- The document discusses the history and development of barbiturates, which were originally synthesized in the 19th century as hypnotic compounds. Barbiturates were widely prescribed as sedatives until being displaced by benzodiazepines in the 1960s due to issues with abuse and overdose.
- Barbiturates are classified based on duration of action and examples are provided. Their pharmacological properties and mechanisms of action in the central nervous system, respiratory system, and elsewhere are described. Adverse effects, signs of toxicity, and treatment approaches for barbiturate poisoning are outlined.
All about barbiturate poisoning , causes , clinical symptoms , types of poisoning , barbiturates classification , adverse effects and toxic effects of barbiturate poisoning , Management of barbiturate poisoning , Scandinavian method , support vital function , prevention and further absorption .
"Barbiturate poisoning" : By rxvichu-alwz4uh!RxVichuZ
Hello buddies!!!
Its Vishnu..back again , with my 17th ppt...
This time, its regarding BARBITURATE POISONING....which is of relevance in the subject CLINICAL TOXICOLOGY, studied in 4th year............
It includes all the required details for BARBITURATE POISONING....Along with fatal doses, and management strategies.............
This will be of help for reading and reference , and also for 4th year students...................
THANKS FOR READING!! DO KEEP SENDING UR REVIEWS!!
Regards and love,
rxvichu-alwz4uh! :) :)
All about barbiturate poisoning , causes , clinical symptoms , types of poisoning , barbiturates classification , adverse effects and toxic effects of barbiturate poisoning , Management of barbiturate poisoning , Scandinavian method , support vital function , prevention and further absorption .
"Barbiturate poisoning" : By rxvichu-alwz4uh!RxVichuZ
Hello buddies!!!
Its Vishnu..back again , with my 17th ppt...
This time, its regarding BARBITURATE POISONING....which is of relevance in the subject CLINICAL TOXICOLOGY, studied in 4th year............
It includes all the required details for BARBITURATE POISONING....Along with fatal doses, and management strategies.............
This will be of help for reading and reference , and also for 4th year students...................
THANKS FOR READING!! DO KEEP SENDING UR REVIEWS!!
Regards and love,
rxvichu-alwz4uh! :) :)
Gut decontamination or methods of poison removal in clinical toxicology Soujanya Pharm.D
This presentation includes various methods of poison removal like emesis, gastric lavage (stomach wash), catharsis, activated charcoal, whole bowel irrigation.
Please find the power point on Organophosphate poisoning and its management. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This presentation was given by me during my M.pharm.
It contains description, classification, mechanism of actions and therapeutic uses of Neuromuscular blockers.
Gut decontamination or methods of poison removal in clinical toxicology Soujanya Pharm.D
This presentation includes various methods of poison removal like emesis, gastric lavage (stomach wash), catharsis, activated charcoal, whole bowel irrigation.
Please find the power point on Organophosphate poisoning and its management. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This presentation was given by me during my M.pharm.
It contains description, classification, mechanism of actions and therapeutic uses of Neuromuscular blockers.
Briefly describe sedative hypnotic drug with their classification and mechanism , therapeutic effect , adverse effect and dose preparation . this presentation is useful for pharma student .
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. • Chemists and physicians have always been seeking chemical compounds that are characterized as
hypnotics, or sleeping compounds.
• The original “drugs” that met this requirement were alcohol, which was used for centuries.
• 19th century, with the beginning of discoveries in chemistry, doctors were prescribing compounds such
as paraldehyde, chloral hydrate and bromides.
• It is documented that in the 1830s, the wife of Abraham Lincoln, Mary Todd Lincoln was given chloral
hydrate for her sleep problems.
HISTORY
3. THE HISTORY OF THE DEVELOPMENT OF BARBITURATES IS AS
BIZARRE AS THE EFFECTS OF THE DRUG ITSELF
• Its founder was a German chemist, Adolph von Baeyer, the person who founded Bayer Chemicals Company,
which is still a major manufacturer of analgesics and well-known and criticized for many of its pesticides and
fertilizers.
• The barbiturates are derivatives of barbituric acid (2,4,6-trioxohexahydropyrimidine)
and were extensively used as sedativehypnotics
• Till the 1960s when the benzodiazepines arrived and quickly displaced them.
4. WHY NAMED BARBI-TURATE ?
• In 1864, Bayer was working on the synthesis of a drug using urea and malonic acid.
• This synthetic drug became known as barbituric acid, named after St. Barbara’s Day.
• In those days, chemists tested drugs by tasting their discovered compounds and seeing what effects they had
on themselves or their employees.
• In 1903 he and two other chemists in Germany altered the compound and created a psychoactive drug named
“barbiturate”.
• It induced sleep and was one of the first hypnotic drugs.
• Mr. Baeyer became famous and his established chemical research won him the Nobel Prize in chemistry in
1905.
5. TYPES
• 1. Long acting (duration of action 6–12 hrs)
•
a. Mephobarbitone.
b. Phenobarbitone.
• 2. Intermediate acting (duration of action 3–6 hrs)
a. Amobarbitone
b. Aprobarbitone
c. Butobarbitone.
3. Short acting (duration of action < 3 hrs)
a. Hexobarbitone
b. Pentobarbitone
c. Secobarbitone.
4. Ultra-short acting (duration of action <15–20
min)
a. Thiopentone
b. Methohexitone.
6.
7.
8.
9.
10.
11.
12.
13.
14. PHARMACOLOGICAL PROPERTIES
• CNS – Suppression post synaptic neurons of cortical and cerebellar pyramidal cell response & pre
synaptic suppression in spinal cord.
Mild sedation to general anaesthesia.
• Sleep
increase in total time of sleep
decrease in sleep latency, number of awakening,duration of REM and slow wave sleep.
• Tolerance
occurs within few days.
Sleep time decreased as much as 50% after 2 weeks.
Cross tolerance to all CNS depressants including ETHANOL
15. • PNS:
DECREASES autonomic ganglionic transmission and nicotinic excitation by choline esters = low BP.
• RESPIRATION:
DEPRESS Resp. drive and mechanism responsible for rhythmic character of respiration.
• CVS:
DECREASED BP and HR = decreased Renal & Cerebral Blood flow.
When used with epinephrine and Halothane = ventricular Arrhythmia.
• RENAL : Oliguric Renal Failure.
• GI:
DECREASES tone of musculature and amplitude of rhythmic contraction.
16. • LIVER:
Alters MICROSOMAL DRUG METABOLISING SYSTEM i.e,CYPs
increase DELTA ALA synthase exacerbates Acute intermittent porphyria.
• EXCRETION : RENAL AND HEPATIC
17. USUAL FATAL DOSE
■ Phenobarbitone: 6 to 10 grams.
■ Amobarbitone, pentobarbitone, secobarbitone: 2 to 3 grams.
■ Lethal blood level for short- and intermediate-acting barbiturates varies from 3 to 4 mg/100 ml,
18. Toxicokinetics
■ Most barbiturates which are used as sedative-hypnotics are administered orally. Intravenous route is usually reserved
for management of status epilepticus or induction/maintenance of general anaesthesia.
■ Following absorption, barbiturates are distributed widely. The long acting barbiturates have a plasma half-life of
about 80 hours.
■ Metabolism of most of these drugs occurs by oxidation in the liver resulting in the formation of alcohols, ketones,
phenols, or carboxylic acids which are excreted in the urine as such or in the form of glucuronic acid conjugates.
Metabolism of barbiturates is more rapid in children and is slower in the elderly.
19. Adverse Effects
■ Residual depression after the main effect of the drug has passed off.
■ Paradoxical excitement (especially in the elderly).
■ Hypersensitivity reaction—localised swelling of eyelid,cheek, or lip, erythematous or exfoliative dermatitis.
■ Synergistic action with ethanol and antihistamines.
■ Barbiturates are contraindicated in patients with acute intermittent
porphyria since they enhance porphyrin synthesis.
20. Clinical (Toxic) Features
1. Slurred speech, ataxia, lethargy, confusion, headache,nystagmus.
2. CNS depression, coma, shock.
3. Pupils are at first constricted, but later dilate because of hypoxia.
4. Hypothermia.
5. Cutaneous bullae (“barb burns”, barbiturate blisters): These are clear, erythematous or haemorrhagic blisters, and
occur in various areas of the body, most typically on the hands, buttocks, and between the ankles and knees, usually
over pressure points. These lesions have also been reported over non-pressure points, such as dorsal surfaces of fingers
and toes, and ocular conjunctiva.
21. 6. Death may occur from respiratory arrest or cardiovascular collapse. Delayed death may be due to acute renal
failure,pneumonia, pulmonary oedema, or cerebral oedema.
7. Chronic barbiturate (ab)use is associated with the development of tolerance which is responsible for decreasing the
therapeutic to toxic index. An addict may obtain therapeutic benefit only with 5 to 6 times the normal dose. Abrupt
withdrawal results in anorexia, tremor, insomnia, cramps,seizures, delirium, and orthostatic hypotension.
22. Diagnosis
1. Serial plasma levels may be useful in the management of phenobarbitone overdose.
Plasma levels exceeding 8 mg/dL (80 mcg/mL) (344 mcmol/L) are generally associated
with some degree of coma.
2. EEG: alpha coma* indicates poor prognosis.
{Alpha coma, an electroencephalogram (EEG) pattern, characterized by a diffuse or
widespread rhythmic activity in the alpha frequency band, is typically recorded in
patients with profound coma].
23. Treatment
1.Monitor CBC, serum electrolytes, glucose, blood urea nitrogen,creatinine, and urine myoglobin in patients with
significant intoxication.
2.The onset of toxic effects is usually within 2 hours, but peak toxicity may not occur for 18 or more hours.
Repeat serum phenobarbitone level at approximately 6 hours after the initial level.
3. Gastric lavage (preferably with a large-bore, double-lumen tube), can be done with benefit upto 12 to 24 hours
postingestion.
4. Multiple dose activated charcoal has been shown to greatly increase phenobarbitone elimination.
24. 5. Forced alkaline diuresis is said to be particularly useful in phenobarbitone poisoning .
no value in the treatment of short acting barbiturate intoxication.
6. ■ Haemodialysis or haemoperfusion:
Barbiturate elimination can be increased by haemodialysis or charcoal haemoperfusion.
Even though haemoperfusion can clear barbiturates two to four times more rapidly than dialysis, haemoperfusion will not
correct electrolyte imbalances, and has been associated with platelet consumption, hypothermia, hypotension, and
decreased serum calcium.
7. ■ Exchange transfusion may be beneficial in severe cases.
8.For hypotension: First administer 10 to 20 ml/kg of isotonic intravenous fluids and place in Trendelenburg position.
If the patient is unresponsive to isotonic fluid therapy administer a vasopressor. Dopamine or noradrenaline should be titrated
to desired response.
25. ■ Supportive measures: supplemental oxygen, intubation, assisted ventilation,
IV fluids.
■ Withdrawal may be treated by reinstitution of phenobarbitone, and a
programme of gradual reduction over three weeks. A tapering schedule of 10
percent every 3 days has been used successfully.
■ The incidence of poisoning with barbiturates has declined dramatically in
recent years as a direct result of decline
in their use as sedative-hypnotics.
This type of (suicidal) poisoning was rampant in the 1960s when these drugs
were widely prescribed and
consequently abused.
One of the most famous cases during this period concerned immortal
Hollywood actress Marilyn Monroe who at the end of her short, tempestuous
career became hopelessly addicted to alcohol and barbiturates.In 1962, at the
age of 36, Marilyn Monroe was found dead at home following an overdose of
barbiturates.
26. ■ Intravenous thiopentone has been used as truth serum. This controversial practice
is closely related to the legitimate psychiatric practice of narcoanalysis used to diagnose certain mental ailments
by placing the patient in a reclining position and administering amylobarbitone or some other short-acting
barbiturate intravenously until lateral nystagmus is induced or drowsiness is noted, when the interview is begun
and sustained in a gentle fashion with periodic maintenance doses of the drug. This is sometimes referred to as
the “Amytal interview”,
Amytal being a popular trade name for amylobarbitone in Some Western countries.
“TRUTH SERUM”
27. Case Report
An 18-year old girl was admitted in the medicine department in an unconscious state with no response to deep painful stimuli
(Grade III coma).
History as elicited from her attendants was suggestive of oral intake of phenobarbitone tablets a night before, after which the
patient was not arousable in the morning.
There was no history of convulsions, vomiting, urinary incontinence or tongue bite. Within few hours of admission,
patient became febrile and tachypnoeic with pulse rate 130 min-1, blood
pressure 120/70 mmHg and arterial oxygen saturation 93%.
Pupils were of normal size and reaction. Plantar and deep tendon reflexes were absent.
A diagnosis of barbiturate poisoning was made and patient was shifted to ICU. Shortly after admission, she had tonic clonic
convulsions which subsided after few seconds spontaneously. She became increasingly tachypnoeic and oxygen saturation
started falling. Blood gas analysis done showed hypocarbia with metabolic acidosis. She was intubated nasally and ventilated by
Evita-2 (Drager) ventilator on intermittent positive pressure ventilation mode with tidal volume 400 ml, FiO2-80% and frequency
– 14/min.
28. Continuous temperature monitoring was done and care was taken to avoid hypothermia.
Antibiotics, phenytoin, ranitidine, low dose dopamine and bronchodilator were started. In
addition, ten tablets of activated charcoal 500mg (5g) with egg albumin were given four hourly
through Ryle’s tube.
Forced alkalinediuresis was started. One litre of lactated Ringer solution was rushed and
injection sodabicarbonate 50cc was given intravenously six hourly. Aim was to keep urinary pH
between 8-8.5. Her serum potassium was 2.5.eq lt-1 and SGOT and SGPT were 118 IU and 99IU
respectively.
Serum proteins were 6g%. Urine was positive for ketone bodiesand serum barbiturate assay was
positive. As her consciousness level did not improve, haemodialysis was planned. Haemodialysis
was done using Sresenius Haemodialyser. Within hours, the patient’s condition improved and
she stared responding to verbal commands. Her vitals were stable. She was extubated once
regular spontaneous respiration was restored.
Oxygen therapy with ventimask (FiO2 – 60%) was instituted. Gradually, the patient was weaned
to FiO2 of 28%. SGOT and SGPT were still elevated (222 IU and 240 IU respectively). Repeat
serum assay now revealed no residual barbiturate.
She was discharged home a week later