Barbiturates (Phenobarbital, Barbamil, Eta-Minal-Sodium).

Barbiturates (Phenobarbital, Barbamil, Eta-Minal-Sodium)

Barbiturates have a selective psychotropic (hypnotic, narcotic) effect. There are four stages of intoxication.

Stage I - drowsiness, apathy, contact with the patient can be established; moderate miosis with a lively reaction to light, bradycardia during shallow sleep, hypersalivation.

Stage II (superficial coma) - complete loss of consciousness, preserved reaction to painful stimulation, weakened pupillary and corneal reflexes, unstable neurological symptoms (decreased or increased reflexes, muscle hypotonia or hypertension, transient pathological reflexes of Babinsky, Rossolimo). Breathing disorders due to hypersalivation, bronchorrhea, tongue retraction, aspiration of vomit.

Stage III (deep coma) - a sharp decrease or absence of corneal and tendon reflexes, lack of response to painful stimulation. The pupils are narrow and do not react to light (in the terminal stage they can dilate). Breathing is rare, shallow, pulse is weak, cyanosis. Diuresis is reduced. In case of prolonged coma (over 12 hours), the development of bronchopneumonia, collapse, deep bedsores and septic complications, impaired liver and kidney function is possible.

In the postcomatose period (stage IV) - unstable neurological symptoms (ptosis, unsteady gait, etc.), emotional lability, depression, thromboembolic complications; Bedsores are typical in the area of ​​the buttocks, sacrum, back, and heels.

The lethal dose is approximately 10 times the therapeutic dose (there are large individual differences).

Treatment:

1. Repeated gastric lavage (in comatose patients - after preliminary tracheal intubation) after 3-4 hours until consciousness returns; introduction of activated carbon. Water-alkaline load in stage I, forced diuresis in combination with alkalization of the blood during the development of coma.

2. Cordiamine (2-3 ml) s.c.

3. Intensive infusion therapy (polyglucin, reopoliglucin, hemodez), vitamin therapy for the treatment of hypoxic damage to the central nervous system. For low blood pressure - norepinephrine in combination with dopamine, cardiac glycosides. It is advisable to administer heparin early, carefully care for the patient, and prevent trophic disorders.