J Korean Soc Emerg Med.  1999 Jun;10(2):294-300.

A Patient with Pulmonary Edema and Cardiac Arrest after Phenobarbital Overdose

• Lee WJ
• Rue EY
• Oh DR
• Park KN
• Kim SK
• Choi KH
• Kim YM
• Yi H
• Jeong SK

Abstract

Phenobarbital is a long-acting barbiturate causing generalized depression of neuronal activity in the brain. Its effect is primarily achieved through enhanced GABA-mediated synaptic inhibition. Its use as an antiepileptic agent was first described in 1912. Before the introduction of phenytoin, phenobarbital is used as sedative-hypnotics. It is used for the treatment of epilepsy and status epilepticus. All barbiturates, including phenobarbital, have a high potential far abuse. They were frequently used for suicide attempts in the past, but they have in large part been replaced by benzodiazepines. the onset of symptoms depends on the drug and the route of administration. Mild to moderate barbiturate intoxication resembles ethanol inebriation with slurred speech, ataxia, and lethargy. Severe acute barbiturate intoxication is life threatening. Early deaths are generally cardiovascular-related. Hypotension, shock, pulmonary edema, and cardiac arrest that occurs with large doses are caused by depression of central sympathetic tone and as well as by direct depression of cardiac contractility. The potentially fatal oral dose of phenobarbital is 6-l0g. We describe an 23-year-old woman with pulmonary edema and cardiac arrest after ingestion of 18 grams of phenobarbital. She was completely recovered by successful cardiopulmonary resuscitation and hemoperfusion. We report a case with literature review.

MeSH Terms

Ataxia
Barbiturates
Benzodiazepines
Brain
Cardiopulmonary Resuscitation
Depression
Eating
Epilepsy
Ethanol
Female
Heart Arrest*
Hemoperfusion
Humans
Hypotension
Lethargy
Neurons
Phenobarbital*
Phenytoin
Pulmonary Edema*
Shock
Status Epilepticus
Suicide
Young Adult
Barbiturates
Benzodiazepines
Ethanol
Phenobarbital
Phenytoin