Acute poisoning with barbiturates: symptoms, treatment

Poisoning and overdosing with various drugs is not uncommon. In this case, one of the most unfavorable intoxications is poisoning with barbiturates, derivatives of barbituric acid, which inhibits the function of the central nervous system. A decade ago, barbiturates were widely used in medicine: they were used as drugs that accelerate sleep, soothe and relieve cramps. However, in recent years, their popularity has declined significantly - primarily because of their addictive properties.

Barbiturates - what is it?

Barbiturates are called preparations made on the basis of barbituric acid. However, this acid itself does not have a hypnotic effect. For all the time of application, about a hundred barbiturates were artificially allocated, but officially, physicians use only about thirty options.

Barbiturates are whitish or yellowish crystals with poor water solubility and good fat solubility. The sodium salt of barbiturates, by contrast, is more soluble in water.

Barbiturates are well absorbed in the digestive organs by the method of passive transport, and this reaction is amplified under the influence of ethyl alcohol. The limiting plasma content is:

• barbital - from 4 to 8 hours;
• phenobarbital - from 12 to 18 hours.

Barbiturates actively intervene in the work of the central nervous system and, depending on the dose, have the following effect:

• weakly calm;
• accelerate falling asleep;
• pain relief;
• eliminate cramps.

Absolutely all barbiturates can inhibit the central nervous system. In small quantities, they can provoke a euphoric state, reminiscent of mild intoxication: coordination worsens, gait and speech are disturbed, control over behavior and emotional manifestations are lost.

To obtain the effect of sedation and ease of sleep it is necessary to take a slightly higher dose of barbiturate, and the highest dosage is already used as a means for surgical anesthesia.

[1], [2]

The list of drugs - barbiturates

Barbiturates are divided into the following types: drugs with ultra-short exposure, with a medium-long and long-lasting effect.

Barbiturates, which today are actively used in surgical anesthesia, have an ultrashort effect. These drugs include Metoheksital, Thiopental, Tiamilal.

Talbutal, Pentobarbital, Butalbital have a medium effect. The effect of such barbiturates is noted already 15-35 minutes after ingestion, and lasts about six hours.

A typical representative of a barbiturate with a prolonged effect of exposure is Phenobarbital - it is used primarily for the treatment of patients with epilepsy.

The basic representatives of barbiturates are the following drugs:

• Amobarbital (fatal poisoning occurs when using 2-4 g of the drug);
• Cyclobarbital (fatal poisoning is observed when taking 5-20 g of the drug);
• Barbital (death occurs after taking 6-8 g of the drug);
• Phenobarbital (death from poisoning is observed after taking 4-6 g of the drug);
• Heptabarbital (fatal poisoning happens when using 20 g of the drug);
• Diethylbarbituric acid (death is observed after consuming 6-8 g of the drug).

Epidemiology

Barbiturate poisoning is recorded in approximately 20-25% of patients undergoing treatment in specialized toxicological clinics; they are about 3% among all intoxications, leading to death. The overall hospital mortality rate for barbiturate poisoning averages 2%, taking into account the cases of combined intoxication with various drugs that have psychotropic effects.

If the barbiturate poisoning is severe, and the patient falls into a coma, the percentage of mortality rises to 15%.

Today, barbiturates are practically not used as hypnotic and sedatives: they are used as an anesthetic, or to relieve convulsive states or prevent epileptic seizures.

[3], [4]

Causes of the barbiturate poisoning

Barbiturate poisoning most often occurs intentionally - for example, in order to commit suicide or murder, or in case of accidental use of a large dose of the drug.

Barbiturates, taken orally, are absorbed by the walls of the small intestine. After penetration into the bloodstream, binding to plasma proteins occurs, and metabolism occurs in the liver. The fourth part of the total number of barbiturates taken is displayed with the urinary fluid in unchanged form: this moment is actively used in the diagnosis of poisoning.

In general, barbiturates are taken by patients to improve sleep, to calm, as sedatives and sedatives. Poisoning can occur with the occasional use of a large amount of the drug: and this is not uncommon, since barbiturates cause a gradual addiction of the organism, a person begins to take more and more large doses. The most common cause of death is the development of respiratory and hepatic failure, shock process and cardiac arrest.

[5], [6]

Risk factors

Most often, poisoning with barbiturates is fixed in such people:

• those who take barbiturates as prescribed by a doctor, but for a long time;
• those who combine barbiturates with alcohol;
• those who independently take such medicines, randomly and in arbitrary dosages;
• for those who use barbiturates for other purposes (for example, in order to get euphoric state).

Thus, the risk group may include patients with neurotic disorders, upset social adaptation, as well as alcohol abusers.

Barbiturates, at their first dose, eliminate insomnia, relieve affective states, relieve anxiety, and improve psychological adaptation. However, against the background of regular and long-term administration, even the dosages recommended by the doctor develop an addiction. At first, it is not so noticeable, but over time the patient feels that the usual therapeutic amount of barbiturate does not have the desired effect. There is a need to exceed the dosage: the so-called tolerance develops, a person becomes dependent and can no longer sleep normally without such drugs. Sooner or later it can lead to poisoning.

As for children, they can get poisoned with barbiturates if the house does not have a special place to store medicines. Having free access to medicines, a child can use this or that tool without the knowledge of adults: this situation often ends tragically, so parents must take all necessary safety measures to prevent medicines from falling into children's hands.

[7]

Pathogenesis

The vast majority of cases of barbiturate poisoning happen deliberately: the goal of death is pursued.

When ingested in excess non-therapeutic doses, barbiturates inhibit the functional activity of the brain stem and cerebral cortex. As a result, the patient loses consciousness, falls into a coma, breathing disorders occur. Reflex activity in the form of the absence of tendon, pain and tactile reflexes is impaired.

Due to the toxic effect of barbiturates on the vasomotor center, the vascular tone drops, the contractile activity of the heart muscle suffers. Severe hemodynamic changes develop:

• blood pressure is falling rapidly;
• cardiac output decreases;
• the volume of the circulating blood decreases;
• Tissue oxygen starvation occurs.

Hemodynamic disorders lead to an imbalance of metabolism, failure of thermoregulation, dehydration.

Excessive concentrations of barbiturates in the blood cause intoxication of the hypothalamus-pituitary system. As a result, diuresis decreases (even anuria is possible) and the level of nitrogen increases (azotemia).

In severe lesions, vasomotor and respiratory paralysis occurs, followed by the death of the patient due to deep cardiac and respiratory failure.

[8], [9], [10]

Symptoms of the barbiturate poisoning

Unfortunately, at the initial stage, poisoning with barbiturates is not always possible to recognize, because the severity of intoxication depends on many factors:

• barbiturate category, its pharmacological characteristics;
• the amount of medication taken;
• general condition of the body at the time of taking the medicine;
• the presence of food, alcohol or other medicines in the stomach;
• the age of the patient, the functionality of the liver and other organs.

The first signs of poisoning may be different, but one of them is always the same: this is a dream. The initial phase of such sleep proceeds with preservation of reflexes, after which a deep phase begins: sensitivity dulled, the person ceases to feel pain and touch, to hear sounds.

The degree of poisoning is determined by the presence of corneal and pupillary reflexes.

A corneal reaction manifests itself as a sharp closing of the eyelids in response to corneal irritation (for example, a cotton swab or the edge of a clean bandage). The rate of such a reaction is to close both eyes when one is irritated.

The corneal reflex can remain stored with relatively small barbiturate poisoning. The lack of reflex indicates a severe degree of intoxication.

The pupillary reaction consists in changing the diameter of the pupil. When the eye is closed or in the dark, the pupil expands. When hit by a light beam, it narrows. The absence of such a reaction indicates a severe degree of overdose with barbiturates.

Respiratory system changes go through four stages:

• Stage I: respiratory rate decreases.
• Stage II: breathing becomes shallow.
• Stage III: breathing becomes intermittent.
• Stage IV: breathing stops.

If the patient has taken a large number of barbiturates, then there is a paralysis of the brain center responsible for breathing, which leads to a complete stop of the respiratory function.

Against the background of respiratory disorders, the content of carbon dioxide increases and the level of oxygen in the body decreases, acidosis develops. At the same time, the blood pressure decreases, the vascular tone is disturbed, and the contractility of the heart muscle decreases. Pulse becomes weak, filiform, and in severe poisoning disappears altogether.

Diuresis is impaired, as a result of increased secretion of vasopressin and deterioration of the blood supply to the kidneys.

Motility of the intestine is slowed down, production of juice in the stomach slows down.

The course of oxidative reactions in the body worsens, the thermoregulation is disturbed, which is manifested by hypothermia.

Pulmonary stagnation develops, air circulation becomes difficult, bronchial lumen decreases. This can cause the development of inflammatory processes, atelectasis.

In clinical practice, barbiturate poisoning is recorded primarily for medium long and long lasting exposure. Such drugs are more available, they are able to accumulate in the body, have a low metabolism and are often taken by patients without the doctor's consent.

Short-acting barbiturate poisoning is usually easily stopped in polyclinic conditions: such drugs are rapidly metabolized in the liver. Self-healing is observed for half an hour, subject to normal ventilation of the lungs.

Stages

It is customary to distinguish such stages in case of poisoning with barbiturates:

1. “Falling asleep”: a person develops drowsiness, indifference, decreases the degree of reactions to irritating factors. However, contact with the victim can be established.
2. "Superficial coma": the consciousness fades away, the pupils diminish for a short time, the cough and swallowing reflex weakens, the tongue may sink. Body temperature may increase slightly.
3. “Deep coma”: reflex reactions are not observed, the functions of the main organs and systems are disturbed. Respiratory function is impaired due to inhibition of the work of the respiratory center: arrhythmic breathing, further paralysis and arrest may develop.
4. “Post-comatose condition”: the patient returns to consciousness. At first, there is capriciousness, a decline in the psychoemotional state, a sleep disorder, and, less commonly, poor motor stimulation.

[11], [12]

Forms

In medicine, these types of barbiturate poisoning are distinguished, depending on the severity of intoxication:

• Easy option: the victim is in a state of sleep, but attempts to wake him up are successful. Reflex reactions saved, breathing even, blood pressure indicators are within normal limits.
• Medium variant: the victim is in a state of sleep, does not respond to attempts to wake him up. However, reflex reactions, respiratory function and pressure indicators are within normal limits. This condition requires round-the-clock monitoring of the patient's condition: if there is no deterioration, then the person wakes up himself after about 2-3 days.
• Severe option: tendon reactions and corneal reflex disappear, the body is not tense. The reaction of the pupils is slowed down, but it can be traced. Respiratory movements are rare, periodically interrupted. Blood pressure is falling. Against the background of continuous medical monitoring and drug support, the victim can recover in 5-6 days.
• Critical, especially difficult option: reflex reactions are not observed, breathing movements are rare with regular stops, skin and mucous tissues are bluish. Blood pressure cannot be measured, pulse shocks are weak. About independent exit of the patient from this state we are not talking.

[13], [14]

Complications and consequences

Such adverse complications are characteristic of barbiturate poisoning:

• development of a coma, various neurological disorders;
• problems with respiratory function;
• heart irregularities;
• trophic disorders, renal pathology.

Respiratory problems are the most common and life-threatening complications associated with a comatose state. Such disorders are recorded in more than half of people with barbiturate poisoning. If the respiratory resuscitation measures are not promptly performed, the patient may die.

Even after the relief of acute respiratory distress, the victim may show signs of respiratory failure due to the development of pneumonia, tracheobronchitis, etc. This is the case in every fourth patient admitted with a diagnosis of barbiturate poisoning.

Cardiac abnormalities are manifested by tachycardia, lower blood pressure, pulmonary edema, and collapse. There is a functional systolic murmur, heart sounds are muffled.

Trophic disorders are found in 6% of patients: necrodermatomyositis, bullous dermatitis are diagnosed, which is manifested by the accelerated appearance of bedsores. This complication is explained by local impaired blood supply to the tissues and deterioration of the function of nerve conduction.

Abnormal kidney function is a consequence of acute cardiovascular collapse. The patient has a decrease in daily diuresis, deterioration of the blood supply to the urinary organs.

With prolonged intoxication with barbiturates in moderate doses, barbiturate dependence develops, manifestations of which are sometimes more pronounced than among heroin addicts.

What causes death?

In most cases, death occurs as a result of respiratory arrest, which is caused by inhibition of the respiratory center, paralysis of the respiratory system.

Less commonly, causes of death are:

• acute liver failure;
• shock reaction with further cardiac arrest.

[15]

Diagnostics of the barbiturate poisoning

Diagnostic measures are aimed at determining the etiology of poisoning. This process consists of three types of activities:

• Clinical and instrumental diagnostics is based on the information collected during the history taking, the scene of the accident, the assessment of existing clinical signs of poisoning. Additional instrumental methods can be used only after providing emergency care, as well as at the stage of patient recovery:

1. electrocardiography;
2. monitoring of blood pressure, pulse, temperature;
3. chest x-ray;
4. Ultrasound of the heart, internal organs;
5. spirography (spirometry);
6. electroencephalography.

• Laboratory tests can qualitatively or quantitatively determine the cause of intoxication. Biological environments in the body are being studied: in particular, an enzyme immunoassay, immunochemical analysis, polarization fluorimmunoassay, etc. Are carried out. These studies are associated with a specific antigen-antibody reaction: the antigen is barbiturate isolated from the victim’s biological environment, and the antibody is a finished IgG fraction of the blood of an immunized animal . Such analyzes relate to rapid diagnostic procedures. If available, you can use special test strips "Immunochrome-barbiturates Express", which are one of the variants of immuno-chromatographic analysis.
• Pathological morphological signs of poisoning with barbiturates is a post-mortem assessment, which is carried out by representatives of the forensic medical examination. According to the place of the incident, the expert needs to determine the cause of the intoxication, the type of the poisoning agent, its quantity and method of administration, as well as the exact time of the poisoning.

[16], [17], [18], [19], [20]

Differential diagnosis

Differential diagnosis of poisoning with barbiturates is carried out with the following conditions:

• acute circulatory disorders of the brain;
• acute neuroinfection;
• closed head injury;
• cardiogenic shock;
• other endogenous or exogenous intoxications.

The basic difference between barbiturate poisoning and other acute brain lesions is the absence of clear neurological signs. Strokes and post-traumatic pathologies are not accompanied by a simultaneous sudden depression of consciousness, acute insufficiency of cardiac activity and renal function.

In case of poisoning with barbiturates, no shell signs typical for acute meningitis or subarachnoid hemorrhage are observed.

Treatment of the barbiturate poisoning

If the victim is conscious, he can be helped before the ambulance arrives by flushing the stomach (causing vomiting). In all other cases, emergency assistance is provided by doctors: they carry out probing, provide ventilation to the lungs.

In inpatient treatment is the use of the following methods:

• infusion treatment, restoration of water-electrolyte and acid-base balance;
• forced diuresis;
• procedures for hemodialysis and / or hemosorption.

To accelerate the elimination of toxic substances from the body and to ensure the release of excess fluid, diuretic drugs are intravenously administered to the patient. In severe poisoning, a drip infusion of saline or 5% glucose is indicated (if the renal excretion capacity is maintained).

Early hemodialysis is indicated for severe long-acting barbiturate poisoning. The hemosorption procedure helps to speed up the removal of a patient from a comatose state: it is particularly effective in the administration of short-acting barbiturates, which are ineffective in hemodialysis.

In cases of impaired respiratory function, tracheal intubation and mechanical ventilation are resorted to.

• Hemodialysis is an extrarenal procedure for blood purification in which blood is “pumped” through the hemodialysis barrier installed in a special apparatus. This method is effective at high concentrations of barbiturates, due to the fact that a large number of toxic substances come into contact with plasma proteins that are not able to penetrate through the membrane of purification.
• Hemosorption is a blood purification procedure using a sorbing agent - for example, activated carbon. Cleaning occurs outside the body of the victim.

Emergency help with barbiturate poisoning

Barbiturate poisoning is always a need for emergency help to the injured person. The algorithm of urgent actions looks like this: first of all, it is necessary to remove toxic substance from the digestive system, remove it from the bloodstream, facilitate respiratory function and improve the functioning of the heart.

Cleansing the stomach involves washing it (as early as possible). The volume of water for washing is not less than 12 liters, you can repeat the procedure.

If the patient's consciousness is preserved, the procedure is carried out by artificially invoking vomiting (after first taking several cups of water, or a weak solution of potassium permanganate, or a solution of mustard powder, one teaspoon of powder per 200 ml of warm water). It is also allowed the use of emetic preparations, subcutaneous administration of 1 ml of 0.5% apomorphine.

To speed up the removal of barbiturates from the stomach, the victim is given a water suspension of activated carbon (at least 20 g of the drug, or more). Important: after 10 minutes, all coal suspension from the stomach should be removed (induce vomiting) so that the absorption of the toxic substance does not become reversible. To remove barbiturates, which had time to get into the intestinal parts of the digestive system, the use of laxative medicines (optimally sodium sulfate, better known as "Glauber's salt"; not recommended to use castor oil for this purpose) is suitable.

To speed up the purification of blood from toxins, the patient is encouraged to drink plenty of fluids while taking diuretic drugs. The patient in the mind give large amounts of ordinary pure water. Patients with impaired consciousness are injected with intravenous saline and / or 5% glucose solution. These measures are appropriate when maintaining renal excretory ability.

If there are pronounced respiratory disorders, it is possible to carry out intubation, pumping out bronchial contents, connecting to the ventilator. If the violations are not so pronounced, then you can do the use of respiratory analeptics.

• In order to avoid inflammatory processes in the lungs antibiotic therapy is prescribed;
• vasoconstrictor preparations are used to normalize vascular tone;
• cardiac glycosides are prescribed to improve cardiac function;
• when cardiac arrest is injected, adrenaline is injected into the left ventricle, with further chest massage.

Antidotes in the form of specific therapy retain their effectiveness only at the initial "toxicogenic" stage of poisoning with barbiturates: they can be used only with reliable clinical and laboratory confirmation of appropriate intoxication. In all other cases, the antidote can have the exact opposite effect and aggravate intoxication.

Antagonist (antidote) of barbiturates is considered to be 0.5% Bemegride, which excites the central nervous system, facilitates breathing and activates blood circulation. When poisoning is administered intravenously slowly from 1 to 20 ml of 0.5% solution.

[21],

Medicines for barbiturate poisoning

With the development of a comatose state, the administration of a 20% camphor solution, 10% caffeine, 5% ephedrine, as well as a subcutaneous injection of cordiamine (2-3 ml in 3-4 hours) is practiced.

Intensive infusion treatment involves the infusion of plasma substitutes (gemodez, polyglukin). Antibiotic therapy, vitamin therapy, with hypotension - administration of 0.2% norepinephrine and 0.5% dopamine (1 ml w / w in 0.4 l of polyglucin) is prescribed.

The introduction of cardiac glycosides (Korglikon, strophanthin), vasoconstrictor drugs (mezaton, glucocorticosteroids) is shown.

Acidosis is eliminated by the drip of 4% sodium bicarbonate in an amount up to 300 ml.

With increasing temperature indicators intramuscularly injected lytic mixture consisting of 2.5% chlorpromazine and 2.5% diprazina.

In order to avoid the occurrence of complications and side effects in the form of allergic and hypersensitive reactions, the patient should always be under the supervision of a medical professional.

Vitamins in case of poisoning with barbiturates are administered intramuscularly:

• vitamin B ₁  and B ₆  in the form of 5% solutions, 6-8 ml;
• vitamin B ₁₂  in an amount of 500 mcg (a group of vitamins B is not administered at the same time!);
• vitamin C in the form of a 5% solution of 5-10 ml;
• ATP in the form of a 1% solution of 6 ml per day.

Physiotherapy treatment

Physical therapy can be one of the methods of physical recovery of a patient who has experienced barbiturate poisoning. The basis of therapy is the impact of natural (air, sunlight, water) and artificial (electric current, magnetic field) physical factors.

The basic methods of physiotherapy include:

• balneotherapy (mineral water intake, mud wraps);
• climatotherapy (salt caves, coniferous and mountain air);
• hydrotherapy, healing showers and baths, thermal springs;
• inhalation drugs to improve the performance of the respiratory tract;
• mechanical treatment (exercise therapy, manual therapy, massages).

Physiotherapy is not included in the scheme of medical-restorative measures, if the patient has such contraindications:

• tumor processes;
• acute purulent and infectious processes;
• tuberculosis;
• decompensated states;
• lesions of the central nervous system with impaired sensitivity.

Alternative treatment

Treatment of poisoning with barbiturates using alternative means is allowed only after the approval of the doctor, and only with a mild degree of intoxication. With severe poisoning, home treatment, unfortunately, will not help: the precious time needed to save the life of the victim will be lost.

How can you help a patient with mild barbiturate poisoning?

• Tinder on a fine grater a piece of ginger root, about half the size of a matchbox. Pour grated root with 200 ml of boiling water, incubate for 10 minutes, then filter and drink. The procedure is repeated three times a day, the course of treatment is 4-7 days.
• Pour boiling water (200 ml) on 10 dry clove buds. Stand under the lid for about half an hour. Take during the day and 1 tbsp. L infusion every 30-40 minutes.
• Take berries or leaves of viburnum (50 g or 100 g, respectively), poured into a thermos one liter of boiling water, infuse for an hour. Infusion filtered, cooled. Drink during the day between meals (for the day you need to drink the entire amount of infusion).
• Take 50 grams of rosehips, pour in one liter of boiling water in a thermos, stand for about three hours. Next, the infusion is filtered and add 50 g of honey. Drink 250 ml three times a day, between meals.

Simple cases of poisoning with barbiturates are quite amenable to treatment with alternative means: it is important to follow the drinking regime in order to speed up the elimination of toxic substances from the body. If the case of poisoning is difficult, then you will not be able to do without the help of a doctor: there is a risk of serious complications, including the death of the victim.

[22], [23], [24],

Herbal medicine

Medicinal plants are considered very effective for the treatment of all kinds of poisoning. However, such means can be trusted only with a mild degree of poisoning with barbiturates: moderate and severe intoxication requires urgent medical intervention. We offer you such simple recipes based on the use of herbs:

• Take 2 tsp. Dried lime flowers, brewed 200 ml of boiling water, incubated for 30 minutes under the lid. This tea is drunk 4-5 times a day for at least two days. Linden color will help restore the health of a weakened body.
• One tablespoon of mint leaves is brewed with 250 ml of boiling water, kept under a lid for two hours, filtered. They drink a big sip of the infusion every two hours until a steady normalization of the condition.
• Brew 2 tsp. Fennel seed 200 ml boiling water, incubated under a lid for 20 minutes. Take the tool three times a day, 100 ml.
• Brew 1 tbsp. L chicory and 1 tsp. Hypericum in two 200 ml cups of boiling water. Drink one sip every 2 hours. The duration of treatment is 2 days.

Variations are possible among recipes: for example, marshmallow, valerian root, dill, greens and dandelion flowers can also be added to mixtures.

Homeopathy

Poisoning mild barbiturates can be eliminated with the help of homeopathy. Such remedies can also help at the stage of recovery of the body after the relief of acute symptoms of intoxication: homeopathic granules and drops will accelerate the elimination of toxic substances from the body, normalizes the water-electrolyte balance.

The following drugs are taken in potency 6C or 30C, but it will be better if the doctor determines the exact scheme of treatment on an individual basis.

• Arsenicum will help with physical weakness, abdominal pain, excessive anxiety and anxiety, as well as in cases where intoxication is accompanied by a disturbance of the digestive processes, or the patient's refusal to eat.
• Carbo vegetabilis especially helps with evening poisoning, when the patient has severe weakness, inability to rise from the bed, cold sweat, weak pulse, cyanosis of the lips.
• Hina is necessary at the first signs of dehydration, as well as in cases where barbiturate poisoning is accompanied by sore bones and joints, exhaustion, irritability and increased general sensitivity.
• Lycopodium will help with signs of indigestion and liver dysfunction.
• Nux vomica is used at the recovery stage after barbiturate poisoning: to normalize sleep, stabilize the nervous system, improve digestive function.

Prevention

Often, barbiturate poisoning occurs as a result of an irresponsible attitude to the storage of medicines, as well as due to distraction or ignorance. In order to avoid such situations, it is necessary to store medicines in hard-to-reach places, in a darkened and dry place. You can not save medicines without names, without packages (for example, in bulk).

You should not rely on your own knowledge and skills and prescribe drugs yourself: only a medical specialist can prescribe barbiturate treatment.

If barbiturates were prescribed by a doctor, then during treatment, in no case should alcohol be consumed: these substances are incompatible and potentiate each other's effects. In addition, it is unacceptable to make their own adjustments to the treatment regimen proposed by the doctor.

[25],

Forecast

Making a forecast of poisoning with barbiturates, doctors take into account all the symptoms, as well as the general state of health and the age of the victim. If the corneal reaction is maintained, breathing is stable, blood pressure is normal, then the prognosis is considered favorable.

A bad prognosis with the risk of patient death can be said in the presence of such negative signs:

• loss of corneal reaction;
• loss of pupillary reaction;
• loss of reactions to stimuli in general;
• blueness of the skin and mucous membranes;
• respiratory function disorders;
• drop in blood pressure.

The severity of poisoning and further prognosis of barbiturate poisoning is determined after first aid.