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Barbiturate overdose is
poisoning A poison can be any substance that is harmful to the body. It can be swallowed, inhaled, injected or absorbed through the skin. Poisoning is the harmful effect that occurs when too much of that substance has been taken. Poisoning is not to ...
due to excessive doses of barbiturates. Symptoms typically include difficulty thinking, poor coordination, decreased
level of consciousness An altered level of consciousness is any measure of arousal other than normal. Level of consciousness (LOC) is a measurement of a person's arousability and responsiveness to stimuli from the environment. A mildly depressed level of consciousn ...
, and a decreased effort to breathe ( respiratory depression). Complications of
overdose A drug overdose (overdose or OD) is the ingestion or application of a drug or other substance in quantities much greater than are recommended.
can include noncardiogenic pulmonary edema. If death occurs this is typically due to a lack of breathing. Barbiturate overdose may occur by accident or purposefully in an attempt to cause death. The toxic effects are additive to those of alcohol and benzodiazepines. The lethal dose varies with a person's tolerance and how the drug is taken. The effects of barbiturates occur via the GABA neurotransmitter. Exposure may be verified by testing the urine or blood. Treatment involves supporting a person's breathing and blood pressure. While there is no
antidote An antidote is a substance that can counteract a form of poisoning. The term ultimately derives from the Greek term φάρμακον ἀντίδοτον ''(pharmakon) antidoton'', "(medicine) given as a remedy". Antidotes for anticoagulants are s ...
, activated charcoal may be useful. Multiple doses of charcoal may be required.
Hemodialysis Hemodialysis, also spelled haemodialysis, or simply dialysis, is a process of purifying the blood of a person whose kidneys are not working normally. This type of dialysis achieves the extracorporeal removal of waste products such as creatinin ...
may occasionally be considered. Urine alkalinisation has not been found to be useful. While once a common cause of overdose, barbiturates are now a rare cause.


Mechanism

Barbiturates increase the time that the chloride pore of the GABAA receptor is opened, thereby increasing the efficacy of GABA. In contrast, benzodiazepines increase the frequency with which the chloride pore is opened, thereby increasing GABA's potency.


Treatment

Treatment involves supporting a person's breathing and blood pressure. While there is no
antidote An antidote is a substance that can counteract a form of poisoning. The term ultimately derives from the Greek term φάρμακον ἀντίδοτον ''(pharmakon) antidoton'', "(medicine) given as a remedy". Antidotes for anticoagulants are s ...
, activated charcoal may be useful. Multiple doses of charcoal may be required.
Hemodialysis Hemodialysis, also spelled haemodialysis, or simply dialysis, is a process of purifying the blood of a person whose kidneys are not working normally. This type of dialysis achieves the extracorporeal removal of waste products such as creatinin ...
may occasionally be considered. Urine alkalinisation has not been found to be useful. If a person is drowsy but awake and can swallow and breathe without difficulty, the treatment can be as simple as monitoring the person closely. If the person is not breathing, it may involve mechanical ventilation until the drug has worn off. Psychiatric consult is generally recommended.


Notable cases

People who are known to have died by suicide from barbiturate overdose include, Gillian Bennett,
Charles Boyer Charles Boyer (; 28 August 1899 – 26 August 1978) was a French-American actor who appeared in more than 80 films between 1920 and 1976. After receiving an education in drama, Boyer started on the stage, but he found his success in American fi ...
,
Ruan Lingyu Ruan Lingyu (born Ruan Fenggen; April 26, 1910 – March 8, 1935), also known by her English name Lily Yuen, was a Chinese silent film actress. One of the most prominent Chinese film stars of the 1930s, her exceptional acting ability and suicid ...
,
Victor Folke Nelson Victor Folke Nelson (June 5, 1898 – December 9, 1939) was a Swedish-American writer,"Prison Ethics." ''The Tennessean''. March 6, 1933."Bound to be Read." ''The Evening Sentinel''. Carlisle, Pa. March 16, 1933."The Articulate Convict Studies Pri ...
, City of Boston Registry, Certificate of Death record for Victor Folke Nelson, No. 10407, filed 14 December 1939."Dr. Brickley Says Nelson Took Poison." ''The Boston Globe''. 11 December 1939.
Dalida Iolanda Cristina Gigliotti (; 17 January 1933 – 3 May 1987), professionally known as Dalida, was an Italian-French singer and actress born in Egypt. She sang in eleven languages and sold millions of records internationally. Her best known son ...
, Jeannine "The Singing Nun" Deckers,
Felix Hausdorff Felix Hausdorff ( , ; November 8, 1868 – January 26, 1942) was a German mathematician who is considered to be one of the founders of modern topology and who contributed significantly to set theory, descriptive set theory, measure theory, an ...
, Abbie Hoffman,
Phyllis Hyman Phyllis Linda Hyman (July 6, 1949 – June 30, 1995) was an American singer, songwriter, and actress. Hyman is best known for her music during the late 1970s through the early 1990s, some of her most notable songs were "You Know How to Love Me" ...
,
Marilyn Monroe Marilyn Monroe (; born Norma Jeane Mortenson; 1 June 1926 4 August 1962) was an American actress. Famous for playing comedic " blonde bombshell" characters, she became one of the most popular sex symbols of the 1950s and early 1960s, as wel ...
,
C. P. Ramanujam Chakravarthi Padmanabhan Ramanujam (9 January 1938 – 27 October 1974) was an Indian mathematician who worked in the fields of number theory and algebraic geometry. He was elected a fellow of the Indian Academy of Sciences in 1973. Like his ...
,
George Sanders George Henry Sanders (3 July 1906 – 25 April 1972) was a British actor and singer whose career spanned over 40 years. His heavy, upper-class English accent and smooth, bass voice often led him to be cast as sophisticated but villainous chara ...
,
Carole Landis Carole Landis (born Frances Lillian Mary Ridste; January 1, 1919 – July 5, 1948) was an American actress and singer. She worked as a contract player for Twentieth Century-Fox in the 1940s. Her breakout role was as the female lead in the 1940 ...
,
Jean Seberg Jean Dorothy Seberg (; ; November 13, 1938August 30, 1979) was an American actress who lived half of her life in France. Her performance in Jean-Luc Godard's 1960 film ''Breathless'' immortalized her as an icon of French New Wave cinema. Seb ...
,
Lupe Vélez María Guadalupe Villalobos Vélez (July 18, 1908 – December 13, 1944), known professionally as Lupe Vélez, was a Mexican actress, singer and dancer during the Golden Age of Hollywood cinema. Vélez began her career as a performer in Mexican ...
and the members of Heaven's Gate cult. Others who have died as a result of barbiturate overdose include Pier Angeli,
Brian Epstein Brian Samuel Epstein (; 19 September 1934 – 27 August 1967) was a British music entrepreneur who managed the Beatles from 1962 until his death in 1967. Epstein was born into a family of successful retailers in Liverpool, who put him i ...
,
Judy Garland Judy Garland (born Frances Ethel Gumm; June 10, 1922June 22, 1969) was an American actress and singer. While critically acclaimed for many different roles throughout her career, she is widely known for playing the part of Dorothy Gale in '' The ...
, Jimi Hendrix,
Inger Stevens Inger Stevens (born Ingrid Stensland; October 18, 1934 – April 30, 1970) was a Swedish-American film, stage and Golden Globe-winning television actress. Early life Inger Stevens was born in Stockholm, Sweden, the eldest child of Per ...
,
Dinah Washington Dinah Washington (born Ruth Lee Jones; August 29, 1924 – December 14, 1963) was an American singer and pianist, who has been cited as "the most popular black female recording artist of the 1950s songs". Primarily a jazz vocalist, she performe ...
,
Ellen Wilkinson Ellen Cicely Wilkinson (8 October 1891 – 6 February 1947) was a British Labour Party politician who served as Minister of Education from July 1945 until her death. Earlier in her career, as the Member of Parliament (MP) for Jarrow, s ...
, and Alan Wilson; in some cases these have been speculated to be suicides as well. Those who died of a combination of barbiturates and other drugs include
Rainer Werner Fassbinder Rainer Werner Fassbinder (; 31 May 1945 – 10 June 1982), sometimes credited as R. W. Fassbinder, was a German filmmaker. He is widely regarded as one of the major figures and catalysts of the New German Cinema movement. Fassbinder's main ...
, Dorothy Kilgallen, Malcolm Lowry,
Edie Sedgwick Edith Minturn Sedgwick Post (April 20, 1943 – November 16, 1971) was an American actress and fashion model, known for being one of Andy Warhol's superstars.Watson, Steven (2003), "Factory Made: Warhol and the Sixties" Pantheon Books, pp. 210& ...
and
Kenneth Williams Kenneth Charles Williams (22 February 1926 – 15 April 1988) was an English actor of Welsh heritage. He was best known for his comedy roles and in later life as a raconteur and diarist. He was one of the main ensemble in 26 of the 31 '' ...
.
Dorothy Dandridge Dorothy Jean Dandridge (November 9, 1922 – September 8, 1965) was an American actress, singer and dancer. She is the first African-American film star to be nominated for the Academy Award for Best Actress, which was for her performance in '' C ...
died of either an overdose or an unrelated
embolism An embolism is the lodging of an embolus, a blockage-causing piece of material, inside a blood vessel. The embolus may be a blood clot (thrombus), a fat globule (fat embolism), a bubble of air or other gas ( gas embolism), amniotic fluid (am ...
.
Ingeborg Bachmann Ingeborg Bachmann (25 June 1926 – 17 October 1973) was an Austrian poet and author. Biography Bachmann was born in Klagenfurt, in the Austrian state of Carinthia, the daughter of Olga (née Haas) and Matthias Bachmann, a schoolteacher. Her f ...
may have died of the consequences of barbiturate withdrawal (she was hospitalized with burns, the doctors treating her not being aware of her barbiturate addiction). Maurice Chevalier attempted suicide in March 1971 by swallowing a large amount of barbiturates and slitting his wrists. While he lived, he suffered severe organ damage as a result and died from multiple organ failure nine months later.


Differential diagnosis

The differential diagnosis should include intoxication by other substances with sedative effects, such as benzodiazepines, anticonvulsants (
carbamazepine Carbamazepine (CBZ), sold under the trade name Tegretol among others, is an anticonvulsant medication used primarily in the treatment of epilepsy and neuropathic pain. It is used as an adjunctive treatment in schizophrenia along with other m ...
), alcohols (
ethanol Ethanol (abbr. EtOH; also called ethyl alcohol, grain alcohol, drinking alcohol, or simply alcohol) is an organic compound. It is an alcohol with the chemical formula . Its formula can be also written as or (an ethyl group linked to a ...
,
ethylene glycol Ethylene glycol (IUPAC name: ethane-1,2-diol) is an organic compound (a vicinal diol) with the formula . It is mainly used for two purposes, as a raw material in the manufacture of polyester fibers and for antifreeze formulations. It is an odo ...
, methanol), opioids,
carbon monoxide Carbon monoxide (chemical formula CO) is a colorless, poisonous, odorless, tasteless, flammable gas that is slightly less dense than air. Carbon monoxide consists of one carbon atom and one oxygen atom connected by a triple bond. It is the simple ...
, sleep aids, and gamma-Hydroxybutyric acid (GHB – a known
date rape Date rape is a form of acquaintance rape and dating violence. The two phrases are often used interchangeably, but date rape specifically refers to a rape in which there has been some sort of romantic or potentially sexual relationship between ...
drug). Natural disease that can result in disorientation may be in the differential, including
hypoglycemia Hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's triad is used to properly identify hypoglycemic episodes. It is defined as blood glucose bel ...
and
myxedema coma Myxedema coma is an extreme or decompensated form of hypothyroidism and while uncommon, is potentially lethal. A person may have laboratory values identical to a "normal" hypothyroid state, but a stressful event (such as an infection, myocardia ...
. In the right setting,
hypothermia Hypothermia is defined as a body core temperature below in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe ...
should be ruled out.


References


External links

{{Poisoning and toxicity Poisoning by drugs, medicaments and biological substances Barbiturates Suicide methods Wikipedia medicine articles ready to translate Wikipedia emergency medicine articles ready to translate