Acute poisoning with ваrbituric acid derivatves. Barbituric coma

Abstract

Introduction. Aim of the study. To summarize the authors’ many years of experience in the diagnosis and treatment of acute poisoning with barbituric acid derivatives and to present the results of a detailed study of the clinic of barbituric intoxication, which prove a toxic damaging effect on the body, causing a deep inhibition of the functions of the central nervous system (CNS) with a predominant effect on the cortex and autonomic centers of the brain trunk. Material and methods. The analysis of 385 patients with acute poisoning with barbiturates of varying severity who were treated in the emergency toxicology department of the N.V. Sklifosovsky Research Institute for Emergency Medicine was carried out. The clinical and encephalographic picture of acute poisoning was assessed. The EEG data of two groups of patients were considered and analyzed, with the possibility of determining the type of bioelectric activity of the brain. The informative value of these types of EEG for a physician is in comparison with the characteristics of clinical and toxicological data. Results. Summarizing the obtained results of clinical and electroencephalographic changes in barbiturate poisoning, it was noted that the identified types of brain bioelectrical activity correspond to certain clinical symptoms and indicate different degrees of poisoning severity. This makes it possible for a practicing physician, after recording an EEG in a patient in a coma, to make a preliminary diagnosis of acute barbiturate poisoning, to purposefully conduct a toxicological study, and to begin specific treatment before receiving an analysis. Analeptic bemegrid causes a direct stimulating effect on the central nervous system. With the introduction of small doses of bеmegrid, a moderate activation of the bioelectrical activity of the brain was noted. Our experience in treating patients with this poisoning showed a negative effect of large doses of bemegrid on the central nervous system, which can lead to an inhibitory phase of parabiotic inhibition (according to N.E. Vvedensky). Conclusion. Poisoning with barbituric acid derivatives currently poses a serious danger to the life and health of patients. This makes the issue of timely diagnosis and treatment measures in the early stages of the disease relevant.