Barbiturates
Introduction
● It is also sedative, hypnotic type of cerebral
poison, used in medical practice as such &
as anesthetics, antiepileptic, in psychotic
disorders, in strychnine poisoning
● It is basically derived from barbituric acid
Classification
● Long acting:
Acts within 1-12 hours-
phenobarbitone, barbitone, etc.
● IntermediateLoading…
acting:
Acts within ½-8 hours-
allobarbitone, amylobarbitone, etc.
Contd.
● Short acting:
Acts within ¼-4 hours-
cyclobarbitone, hexabarbitone, etc.
Contd.
● Ultra short acting barbiturates:
Acts immediate & give adequate
anesthetic effect-
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Thyopentone sodium
Methohexobarbitone, etc.
Action
● At all levels of CNS, it acts as a
depressant, degree of depression altered
from mere tranquility to deep coma with
altering dose
● It can act synergistically with analgesics
and such other drugs, such as with
alcohol it increases the action of alcohol
Contd.
● It has cumulative effects as it’s metabolism
& excretion is very slow
Signs/Symptoms
● Acute intoxication presenting in three
stages such as:
1. Early manifestations
2. Late manifestations
3. Coma & death
● Barbiturates automatism
● Chronic intoxication
Acute Intoxication
● Early manifestations are:
Giddiness, ataxia, slurred speech initially
● Which is followed by:
Stupor
The limbs become flaccid, reflexes lost,
there may be diplopia, pupil may show
hippus (alternate dilatation and contraction)
Contd.
● Late manifestation as the poisoning
advances:
Face tends to become cyanotic
progressively, respiration slow, sighing &
periodic (Chine-Stokes) to turn soon rapid
and shallow, fall of blood pressure,
subnormal body temperature, oliguria with
urine containing albumin and sugar
Contd.
● Coma & death:
Finally coma will supervene & death due to
respiratory failure which may occur
suddenly andLoading…
unexpectedly, lung edema,
bronchopneumonia, cardiac failure, etc.
Contd.
● Stage of Recovery:
Occasionally patient may recover
gradually from coma, but being recovered
will have- physical weakness, low blood
pressure, anemia, etc.
Contd.
● There may be dermatological changes
called barbiturates blisters which are
found at the friction areas such as axilla,
inner aspect of the knee, calves, inter
digital cleft, etc. recently considered as
“dependent blisters” due to slow venous
flow in long lying
Differential Diagnosis
● Barbiturate poisoning is to be differentiated
from carbon monoxide poisoning,
meprobamate poisoning, etc.
Barbiturate automatism
● Taking barbiturate repeatedly to get sleep
occasionally out of mental confusion is
called barbiturate automatism caused in
a patient who is suffering from insomnia
due to pain, if no analgesic is prescribed
with barbiturate resulting in mental
confusion in the patient, he or she fells not
taking the drug and compels to take more &
more tablets, ultimately toxicity develops
Medico legal importance
● Barbiturate automatism may be more
pronounced with:
● Alcohol consumption
● Intended suicide or attempting to commit
suicide
Chronic Intoxication or Addiction
● Manifestations are: Apathy, loss of power
of concentration, vertigo, tremor, ataxia,
thick speech, delirium, hallucination mostly
visual, mental disorientation, emotional
instability, etc.
● Urine will slow with albumin, sugar & casts
microscopically
Laboratory tests for confirmation of
poisoning
● All barbiturates give a violet coloration with
copper except thiocompounds
● Minute amount of the drug can be detected
& measured in protein free blood and tissue
fluid extracts by violet spectrophotometry
How to assess the severity of
poisoning?
● If there is no bowel sounds and the patient
is unconscious, suggests poisoning of
severe degree
● If the patient is in a phase of recovery, if the
bowel sounds are heard reasonably early, it
is a sign of favorable good prognosis and
recovery
Fatal dose & Fatal period
● When taken alone:
Long acting-----------------10 mg per 100
ml Intermediate acting-------7 mg
per 100 ml Short acting-----------------3 mg
per 100 ml
● When taken with alcohol:
Alcohol potentates its action & thus
even a sub lethal dose of either can bring
about death easily
Contd.
● Fatal period:
24-48 hours
● Toxicity rating:
4-5
Treatment
● Gastric lavage with potassium
per manganate and animal charcoal
● Bowel wash by enema & saline
purgatives
● Keeping the patient warm & clear airway
● Providing continuous oxygen & artificial
respiration
Contd.
● To give metarminol aramine 2.5 mg i/v at
20 minutes interval to prevent circulatory
shock
Contd.
● Analeptics may be given to stimulate the
nervous system, especially the respiratory
center which are bemigride,
amiphenazole, etc.
● Risk of analeptics are: 1.Ineffective in
severe poisoning 2. May also develop
greater depression of vital centers after
initial stimulation 3. May produce cardiac
arrhythmia & convulsions
Postmortem Findings
● Those of asphyxia mainly
● Froth in the mouth & nostrils
● Stomach may show tablets or capsules or
powder
● Edema or bronchopneumonia
● Subendocardial hemorrhage
Contd.
● Other viscera are congested
● It is detected in urine in both acute &
chronic poisoning as the drug readily
excreted by the kidneys
Contd.
● In resistant cases Cora mine is given 5 ml
i/v initially, repeated by 10 ml after 15
minutes then 20 ml every 30 minutes
● Amphetamine Loading…
sulfate 10 mg, every 30
minutes
● Dialysis/exchange transfusion is life
saving
Contd.
● Dialysis & exchange transfusion is life
saving
● Treating of chronic drug addiction patient,
withdrawal convulsion may take place in
4-5 days of stoppage of the
drug
Medico legal importance
● Most of the deaths are suicidal or
accidental by over dosage
● Addiction due to excessive use to relieve
the hurrying pace & anxieties of modern life
● Barbiturate automatism
● Simultaneous use with alcohol
That’s it
● Best of luck..
Thak you very much......
