Emergency Treatment

Overdose. Although the toxic dose of am-obarbital varies according to height, weight, and other factors, 1 gram taken by mouth usually produces serious poisoning in an adult. Two to 10 grams are usually a fatal dose. Emergency treatment is supportive, including oxygen administration if necessary, fluid therapy and other standard treatment for shock, and forced diuresis if the patient has normal kidney function. This procedure speeds the excretion of the barbiturate in the urine.

Withdrawal. The symptoms of withdrawal from amobarbital or any barbiturate may be severe or even fatal if the patient has been taking the drug in large doses (800 mg/day). The barbiturate withdrawal syndrome is similar to delirium tremens. Within 12 to 20 hours after withdrawal, the patient becomes restless and weak. During the second and third days, 75 percent of patients develop convulsions, which may progress to status epilepticus and death. From the third to the fifth day, untreated withdrawal syndrome is marked by delirium, hallucinations, insomnia, fever, and dehydration. To prevent withdrawal syndrome, patients are treated with a dose of phenobarbital equivalent to one-third of the daily dose of amobarbital on which they are dependent. This initial dose of phenobarbital is decreased by 30 milligrams per day until the patient's system is clear of drugs.

BIBLIOGRAPHY

Beers, M. H., and Berkow, R., eds. (1999).The Merck manual of diagnosis and therapy, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories.

Brophy, J.J. (1994). Psychiatric disorders. In: L. M. Tierney et al. (Eds.), Current medical diagnosis & treatment, 33rd ed. Norwalk, CT: Appleton & Lange. Hardman, J. G., and Limbird, L. E., eds. (1996). Goodman and Gilman's the pharmacological basis of therapeutics, 9th ed. New York: McGraw-Hill. Medical Economics Company (1999). Physicians' desk reference, (PDR), 53rd edition. Montvale,NJ. Author. Wilson, B. A., Shannon, M. T., and Stang, C. L., eds. (1995). Nurses drug guide, 3rd ed. Norwalk, CT: Appleton & Lange.

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