Old and Cold: A Novel Case of Combined Secobarbital and Pentobarbital Poisoning in an Elderly Woman

Abstract

A 94-year-old woman was found unresponsive in her room at an independent living facility. Upon paramedic arrival, the patient had a Glasgow Coma Scale of 3, and she was transported to the emergency department (ED). In the ED, she was unresponsive but spontaneously breathing, bradycardia, and hypothermia. Serum concentrations of both secobarbital (3.3µg/mL; therapeutic 1.0-2.0µg/mL) and pentobarbital (9.5µg/mL; therapeutic < 5.0µg/mL) were detected and elevated. This type of poisoning is quite rare and should be considered in patients presenting with hypothermia and coma, even in patients showing brain death signs. The use of hemodialysis for refractory pentobarbital poisoning may be helpful.

A Case of Barbiturate Poisoning From Pentobarbital in a Young Japanese Patient

“…The treatment involved relieving the airway obstruction by inserting the nasopharyngeal airway to prevent glossoptosis, saline infusion and vasopressors for hypotension, and rewarming in an internal medicine ward. An infusion of sodium bicarbonate to promote urinary alkalinization was also administered, although the evidence of urinary alkalinization for improvement of mortality in patients with pentobarbital intoxication was limited [11]. She was also commenced on ampicillin/sulbactam for aspiration pneumonia.…”