Barbiturate toxicity


  • Death most commonly due to respiratory arrest and cardiovascular collapse
  • Assume severe poisoning if >10x hypnotic dose has been ingested

Clinical Features

Mild-moderate toxicity

  • Resembles ETOH intoxication

Severe toxicity

Differential Diagnosis

Sedative/hypnotic toxicity


  1. Airway assessment and stabilization
    • Mechanical ventilation often required
  2. Hypotension
  3. Hypothermia
    • Rewarming measures
  4. GI Decontamination
    • Activated charcoal x1 if present within 1hr of ingestion
    • Multi-dose activated charcoal
      • Consider only if patient has ingested life-threatening amount of phenobarbital
      • Give 50-100gm PO initially; follow by 12.5-25gm PO q4hr
  5. Urinary alkalinization
    • Less effective than multi-dose activated charcoal
  6. Dialysis
    • Only effective for phenobarbital (long-acting barb)
    • Reserved for patients who are deteriorating despite aggressive supportive care


  • Consider discharge if improvement in neuro status / vital signs over 6-8hr
  • Evidence of toxicity after 6hr requires admission

See Also


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