DEATH DUE TO WITHDRAWAL OF BARBITURATES

Abstract

Seevers and Tatum (1931) observed that dogs chronically intoxicated with barbiturates may die if barbiturates are suddenly withdrawn. Except for the case of Myer, no human deaths have so far been reported. This case is that of a 49-year-old male who had been taking 5.0 grams of secobarbital daily for 4 mos. prior to hospitalization. On admission he denied the use of barbiturates and was given only 0.1 to 0.2 g. pento-barbital daily during the first 5 days in the hospital. He developed a severe barbiturate abstinence syndrome characterized by vomiting, nervousness, tremor and visual and auditory hallucinations. On the 6th hospital day his pulse was weak and thready with a rate of 120-146/min. He was cyanotic with cold hands and feet, and had continuous clonic movements of all extremities. His blood pressure had dropped from 170/90 to 90/70 and body temp, in the axilla was 107[degree]F. Sodium amytal, 0.5 g., was given intraven. 3 times and temporary relief was obtained twice. He expired on the 6th day. Gross pathology showed left cardiac hypertrophy and an enlarged liver, but gross observations of the tissues were inadequate to explain the cause of death. The principle histological findings were: cerebral encephalopthy with diffuse neural degeneration; cerebral edema; and marked fatty metamorphosis of the liver.