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Critical Care Toxicology pp 955–964Cite as

Barbiturates

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Abstract

Barbiturates were originally introduced as sedative-hypnotics and anticonvulsants in the early 1900s. Secondary to the frequency of their prescription and illicit use, unintentional/intentional overdoses and the ensuing toxicities became commonplace. Barbiturates are hazardous and have the highest risk of morbidity and mortality among all sedative-hypnotics [1]. The use of newer, relatively less-toxic medications (such as benzodiazepines) has largely supplanted the routine use of barbiturates. As a result, the incidence of serious toxicity related to barbiturate use has declined. Nevertheless, barbiturates are occasionally used today. Examples include phenobarbital and butalbital, which currently are prescribed for seizure disorders and migraine headaches, respectively [2]. Phenobarbital is also often employed to treat moderate-to-severe γ-aminobutyric acid (GABA)-agonist withdrawal [3]. Primidone, used as an anticonvulsant and in management of GABA-agonist withdrawal, is metabolized to phenobarbital [4]. Barbiturates such as methohexital are used for induction of anesthesia, and pentobarbital is commonly relied on for control of intracranial pressure and status epilepticus in intensive care units [5, 6]. Barbiturates are sometimes used as adjunctive therapy for neonatal hyperbilirubinemia [7]. Illicit drug use also may involve barbiturates because of their high abuse potential. These agents have also been employed in self-harm gestures, particularly in those populations with access to these medications, such as healthcare and veterinary workers. Consequently, clinicians must be aware of the potential toxicities due to accidental or intentional ingestions of barbiturates and remain astute as to the potential addictive properties of barbiturates, with the attendant risk for tolerance and abstinence-induced withdrawal. Finally, secondary to their potent clinical effects, these agents have been employed in criminal poisonings and suicide attempts. [8, 9]

Keywords

  • Barbiturate
  • Sedative
  • Hypnotic
  • Seizure

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Author information

Authors and Affiliations

  1. Division of Medical Toxicology, Einstein Medical Center, Philadelphia, PA, USA

    Steven J. Walsh

  2. University of South Florida Morsani School of Medicine, Tampa, FL, USA

    Kenneth D. Katz

  3. Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA

    Kenneth D. Katz

  4. Medical Toxicology and Emergency Medicine Core Faculty, Lehigh Valley Health Network, Allentown, PA, USA

    Kenneth D. Katz

Authors
  1. Steven J. Walsh
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Corresponding author

Correspondence to Steven J. Walsh .

Editor information

Editors and Affiliations

  1. Department of Medicine, Division of Clinical Pharmacology and Toxicology, University of Colorado, School of Medicine, Aurora, Colorado, USA

    Jeffrey Brent

  2. FDA, Office of New Drugs/Immediate Office, Center for Drug Evaluation and Research, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas’ Hospital, Silver Spring, Maryland, USA

    Paul Dargan

  4. Toxicology Associates, University of Colorado, School of Medicine, Denver, Colorado, USA

    Benjamin Hatten

  5. Medical Toxicological Intensive Care Unit, Lariboisiere Hospital, Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. Toxicology Associates, University of Colorado, School of Medicine, Denver, Colorado, USA

    Robert Palmer

  7. Toxinology Department, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia

    Julian White

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

  1. I

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2

    Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.

  4. II-3

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III

    Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.

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Walsh, S.J., Katz, K.D. (2017). Barbiturates. In: , et al. Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-17900-1_13

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