Beauchamp, Gillian A., MD

Cannon, Robert D., DO

Cook, Matthew D, DO

Katz, Kenneth D, MD

Koons, Andrew L, DO

Surmaitis, Ryan M, DO

Wier, Amy, DO

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of Emergency MedicineBeware of Barbiturates: Coma and Hypothermia ina 94-year-old Woman Due to CombinedSecobarbital and Pentobarbital ToxicityAndrew L. Koons DOLehigh Valley Health Network, andrew.koons@lvhn.orgAmy Wier DOLehigh Valley Health Network, Amy.Wier@lvhn.orgKenneth D. Katz MDLehigh Valley Health Network, Kenneth_D.Katz@lvhn.orgMatthew D. Cook DOLehigh Valley Health Network, Matthew_D.Cook@lvhn.orgRobert D. Cannon DOLehigh Valley Health Network, Robert_D.Cannon@lvhn.orgSee next page for additional authorsFollow this and additional works at: https://scholarlyworks.lvhn.org/emergency-medicinePart of the Emergency Medicine CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtKoons, A. Wier, A. Katz, K. Cook, M. Cannon, R. Beauchamp, G. Surmaitis, R. (2019, April 12). Beware of Barbiturates: Coma andHypothermia in a 94-year-old Woman Due to Combined Secobarbital and Pentobarbital Toxicity. Poster Presented at: The AmericanCollege of Medical Toxicology (ACMT) Annual Meeting, San Francisco, CA.AuthorsAndrew L. Koons DO, Amy Wier DO, Kenneth D. Katz MD, Matthew D. Cook DO, Robert D. Cannon DO,Gillian A. Beauchamp MD, and Ryan M. Surmaitis DOThis poster is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/emergency-medicine/549LVHN.org© 2019 Lehigh Valley Health NetworkBeware of Barbiturates: Coma and Hypothermia in a 94-year-old Woman Due to Combined Secobarbital and Pentobarbital Toxicity Andrew L. Koons, DO, Amy E. Wier, DO, Kenneth D. Katz, MD, Matthew D. Cook, DO, Robert D. Cannon, DO, Gillian A. Beauchamp, MD, Ryan M. Surmaitis, DOAll authors affiliated with Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PABACKGROUNDBarbiturates are GABAA agonists commonly used in-hospital for seizure control, alcohol withdrawal, headaches, and general anesthesia. Secobarbital and pentobarbital are used as primary euthanasia agents  in both humans and animals and are not prescribed for general use. METHODSThis is a rare case (last cases reported in 1979) of a patient suffering from a combined secobarbital and pentobarbital poisoning. A 94-year-old woman was found obtunded at her independent living facility. Upon EMS arrival to ED, she was spontaneously breathing with a Glasgow Coma Scale of 3 and vital signs: HR 56 bpm, BP 111/54 mmHg, temperature 35.7ºC, RR 16 rpm, and room air pulse oximetry 96%. The physical exam was otherwise unremarkable. Dextrose measured 106 mg/dL; she had  no response to IV naloxone. Initial diagnostics (including CT of the head, chest, abdomen, and pelvis) were unremarkable, except for rapid urine drug screen detecting barbiturates. Serum phenobarbital concentration was undetectable.RESULTSThe patient was admitted; her clinical signs and symptoms resolved over 72 hours with supportive care. MRI of the brain was unremarkable; EEG demonstrated diffuse slowing. TSH levels were normal. Qualitative blood LC/MS toxicology testing detected both secobarbital and pentobarbital. Serum secobarbital and pentobarbital concentrations were: 3.3 µg/mL (therapeutic 1.0-2.0 µg/mL; toxic >3.0 µg/mL) and 9.5 µg/mL (hypnotic 1.0-5.0 µg/mL, toxic >10.0 µg/mL), respectively. Both concentrations were undetectable five days later. Patient improved without sequelae and was discharged to a skilled nursing facility without admitting to drug exposure, although, as a former nurse, she was knowledgeable about these drugs.DISCUSSIONCombined secobarbital and pentobarbital poisoning is exquisitely rare and should be considered in patients presenting with hypothermia and coma, even those mimicking brain death. Treatment is largely supportive with possible use of hemodialysis for refractory pentobarbital poisoning.CONCLUSIONIn patients presenting with hypothermia and coma, barbiturate poisoning must be considered. 

Beware of Barbiturates: Coma and Hypothermia in a 94-year-old Woman Due to Combined Secobarbital and Pentobarbital Toxicity

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1565&context=emergency-medicine

Beware of Barbiturates: Coma and Hypothermia in a 94-year-old Woman Due to Combined Secobarbital and Pentobarbital Toxicity

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