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Self-administered pentobarbitone overdose with prolonged coma and delayed toxicological diagnosis
William Li1, Athanasia Vardakis2
1Medicine, The University of Sydney - Camperdown and Darlington Campus, Sydney, New South Wales, Australia wili0140@uni.sydney.edu.au.
BMJ Case Reports
|June 19, 2026
Summary
This case report details a patient with pentobarbitone overdose who required prolonged mechanical ventilation. Early and comprehensive toxicological analysis is crucial for diagnosing pentobarbitone toxicity, which can mimic neurological injury and be missed by standard drug screens.
Area of Science:
- Toxicology
- Pharmacology
- Emergency Medicine
Background:
- Pentobarbitone, a short-acting barbiturate, is used in veterinary medicine and has clinical applications in anesthesia and seizure management.
- It can also be encountered in cases of intentional overdose, presenting diagnostic challenges.
- Standard hospital drug screens may not detect pentobarbitone due to lack of cross-reactivity with common assays.
Purpose of the Study:
- To report a case of pentobarbitone overdose requiring intensive care.
- To highlight the diagnostic difficulties and potential complications associated with pentobarbitone toxicity.
- To emphasize the importance of comprehensive toxicological analysis in suspected cases.
Main Methods:
- Case report of a patient with intentional pentobarbitone ingestion.
- Monitoring of pentobarbitone blood concentrations post-ingestion.
- Intensive supportive care including mechanical ventilation.
Main Results:
- The patient required mechanical ventilation for 6 days.
- Sustained detectable blood concentrations of pentobarbitone were observed for over 100 hours.
- The patient experienced coma, respiratory failure, and barbiturate-associated skin and vascular complications.
- Full recovery was achieved following intensive supportive care.
Conclusions:
- Pentobarbitone toxicity can mimic severe neurological injury and may be missed by routine toxicology screening.
- Prompt and comprehensive toxicological analysis is critical for accurate diagnosis and management.
- This case underscores the need for awareness of pentobarbitone's potential toxicity in overdose scenarios.
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