Picrotoxin in the Treatment of Barbiturate Poisoning

Lovibond, J.L.; Steel, G. C.

doi:10.1016/s0140-6736(00)73944-4

“…Lovibond and Steel (1939) used 60 mg. over a period of 12 hours, with recovery of consciousness, and they emphasized the risk of relapse into unconsciousness if picrotoxin is discontinued too soon; this relapse into coma observed by other writers is confirmed here.…”

mentioning

confidence: 99%

Delayed Dicoumarol Intoxication

Davies¹

1948

BMJ

0

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Rovenstine (1938).ln a perusal of easily available literature we found no mention of the vital necessity for colonic lavage. In the case described below no less than 50% of the ingested drug was recovered undissolved by early colonic lavage. It is obvious that in this instance colonic lavage was much more than a ceremony.CASE HISTORY A woman aged 27 was admitted at 4 p.m. on July 13, 1947, as a possible case of poisoning. She was an old case of psoriasis, and phenobarbitone had been prescribed at intervals over the past 18 months. She had been heavily asleep that morning, but nothing unusual was suspected until 1 p.m.On examination she was comatose and flaccid, and, except for a flexor plantar response, all reflexes, including the corneal, were absent. She did not respond to painful stimuli. The pulse was 70 a minute and of good volume; temperature and respirations were normal. Routine tests showed no abnormality in the urine. Stomach wash-out resulted in bile-stained fluid, and lumbar puncture was normal. Despite the lack of positive evidence, a diagnosis of barbiturate poisoning was made, and picrotoxin, 10 mg. two-hourly, was given intramuscularly, no veins being available.Next day the patient was comatose but restless; the limbs were flaccid and the corneal reflex sluggish. At noon a colonic washout produced 40 to 50 smal white tablets in the faeces, partly dissolved. They proved to be l-gr. (65-mg.) tablets of phenobarbitone. Picrotoxin was stopped at 11.30 p.m., 130 mg. having been given. The evening temperature was 99.5°F. (37.5°C.). A further colonic wash-out was returned with no faeces or tablets. On July 15 she was still unconscious, but moved on painful stimulation. Picrotoxin, 48 mg., was given between 1.15 and 9 p.m. with no apparent effect. The evening temperature was 1000 F. (37.8°C.). She was incontinent.The following morning the patient was conscious and recognized her father, but later became unconscious again. At 11.15 pm. she was deeply unconscious and could not be roused. Picrotoxin, 16 mg., was given intravenously with some increase of activity. A stomach wash-out and an enema were given; faeces were found, but no further tablets. The temperature rose to 100.4°F. (380 C.)

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“…The place of picrotoxin in the treatment of barbiturate poisoning is now 'generally accepted, but in this country the large doses necessary are not always realized. Lovibond and Steel (1939) used 60 mg. over a period of 12 hours, with recovery of consciousness, and they emphasized the risk of relapse into unconsciousness if picrotoxin is discontinued too soon; this relapse into coma observed by other writers is confirmed here.…”

mentioning

confidence: 99%

Barbiturate Poisoning Treated with Picrotoxin and Colonic Lavage

Bazeley¹,

Garrard²

1948

BMJ

1

0

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Rovenstine (1938).ln a perusal of easily available literature we found no mention of the vital necessity for colonic lavage. In the case described below no less than 50% of the ingested drug was recovered undissolved by early colonic lavage. It is obvious that in this instance colonic lavage was much more than a ceremony.CASE HISTORY A woman aged 27 was admitted at 4 p.m. on July 13, 1947, as a possible case of poisoning. She was an old case of psoriasis, and phenobarbitone had been prescribed at intervals over the past 18 months. She had been heavily asleep that morning, but nothing unusual was suspected until 1 p.m.On examination she was comatose and flaccid, and, except for a flexor plantar response, all reflexes, including the corneal, were absent. She did not respond to painful stimuli. The pulse was 70 a minute and of good volume; temperature and respirations were normal. Routine tests showed no abnormality in the urine. Stomach wash-out resulted in bile-stained fluid, and lumbar puncture was normal. Despite the lack of positive evidence, a diagnosis of barbiturate poisoning was made, and picrotoxin, 10 mg. two-hourly, was given intramuscularly, no veins being available.Next day the patient was comatose but restless; the limbs were flaccid and the corneal reflex sluggish. At noon a colonic washout produced 40 to 50 smal white tablets in the faeces, partly dissolved. They proved to be l-gr. (65-mg.) tablets of phenobarbitone. Picrotoxin was stopped at 11.30 p.m., 130 mg. having been given. The evening temperature was 99.5°F. (37.5°C.). A further colonic wash-out was returned with no faeces or tablets. On July 15 she was still unconscious, but moved on painful stimulation. Picrotoxin, 48 mg., was given between 1.15 and 9 p.m. with no apparent effect. The evening temperature was 1000 F. (37.8°C.). She was incontinent.The following morning the patient was conscious and recognized her father, but later became unconscious again. At 11.15 pm. she was deeply unconscious and could not be roused. Picrotoxin, 16 mg., was given intravenously with some increase of activity. A stomach wash-out and an enema were given; faeces were found, but no further tablets. The temperature rose to 100.4°F. (380 C.)

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