "Cyclobarbital" - 5-20 g.

When the patient comes out of a coma, during the first day there are manifestations of disorders of the central nervous system - hysteria, tearfulness. The victim is in an excited state, suffers from insomnia. Even if the victim was taken to a medical facility and underwent all the necessary procedures to eliminate excess toxins from the stomach and blood, the possibility of complications cannot be ruled out. These include mental disorders, pulmonary and cerebral edema, metabolic disorders, acute renal failure.

First steps to help the victim

A person with signs of barbituric acid intoxication requires emergency care, even if the poisoning is characterized by the most mild degree. The first thing to do is call an ambulance.

First emergency aid before the arrival of specialists, if the victim has not lost consciousness:

Reduce the content of toxic substances in the stomach and blood. For this purpose, it is necessary to give the patient to drink at least a liter of warm water (it is recommended to give from 10 to 13 liters in order to more effectively remove toxic compounds), after which, pressing on the root of the tongue with a finger or a spoon, induce vomiting.
After the victim's bouts of vomiting are over, give an intestinal sorbent - "Smecta", activated charcoal. Then it is necessary to induce vomiting again;
Put the patient to bed, give tea with plenty of sugar to drink.

If a person is unconscious, it is strictly contraindicated to carry out the washing procedure. The only thing that can be done before the doctor arrives in this case is to lay the person on his side, cover him with a blanket. In no case should the victim be laid on his back and left unattended: in the event of an attack of vomiting and throwing the remnants of undigested food into the respiratory tract, respiratory arrest and death may occur.

Pulmonologist, Therapist, Cardiologist, Functional diagnostics doctor. Doctor of the highest category. Experience: 9 years. She graduated from the Khabarovsk State Medical Institute, clinical residency in the specialty "therapy". I am engaged in the diagnosis, treatment and prevention of diseases of internal organs, I also conduct medical examinations. I treat diseases of the respiratory system, gastrointestinal tract, cardiovascular system.

Barbiturates are drugs that are derivatives of barbituric acid, which have a depressant effect on the central nervous system. They have a strong effect, and therefore it is important to take them in doses and as directed by a doctor.

Poisoning with barbiturates can lead to negative consequences. And now we will talk about what symptoms indicate an overdose, what to do in such cases and what is the further treatment.

List of drugs

Before talking about barbiturate poisoning, we need to list some of the popular medicines that belong to this group. Since it is precisely because of their excessive intake that overdoses occur. The list is like this:

"Luminal".
"Amutal".
"Librium".
"Butizol".
"Alurat".
"Seconal".
"Reposal".
Flurazepam hydrochloride.
"Terazin".
"Barbamil".
Valium.
"Phenobarbital".
"Lotuzat".
"Estimal".
"Chloral Hydrate".
Nizatrepam.
Triazolam.
"Talbutal".
Flunitrazepam.
"Brevital".

Of course, this is only a small list of drugs belonging to this group. It should be noted that drugs differ in the duration of exposure. Some act literally 5-15 minutes (they are used to calm a person before introducing anesthesia), others - about 6 hours.

How does an overdose happen?

Usually the cause of barbiturate poisoning is one of two things - either a suicide attempt or an accidental excess of a therapeutic dose.

After the agent enters the body in a toxic dose, the function of the cerebral cortex, as well as the brain stem, is inhibited. A person loses consciousness, breathing is disturbed, coma may develop. Pain, tactile and tendon reflexes also disappear.

Toxic effects cause a decrease in the tone of blood vessels, as well as a deterioration in contractility.

Hemodynamic disorders

Barbiturate poisoning leads to them first of all. Here's what happens as a result:

Decreased cardiac output.
Decrease in arterial and venous pressure.
Reducing the volume of circulating blood.
tissue hypoxia.

Respiratory paralysis also begins to develop, and if help is not provided to a person in time, a fatal outcome is possible due to heart and respiratory failure.

Due to violations of hemodynamics, there is also a failure in metabolism. Heat dissipation increases, body temperature decreases. Although, if acute barbiturate poisoning occurs in a child, he, on the contrary, will develop a fever. The reason is a pronounced hypoxia of the subcortical centers of the brain.

In addition to the above, an overdose of barbiturates leads to disorders in the hypothalamic-pituitary system. As a result, diuresis is significantly reduced, anuria develops, and the amount of nitrogen contained in the blood also increases.

Sleep stage

It must be noted that the clinical picture of poisoning includes several stages. The first is the sleep stage. Signs of barbiturate poisoning are as follows:

Ataxia.
Apathy.
Muscle weakness.
Drowsiness.
Unclear speech.
Increased salivation.
Constriction of the pupils (reaction to light persists).

Reflex activity is present at this stage, and there are no cardiovascular and respiratory disorders.

What to do?

Having noticed the above signs of barbiturate poisoning, emergency care should be provided immediately. Because in one of the next stages, which will be discussed later, a person may faint. And it is necessary to provide assistance when a person is still conscious.

First you need to call an ambulance. Then - wash the stomach. The victim should drink about a liter of warm water in one gulp. Then he is pressed on the root of the tongue, thereby causing vomiting. All the liquid drunk should come out of the stomach along with the medicine that has not had time to fully absorb.

Then the person should use an aqueous suspension of activated charcoal. Suitable "Filtrum STI" or "Smekta", as well as any other sorbent.

After that, you need to put the person to bed, be sure to cover with a blanket and give sweet warm tea.

In the event that the victim has lost consciousness at the stage of falling asleep, it is strictly forbidden to wash the stomach. Having called an ambulance, he must be laid on his side in bed, also covered with a blanket. This will prevent mechanical asphyxia, which can cause aspiration of vomit or tongue retraction.

Superficial coma stage

Unfortunately, if it occurs, then it is useless to provide emergency care for barbiturate poisoning. It remains to wait for the doctors. The patient loses consciousness, he falls into a deep sleep, pupils constrict. Corneal, tendon and pupillary reflexes are also weakened.

At this stage, stiff neck is often observed. Pathological reflexes of Babinsky and Rossolimo may appear. The frequency of respiratory movements decreases, the skin and mucous membranes become bluish.

The pulse becomes frequent, blood pressure can also change, but not much - it remains within the normal range.

Deep coma stage

It develops if the symptoms of barbiturate poisoning were ignored and the person was not given first aid. In this case, the following consequences arise:

Areflexia.
Bradycardia.
Severe cyanosis of the skin and mucous membranes.
Lack of muscle tone.
A sharp drop in temperature.
Cooling of the extremities.
A sharp narrowing of the pupils, which is replaced by expansion during hypoxia.
Hypotension.
Weak, slow, shallow breathing.

Post-coma period

The stage described above can last from a couple of hours to several days. When providing medical care, a person comes out of a coma. But for a certain time (how long it takes depends on the degree of intoxication), a number of severe symptoms persist. Among them:

Impaired coordination of movements.
Eyelid ptosis.
Diplopia.
emotional lability.
Eye convergence.
Nystagmus.
Motor restlessness.
Transient neurological disorders.
Psychic stupor.

If help was not provided in time, then after the post-coma period, complications may begin to develop. Mental disorders, bronchopneumonia, bedsores, pulmonary and cerebral edema, mechanical asphyxia are often formed.

Therapy

Unfortunately, no specific antidote has been developed. Barbiturate poisoning has many consequences, and therefore the treatment is carried out in a complex manner.

Mandatory stage - infusion therapy and elimination of toxins through the genitourinary system. For this, insulin, sodium bicarbonate, ascorbic acid and glucose are used.

You also need to reduce hypoxia. For this, drugs such as Mexidol, Piracetam and Vinpocetine are used.

If a person has respiratory failure, caffeine is administered to him. An antidote in this case can also be an antagonist of sleeping pills.

Which drug will be chosen depends on the medication that poisoned the person. So, for example, with an overdose of Diazepam, Naloxone is administered. If the victim was poisoned by Cyclobarbital or Phenobarbital, he is shown Bemegrid.

If swelling of the brain tissue occurs, the patient is given a plasma transfusion, and then a diuretic is prescribed. This is necessary for the excretion of toxic agents by the kidneys. You will also have to use vitamins to improve metabolism and minimize hypoxia.

Recovery period

For some time after the elimination of the primary consequences, the person will continue to feel weak. It is recommended to lead a sparing lifestyle, not to expose yourself to physical and emotional stress. Daily walks in the fresh air will be useful.

Rosehip is also effective - you need to pour 2-3 tbsp. l. dried berries with boiling water (300 ml), boil, sweat, and then cool. After filtering, you can drink, it is allowed to add a little sugar. Drinking this tea daily will help cleanse the kidneys.

A pathological condition that occurs when toxic doses of barbamyl, phenobarbital, barbital sodium and other drugs of this pharmacological group are taken orally. It is manifested by the development of a coma, respiratory, cardiovascular, renal failure, trophic disorders. At the prehospital stage, the diagnosis is made by the presence of relevant clinical manifestations, anamnesis and indications for taking drugs (empty blisters from pills, stories of relatives). Specific treatment includes hemosorption, intestinal lavage, gastric lavage, and other methods of active detoxification.

ICD-10

T42.3 Barbiturates

General information

Poisoning by means of the barbiturate group takes a leading place among other drug intoxications. In specialized toxicological centers, their number reaches 20% of the total flow of patients. Differ in high mortality: 3% in moderate forms and 15% in severe pathology. The frequency of occurrence increases in spring and autumn during the period of exacerbation of mental illness. The ratio of affected men and women is 3:7. The most complex poisoning occurs after taking short- and medium-acting tablets. Prolonged drugs are absorbed longer, so a sharp rise in the concentration of barbiturates in the blood does not occur.

The reasons

Barbiturate poisoning is almost always the result of taking too much of the drug. Sometimes therapeutic doses of the drug lead to the development of a poisoning clinic. The psychiatrist and toxicologist are engaged in determining the causes of the pathology. If there is evidence of a criminal component, this is reported to law enforcement agencies. The main causes of poisoning include:

Attemptandsuicide. In 85% of cases, a person is driven to take sleeping pills by the desire to die independently and painlessly. Such desires arise against the background of serious psycho-emotional trauma, incurable pathology, exacerbation of diseases, difficult life situations, unrequited love. The age of patients who commit suicide ranges from 15 to 30 years. The next wave of victims falls on the category of 70-85 years. Suicide attempts end in the most severe poisoning, since the volume of the drug taken is many times higher than the therapeutic dosage.
Wrong dosage. Usually it becomes the result of illiterate self-medication. To enhance and accelerate the effect, a person takes pills in an amount 2-3 times higher than the maximum allowable. Cases of iatrogenesis are extremely rare. They occur only with intravenous administration of the drug, if the medical staff made a mistake when calculating the required volume of drugs.
excretion disorder. Renal or hepatic insufficiency leads to a slowdown in the rate of metabolism and elimination of drugs. With daily intake of sleeping pills, they accumulate in the body. At some point, the concentration becomes critical, a clinic of poisoning develops. In such situations, the symptoms appear gradually, which allows you to recognize what happened in a timely manner and take the necessary rescue measures.
Narcotization. Means of this pharmacological group have some heady influence. Sometimes they are tried to be used as a drug. Tolerance quickly develops to the drug, which requires a constant increase in the number of drugs. Critical dosages for barbituromania are achieved after 4-6 months of regular use of the medication.
Crime. Situations are known when sleeping pills were used to bring a person into an unconscious state for robbery, rape and other illegal acts. The goal of the perpetrator is to achieve the fastest and deepest possible sleep of the victim. Therefore, the volume of the drug used is very high. Criminal barbiturate poisoning is usually comparable in severity to suicidal poisoning.

Pathogenesis

After absorption of the drug in the small intestine, it enters the bloodstream, partially binds to plasma proteins. The active proportion of the agent passes through the blood-brain barrier, is introduced into the inner lipid layers of neurons, changing their structure and state of aggregation. There is a suppression of the production of acetylcholine, stimulation of the synthesis of gamma-aminobutyric acid, which has an inhibitory effect. The process is characterized by a general depression of the central nervous system, a violation of the process of impulse transmission in synapses.

At the macro level, barbiturate poisoning is manifested by paralysis of the vasomotor center, hyporeflexia, impaired breathing, consciousness, decreased myocardial contractility, and increased vascular permeability. The latter causes pulmonary and cerebral edema. These clinical manifestations are due to the toxic effect of the drug on the medulla oblongata and trunk. The metabolic component of intoxication is the induction of liver enzymes, the activity of which increases. This is most noticeable with long-term use of barbiturates.

Classification

The division of drug intoxications into groups can be made using various principles: by causes (accidental, deliberate, criminal), time of development (acute, chronic, subacute). However, the most common is the clinical classification, which is based on the severity and level of violation of the vital functions of the body. In accordance with it, there are the following degrees of poisoning:

Light. There is no suppression of consciousness, there are changes that do not affect vital processes to a large extent. There may be a clinic of intoxication, nausea, increased effects of the drug. Hospitalization is usually not required. Negative phenomena disappear within 1-2 days from the moment the drug is discontinued.
Average. Moderate disturbances of consciousness are noted: more often stupor or delirium, in rare cases superficial coma. There are no generalized symptoms of hypoxia. Muscle tone and tendon reflexes are weakened. The concentration of the drug in the blood ≤ 100 mcg / ml. Shown hospitalization in the department of the toxicological center.
Heavy. There are significant changes in the functioning of the body. Respiratory failure is pronounced. A deep coma, miosis, hypothermia develops. With long-term exposure before the arrival of doctors, positional compression syndrome occurs. The content of the drug in plasma exceeds 100 mcg / ml. Treatment is carried out in the toxicological intensive care unit.
Extremely heavy. All signs of poisoning are expressed as much as possible. The patient loses the ability to adequately breathe, develops vascular collapse, a critical decrease in blood pressure. According to the Glasgow scale, the coma is in the range of 4-8 points (severe damage). In the absence of immediate assistance, it ends with cardiac arrest and death of the patient after 1-2 hours.

Symptoms of barbiturate poisoning

The clinic goes through 4 main stages. On the first of them, apathy, drowsiness, weakening of the victim's reaction to stimuli is noted. Contact with a person is preserved, but gradually lost. There are no other visible signs of violations. With the simultaneous administration of a large number of tablets, nausea and vomiting may occur. The duration of the stage depends on the dose of the drug taken and ranges from 20-60 minutes in case of acute poisoning.

The second stage is characterized by the development of superficial coma. There is a loss of consciousness, a complete loss of contact with the patient. There is a retraction of the tongue, which leads to respiratory failure. There is hyporeflexia, in which the swallowing and cough reflex disappears first. The reaction to pain is weakened, there is an expansion of the pupil, slight physical activity. Body temperature rises to 39-40°C due to toxic damage to the thermoregulatory center.

The aggravation of the situation leads to the occurrence of a deep coma, in which there are no reflexes, a reaction to physical impact, spontaneous breathing. Hemodynamics is unstable, blood pressure is sharply reduced, medical support is required. There is tachycardia, hypersalivation, bronchorrhea. The pupils are dilated. Skin temperature drops. With a long stay in a coma, the patient develops bedsores, congestive pneumonia. Possible weakening of urinary function up to acute renal failure.

The post-comatose period is characterized by a gradual recovery of consciousness, mental disorders (tearfulness, inadequate perception of reality, delirium), lack of sleep. Depression, emotional lability, staggering gait, and other neurological symptoms may occur. If there was a clinical death, the person has signs of post-resuscitation disease. In some cases, they remain for life. There may be persistent residual changes in the cardiovascular, urinary, respiratory systems, disorders of the liver, cerebral structures.

Complications

The most dangerous complication of barbiturate intoxication is posthypoxic brain damage. It occurs in 35% of cases of severe and extremely severe poisoning. It is manifested by a weakening of mental abilities, paralysis, paresis, dysfunction of internal organs and executive motor systems. Developing cerebral edema sometimes leads to the death of the patient or irreversible damage to the central nervous system. It occurs in approximately 10% of cases and is characterized by a number of stem and focal symptoms. Patients who are on mechanical ventilation for a long time and in a stationary state are prone to the development of severe pneumonia of congestive type. This occurs in 40% of victims if artificial respiratory support is carried out for more than 2-3 days.

Diagnostics

In most cases, the diagnosis of "barbiturate poisoning" is made by an emergency physician who arrives at the scene. Toxicologists or resuscitators are engaged in its confirmation, based on the results of laboratory and hardware examinations. Differential diagnosis is carried out with coma of a different etiology, including hypoglycemic, caused by poisoning with other drugs or drugs, traumatic (TBI), infectious genesis. The main search methods include:

Physical. There is no or weakened reaction to external stimuli, the skin is pale, blood pressure is reduced, the pulse is frequent, weak tension and filling. There is an increased secretion of saliva, wheezing during breathing. In severe lesions, signs of hypoxia are found: diffuse cyanosis, sweating. Respiratory rate varies within 8-10 per minute, heart rate 90-120. In the terminal stage, bradycardia occurs. May show lateral nystagmus and diplopia.
Laboratory. In plasma, the presence of barbiturates in a toxic dose is detected. The pH is reduced, which indicates the development of metabolic acidosis. The oxygen content in the blood decreases, the increase in the partial pressure of carbon dioxide above 40 mm Hg. There are changes in the electrolyte composition, in the event of massive edema, a decrease in BCC occurs with a corresponding decrease in central venous pressure of less than 4 cm of water column.
Hardware. Used primarily to clarify secondary changes. X-rays may show signs of pulmonary or cerebral edema. On the ECG - sinus tachycardia, diffuse transformation of the myocardium. The use of electroencephalography reveals characteristic barbiturate eddies.

Treatment of barbiturate poisoning

The basis of first aid is gastric lavage. It is carried out both at the prehospital stage and in the hospital. In patients in a coma, the procedure is carried out through a thick gastric tube. It is permissible for people with intact consciousness and a swallowing reflex to remove gastric contents using a tubeless method. Manipulation is carried out to clean washing water. In addition, the SMP team carries out activities aimed at maintaining vital functions: intubation, transfer to mechanical ventilation, the introduction of cardiotonic drugs, infusion solutions.

Treatment in a hospital is aimed at removing the toxic agent as soon as possible. Intestinal lavage, forced diuresis, hemo- or peritoneal dialysis are used. Symptomatic therapy is carried out, aimed at eliminating severe disorders of the heart, kidneys, and lungs. Respiratory support is continued until spontaneous breathing is restored. It is mandatory to introduce 4% sodium bicarbonate, which is necessary to correct acidosis and accelerate the removal of barbiturates from the blood.

In moderate poisoning, an infusion of analeptics (cordiamin, caffeine) is indicated. They have a stimulating effect on the nervous system, which allows you to partially neutralize the effects of sleeping pills. Deep depression of the central nervous system is a contraindication to the use of stimulants due to the inefficiency of the latter. Specific barbiturate antidotes - bemegrid, flumazenil (aneksat) are injected in a stream until consciousness is restored or the maximum allowable single dose is reached. In the absence of an immediate effect, they are prescribed daily, several injections per day.

Forecast and prevention

Severe barbiturate poisoning has a poor prognosis. About 15% of patients die, and 40% of the survivors after recovery undergo one or another change in the psyche or internal organs (kidneys, liver). The situation further worsens if there has been pulmonary or cerebral edema, renal failure. Poisoning with barbiturates of a small and moderate degree does not lead to such deplorable consequences, in the vast majority of cases it is cured completely. Symptoms can be resolved within a week.

Prevention on the part of the patient consists in taking the drug strictly according to the doctor's prescription and in a dose not exceeding the therapeutic one. Iatrogenic poisoning can be avoided by carefully taking the patient's history and finding out if there are any contraindications to the drug. It is required to limit independent access to medicines for people prone to tantrums, depression, mental breakdowns, suffering from mental illness.

Barbiturate poisoning occurs as a result of improper intake of such drugs. The drug is used as a sedative, but can cause persistent dependence. Barbiturates are used only as prescribed by a specialist. What to do in case of an overdose, how to help the body cope with unpleasant symptoms?

How poisoning occurs

Barbiturates are drugs based on barbituric acid. Medicines are aimed at suppressing the nervous system, the effect depends on the dosage taken. At the use of the increased quantity development of serious poisoning is possible. Currently, barbiturates are used quite rarely due to the side effects and possible addiction.

What effect do barbiturates have on the body in adults?

Action:

sedative,
narcotic,
Relieves convulsive manifestations,
Reduces anxiety, suppresses fear,
It has a relaxing effect on muscle fibers.

Why does a barbiturate overdose occur?

Factors:

The main cause of poisoning is considered to be intentional consumption with the intent to commit suicide.
Often the cause of intoxication with barbiturates is the use of an increased dosage of the drug or an increase in the frequency of administration.
Sometimes poisoning is possible as a result of the use of medicines that have been stored incorrectly or have expired.
In children, poisoning occurs as a result of the carelessness of parents who leave such medicines in accessible places.

When taking an increased dosage of barbiturates, there is a violation of the functionality of the brain. Gradually, oxygen deficiency develops in the body, all organs and systems suffer.

In order for poisoning to develop, it is enough to consume five grams of the substance. The absorption of the substance occurs instantly, so the patient needs to provide first aid very quickly.

Symptoms and stages of intoxication

Poisoning with such medicines is diagnosed according to certain signs. Barbiturate intoxication is characterized by the development of symptoms in several stages.

First stage

It is considered the easiest, does not have any special effects on the body, does not pose a danger. It is allowed to treat at home.

How it manifests itself:

There is a reaction to light, the pupils are normal,
Coordination problems, wobbly gait,
desire to sleep
Speech becomes incoherent
Intensive separation of saliva,
Weakness in the muscles
Depressive state.

Second stage

The next stage of poisoning is called superficial coma. The patient's condition becomes worse, it is allowed to take the antidote on their own, but it is better to visit a medical facility.

What's happening:

Reaction to light gets worse
There is a disturbance of consciousness
Reflexes are weaker
The process of breathing is disturbed
The pulse becomes faster
The man falls into a deep sleep.

Third stage

This stage of poisoning poses a danger to humans, the development of a lethal outcome is possible. The patient is urgently taken to intensive care, where various actions are carried out to restore the functionality of organs and systems.

What is typical:

Decrease in body temperature (in children, on the contrary, an increase),
Lack of reaction to light, constricted pupils,
Low pressure,
Breathing problems, choking,
cold extremities,
The heartbeat becomes rare
Blue discoloration of the skin and mucous membranes.

Fourth stage

This stage of poisoning is post-coma. It is observed in a patient who has come out of a coma, the probability depends on the severity of the poisoning.

Signs:

Involuntary movements of the eyeballs
gait disorder,
hysterical states,
depression, apathy,
Sleep disturbance,
Convulsive manifestations of the limbs.

With the correct and timely treatment of intoxication with barbiturates, such symptoms will gradually disappear, emergency care plays an important role.

Barbiturate Poisoning: First Aid

If signs of barbiturate poisoning are found, a medical team should be called immediately. Before their arrival, it is allowed to try to provide first aid to the victim to alleviate his condition. What to do in case of acute poisoning?

How to help:

The patient is given to take at least a liter of water, provoke vomiting. Repeat this procedure until the water comes out without impurities.
After the end of the procedure, the victim is given a drink - a,.
It is allowed to use a cleansing enema to more quickly remove the toxin from the body.
The victim is provided with peace, laid down and covered with a blanket.
In the absence of consciousness, such a cleansing of the stomach is not allowed.

Further treatment is carried out in the intensive care unit, resuscitation.

When should you see a doctor?

In case of intoxication with barbiturates, it is required to consult a doctor in any case. The doctor will conduct an examination and prescribe the appropriate treatment. Therapy includes a number of actions that contribute to the normalization of the patient's condition.

What happens:

Using a gastric emptying tube
Saline laxatives are prescribed
Formed diuresis is carried out,
If necessary, connect the device for artificial ventilation of the lungs,
Plasmapheresis, hemosorption,
To restore the work of the respiratory process, special means are used to stimulate breathing (antagonists) - Bemegrid,
If necessary, hormonal preparations are used.

Treatment of intoxication with barbiturates is carried out until complete recovery, vitamin complexes and proper nutrition are selected.

Complications and prevention

What happens to a person after recovery? What are the consequences of an overdose?

Effects:

Diseases of the bronchi and lungs
Swelling of the lungs and brain,
Suffocation,
Psychological disorders.

Preventive measures are quite simple. It is required to carefully observe the prescribed dosage, not to exceed it and not to engage in self-treatment. Preparations are stored in places inaccessible to children.

Poisoning with barbiturates can lead to unpleasant consequences and death in the absence of proper and timely treatment. It is possible to avoid an overdose if preventive measures are observed.

Below is a video about harm, interesting and informative

About the dangers of barbiturates - video

The lethal dose is from 4 to 8 g (depending on the toxicity of the drug and individual perception). Barbiturates are often used in domestic suicide attempts. Barbiturates of average (barbamil, veronal, medinal) and long-acting (phenobarbital, barbital) include most of the sleeping pills. O.'s course depends on the dose of the drug. Drowsiness, slurred speech, absence of a gag reflex, deep and rare breathing, dilated pupils are noted. As the severity of the condition increases, the patient has a frequent pulse of weak filling, a decrease in blood pressure, Cheyne-Stokes breathing with a transition to frequent superficial. In the future, there may be respiratory arrest.

Treatment. If more than 6 hours have passed since the intake of barbiturates, gastric lavage is not performed so that the lavage water through the open pyloric sphincter does not enter the intestine and does not contribute to the dissolution and absorption of the poison. In this case, it is better to suck out the contents of the stomach, followed by administration of enterosorbents.

If there are signs of respiratory failure, the patient is transferred to a ventilator. Accelerated release of the body from barbiturates is carried out using forced diuresis in combination with plasma alkalization with 4% sodium bicarbonate solution and replenishment of blood electrolytes under the control of CVP, hematocrit, diuresis.

The early use of piracetam in large doses contributes to the acceleration of the exit from the coma. An effective way to cleanse the blood of barbiturates is hemosorption. The treatment includes large doses of vitamins, vascular agents, glucocorticoids, antibiotics, cardiac glycosides.

Drug poisoning.

Opium tincture, morphine, codeine phosphate, fentanyl, omnopon, promedol. Routes of drug entry into the body: intravenous, intramuscular, s / c, oral and inhalation. When it enters the bloodstream, morphine is partially excreted with bile into the intestinal lumen with subsequent reabsorption, and is also excreted with feces, urine, saliva and sweat. When taken orally, opiates are rapidly absorbed in the stomach and continue to be absorbed in the intestines. They cause spasm of the pyloric sphincter, which leads to their prolonged stay in the stomach.

Signs of depression of the function of the central nervous system and gastrointestinal tract come to the fore. BP is reduced. A convulsive syndrome, toxic coma, ARF (bronchospasm, increased bronchial secretion, pulmonary edema, respiratory failure up to apnea) and acute cardiovascular insufficiency develop.

In the initial stages of poisoning, euphoria is observed, which is replaced by drowsiness. There is tinnitus, dizziness, dry mouth, nausea, vomiting. Then stupor and coma. Characterized by a sharp narrowing of the pupils to the size of a pinhead (miosis) with no reaction to light. In severe hypoxic coma, the pupils dilate. There may be a delay in urination and defecation.

Blood pressure is reduced, bradycardia, cardiac arrhythmia, there is a violation of pain sensitivity.

In case of severe and extremely severe poisoning, a deep or transcendental coma (terminal), miosis, bradypnea 4-8 in 1 minute develops. Pathological types of breathing are noted. There is no reaction of pupils to light, corneal, pharyngeal reflexes, as well as a reaction to pain stimulation. Body temperature is reduced.

Treatment. 1) repeated gastric lavage is mandatory, even if the drug is administered parenterally; 2) activated charcoal, saline laxatives; 3) alkalization of blood; 4) morphine antagonists (3 ml of a 0.5% solution of nalorphine - s / c or / in repeatedly, antidote therapy) and 1-2 ml of a 0.1% solution of atropine sulfate; 5) oxygen therapy, according to indications - mechanical ventilation; 6) forced diuresis; 7) body warming.