TREATMENT FOR BARBITURATE INTOXICATION.

Abstract

To the Editor:— A communication in the Sept 21, 1963, issue ofThe Journal( 185 :936) by Drs. Myschetzky and Lassen reported the efficacy of alkalinization and osmotic diuresis for barbiturate coma. Their selection of patients whose blood barbiturate level was greater than 10 mg/100 ml may have biased the study, since levels are often much lower in deep coma induced by barbiturates having short or intermediate action. Likewise, to attribute shortened duration of coma to augmented renal elimination of the drug is not necessarily warranted. Acidosis potentiates the anesthetizing action of barbiturates, and, since respiratory acidosis occurs regularly in barbiturate coma, perhaps alkalinization per se was responsible for improvement of the treated group. The authors stated: Only severe cases involving the relatively slowly eliminated barbiturates were accepted for treatment. This is misleading, since nearly one half of the treated patients ingested phenobarbital or barbital. Of all barbiturates, these are