faust
lost among the stars
- Jan 26, 2020
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Hello! I would like to share with you some N overdose case reports which were in the journal "Reactions Weekly".
Enjoy reading!
Enjoy reading!
Coma and death in an elderly patient: case report |
A 79-year-old woman became comatose after injecting herself with pentobarbital; she subsequently died [amount injected and time to reaction onset not stated]. The woman was found at home in a coma, with a small injection mark on her left arm. A syringe and a 100mL bottle containing approximately 2–3mL of an unknown viscous liquid and crystals were found nearby. She had no heart action upon admission to the emergency room. Following resuscitation and return of spontaneous circulation, she was admitted to the ICU. She had a Glasgow coma score of E1-M1-V1, and was in cardiogenic shock with bradycardia. A urinary toxicology screen revealed the presence of barbiturates, and she had a serum pentobarbital concentration of 33 mg/L. Toxicology screening of the liquid and crystals in the bottle revealed the presence of alcohol, propylene glycol and pentobarbital at a concentration of 16g/100mL. The woman was treated with mechanical ventilation, therapeutically-induced hypothermia, norepinephrine and dopamine. Her family produced a written statement including her refusal to be treated in the case of coma. Treatment was continued overnight while legal advice was sought. The next morning, she displayed signs of clinical brain death, with an iso-electric EEG. Mechanical ventilation was discontinued, and she died a few minutes later. Author comment: "[T]he patient showed the critical condition of brain death, including an iso-electric EEG, which may have been induced by the pentobarbital."
Alright, what conclusions can we make? N is a good method. If a person were not found, there would not be any chances to save her.
The mistakes done in CTB method:
1) Injecting N. There is a huge likelihood you will fall asleep before injecting the full dose.
2) She did not have enough time to pass away. Always consider this point, otherwise the suicide attempt may be failed.
3) Since we don't know what amount was injected, it is worth to remind that the recommended dose (12g) is two bottles. And once again, never try to inject N!
Alright, what conclusions can we make? N is a good method. If a person were not found, there would not be any chances to save her.
The mistakes done in CTB method:
1) Injecting N. There is a huge likelihood you will fall asleep before injecting the full dose.
2) She did not have enough time to pass away. Always consider this point, otherwise the suicide attempt may be failed.
3) Since we don't know what amount was injected, it is worth to remind that the recommended dose (12g) is two bottles. And once again, never try to inject N!
Cardiac, respiratory and central nervous system failure: case report |
A young man [age not stated] developed cardiac, respiratory and central nervous system failure following an overdose of pentobarbital. The man had been found unconscious after ingesting pentobarbital; there were empty vials accounting for a total of 13g [time to reaction onset not stated]. He experienced respiratory arrest at the scene, and he was intubated and transferred to a hospital. On arrival, he had a core temperature of 32°C. The man received naloxone, and he had a Glasgow coma score (GCS) of 3/15. Pupillary and cough reflexes were absent, and he had a BP of of 50/20mm Hg. He was transferred to an ICU and warmed with warming blankets. There were signs of aspiration, and bronchoscopic lavage was performed before he received broad-spectrum antibacterials. Local laboratories were unable to process pentobarbital levels. Charcoal lavage was started, and he received norepinephrine [noradrenaline] and dobutamine. Sodium bicarbonate was given to enhance excretion, and nasogastric feeding was started. After the first 48 hours, he developed myoclonic jerks of his upper limb; hypoxic brain injury was initially suspected. He received phenytoin and lorazepam. His cardiovascular function began improving on admission day 3, and he began making spontaneous respiratory breaths on day 6; the myoclonic jerks also stopped. His GCS had improved to 9/15, and he was extubated. Thereafter, he found it difficult to clear his secretions, and his GCS fluctuated. He became increasingly tachypnoeic and was reintubated. Bronchoscopy was performed again, with propofol and remifentanil for tube tolerance. He was successfully extubated the next day; no functional deficits were noted. He later recovered without neurological sequelae. Author comment: "A case report of non-fatal pentobarbital overdose of 13g is described. . . The patient had cardiac, respiratory and central nervous system failure from the overdose.
This case shows the same mistake - a person did not leave much time to pass away. Also, this case proves that the method is safe because the person recovered.
This case shows the same mistake - a person did not leave much time to pass away. Also, this case proves that the method is safe because the person recovered.
Cardiorespiratory arrest: case report |
A 25-year-old woman developed cardiorespiratory arrest following an overdose of pentobarbital [time to reaction onset not stated]. The woman was found unconscious by a friend after previously announcing her intention to commit suicide. Two 20mL syringes, each containing traces of pink liquid, were found nearby. Upon her arrival in the emergency department, she was in cardiorespiratory arrest. Following successful cardiopulmonary resuscitation, she was admitted to the ICU. She had a Glasgow Coma Scale score of 3, profound hypothermia (30.6°C), nonreactive intermediate pupils, osteotendinous areflexia, absence of cerebral trunk reflexes and a BP of 58/42mm Hg. Transthoracic echocardiography demonstrated global hypocontractility, and an ECG showed regular sinusoidal rhythm and a flattened T-wave related to hypokalaemia (3 mmol/L). Laboratory investigations included the following: AST 138 IU/L, ALT 179 IU/L, pH 7.20, bicarbonate 15 mmol/L and lactate 9.1 mmol/L. Urine toxicology was positive for barbiturates, and her serum pentobarbital concentration was 85.1 mg/L. The woman was treated with cutaneous rewarming, vascular replenishment and haemodynamic monitoring, followed by 36 hours of haemofiltration. Her pentobarbital concentration decreased to 2 mg/L. Her progress was marked by neurological stability, but she developed face and limb myoclonia on day 5. An EEG confirmed an epileptic state, which regressed after treatment with levetiracetam, diazepam and fosphenytoin. Diffuse brain damage persisted, with alternating "alpha coma" and "theta coma" traces. A tracheotomy was performed on day 14, allowing withdrawal of mechanical ventilation. She was transferred to the coma reawakening centre on day 34 with a neurological picture of subcortical reawakening. Mail left by the woman and later found by her family mentioned the nature and quantity of the product used in her suicide attempt. The product, Dolethal, is used in veterinary medicine and contains pentobarbital sodium at a concentration of 200 mg/mL. The estimated quantity orally ingested was 8mg of pentobarbital. Author comment: We present notes on our observation of a case of cardiac arrest secondary to attempted suicide by oral ingestion of about 40mL of Dolethal, a product used in veterinary medicine, with pentobarbital sodium as the active principal ingredient.
As we can see from this case, saying about your intentions to CTB maybe very risky. You are likely to be saved. So be careful with everything you say before you go!
As we can see from this case, saying about your intentions to CTB maybe very risky. You are likely to be saved. So be careful with everything you say before you go!
Lactic acidosis: case report |
A 3-year-old boy developed lactic acidosis following pentobarbital overdose containing propylene glycol (PG). The boy, who was already admitted in pulmonary ICU and had received various anti-epileptics earlier, was administered IV pentobarbital loading dose 10 mg/kg followed by 5 mg/kg/dose every 12hr four new-onset seizure, on day 3 of his hospitalisation (HD). On day 5, continuous infusion (CI) of pentobarbital was administered, titrated to a peak dose of 10 mg/kg/dose. Concomitantly he received various other antiepileptics. On HD 15, he developed hypotension and venous LA was seen. He received epinephrine and pentobarbital was decreased to 8 mg/kg/hour. Pentobarbital concentration was found to be elevated and propylene glycol cumulative dose was found to be 1398 mg/kg for all medications. Later, pentobarbital dose was increased to 10 mg/kg/hour, as he continued have subclinical seizures over the next week. On HD 37, again he developed hypotension and lactic acidosis, with an osmolar gap of 20.4 mOsm/kg. The boy received ringer lactate, sodium bicarbonate and dopamine. Pentobarbital was reduced to 5 mg/kg/hr, later tapered off as PG cumulative dose was found to be 4045.8 mg/kg. He was later discharged on levetiracetam, valproic acid, and diazepam Author comment: "[Pentobarbital] contains 40% propylene glycol (PG) and could result in lactic acidosis (LA)." "On HD 15 and 37, our patient received more than this threshold. The Naranjo probability scale supports a highprobable drug-related adverse event in our patient."
This is just a medical case without intentions to CTB. And it is not the first case when lactic acidosis was caused administering pentobarbital with propylene glycole. So buying N, please, check the contents. There might be Dilantin or propylene glycol a part of non-sterile liquid.
This is just a medical case without intentions to CTB. And it is not the first case when lactic acidosis was caused administering pentobarbital with propylene glycole. So buying N, please, check the contents. There might be Dilantin or propylene glycol a part of non-sterile liquid.
Comatose: case report |
A 43-year-old woman went comatose after the overdose of pentobarbital in an attempt to suicide [pentobarbitone; time to reaction onset not stated] The woman, who intentionally took pentobarbital overdose subcutaneously, was found comatose with bottle of 20% pentobarbital, from which 75mL was missing and a syringe. She was brought to emergency department with bag mask ventilation. She was neurologically unconscious with glasgow coma scale (GCS) score of 6 and was intubated. She was transferred to critical care unit and examination revealed mass on her anterior abdominal wall, which was considered as injection site. The woman was started on multiple doses of nasogastric charcoal [activated charcoal] and 24 hours later, she was started on haemodialysis. Head CT and EEG ruled out any intracranial pathology and dialysate fluid was positive for benzodiazepines. Subsequently, after a failed extubation, she developed ventilator-associated pneumonia. Fifteen days later, she was extubated and was discharged after 1 month. Author comment: "[T]his is the only case of attempted suicide by subcutaneous pentobarbitone poisoning in the literature.
As we can see, there was not a huge time span before she was found. And that is reducing our chances to die. So it is better to select an appropriate time, otherwise you may have to spend a month in a hospital. And again, no injection!
As we can see, there was not a huge time span before she was found. And that is reducing our chances to die. So it is better to select an appropriate time, otherwise you may have to spend a month in a hospital. And again, no injection!
Various toxicities: case report |
A 45-year-old man developed coma, cardiac arrest, fixed dilated pupils, apnoea, hypothermia, hypotonia, polyuria and hypernatraemia following an overdose pentobarbital with an intention of self-poisoning [time to reaction onsets not stated; not all outcomes stated]. The man self ingested 20 grams of pentobarbital (Nembutal) with an intention of self-poisoning. He had purchased pentobarbital via the internet two years prior. His medical history was significant for trigeminal neuralgia, chronic pain and bipolar affective disorder. His medications included asenapine, venlafaxine and gabapentin. Ten minutes after the overdose, he alerted his mother about it. The mother contacted emergency medical service (EMS). The mother found him unconscious on the floor and immediately started cardiopulmonary resuscitation (CPR). After 20 minutes of overdose, the EMS arrived and he was found to be in a pulseless electrical activity cardiac arrest. The CPR was continued along with additional advanced life support measures. During initial resuscitation, the man received epinephrine and spontaneous circulation was returned after 10 minutes. He was intubated and ventilated. After 30 minutes, he had a brief cardiac arrest. He received epinephrine along with CPR for 2 minutes and the spontaneous circulation was returned. He was shifted to the emergency department. Ninety-five minutes following the initial call to EMS, he arrived to the emergency department. On admission, he had fixed dilated pupils and was unconscious. The glasgow coma scale score was 3/15, and he was apnoeic on the ventilator. Additionally, he was hypothermic and hypotonic, with absent brainstem reflexes. His BP was 117/62mm Hg and HR was 116bpm. Venous blood gas test showed the following: pCO2 60mm Hg, pH 7.02, lactate 11.9 mmoL/L and bicarbonate 15 mmoL/L. ECG was unremarkable and CT scan during the hospitalisation showed no acute abnormalities. Treatment with activated charcoal was initiated, and he was shifted to the ICU. On day 1 of ICU admission, he developed polyuria and hypernatraemia and was treated with desmopressin. For the first 5 days, he received norepinephrine infusion as vasopressor. He continued to be in coma without sedation. On the third day of ICU, cerebral angiogram revealed normal cerebral perfusion. Qualitative analysis of urine detected presence of pentobarbital, which confirmed the cause of persistent coma. On the fifth day, the gag reflex returned on suctioning and eyes opened to painful stimuli. From the seventh day, he was started on propofol. However, he developed aspiration pneumonitis and the extubation was delayed. On day 10, he was extubated, and he was shifted to the medical ward on the following day. He received treatment for an additional ten days due to aspiration pneumonitis. After complete neurological recovery, he confirmed of ingesting pentobarbital 20 grams powder with water. Twenty-two days after the overdose, he was discharged to an inpatient mental health facility. He remained in the inpatient facility for further three weeks and was discharged. His serum pentobarbital concentrations were retrospectively analysed, which showed following pentobarbital concentrations: 112mg/L at 2.5 hours postingestion, 116mg/L at 29 hours post-ingestion, 2mg/L at 190 hours post-ingestion and was undetectable at 200 hours post-ingestion. Author comment: "We report a case of survival following deliberate self-poisoning with a potentially lethal dose of pentobarbital." "It is therefore important for clinicians to recognise that deep coma may be prolonged following pentobarbital overdose.
The person alerted his mother, destroying his chances to die (maybe he just did not want). 22 days in hospital and 3 weeks in mental health facility. No reports about any damage caused by N, hence we can assume the person successfully recovered. Besides, 20g of N seems too much for me, there is no need in overkilling yourself.
The person alerted his mother, destroying his chances to die (maybe he just did not want). 22 days in hospital and 3 weeks in mental health facility. No reports about any damage caused by N, hence we can assume the person successfully recovered. Besides, 20g of N seems too much for me, there is no need in overkilling yourself.
Various tocixities secondary to suicide attempt: 2 case reports |
A 24-year-old pregnant woman experienced various toxicities, including cardio-respiratory arrest, hypotension, deep hypothermia, reactive miosis, hypotonia, reduced consciousness and hypercapnic acidosis resulting from the ingestion of an overdose of pentobarbital in an attempt of suicide. Further, fetal movements transiently became absent. The 20 week-pregnant woman presented to hospital following the ingestion of 9g pentobarbital [Dolethal] in an attempt of suicide. At presentation, she was found to be in cardio-respiratory arrest. Fetal movements were absent. The woman received an external cardiac massage, following which she was intubated and admitted to the ICU for further management. She was found to have a deep hypothermia of 33.3°C and hypotension. Neurological examination revealed hypotonia, reactive miosis and a Glasgow Coma Scale (GCS) score of 3. A complete biological investigation of blood was undertaken. Initially, only hypercapnic acidosis was detected, with a pH of 7.28 and a pCO2 of 50mm Hg. Toxicological analyses revealed only presence of pentobarbital. The pentobarbital concentration in serum approximately 3 hours after the overdose was noted at 68.3 mg/L. Hence, continuous venovenous haemodiafiltration was initiated. The concentration of pentobarbital in serum after the procedure was noted at 33.6 mg/L. Thereafter, the concentrations steadily decreased to 28.9 mg/L, 15.9 mg/L and 6.7 mg/L at 30 hours, 50 hours and 70 hours post-ingestion. This coincided with an improvement in her state of consciousness, as monitored by her improving GCS score. By hospital day 2, the fetal movements, which were absent during admission, spontaneously recovered. No malformations or developmental problems were reported in the fetus [not all outcomes stated]. Author comment: "We describe a case of pentobarbital (Dolethal) acute intoxication in a 20 weeks pregnant woman and discuss the intoxication consequences in the mother and in the foetus.
The woman presented to hospital... It is not written did she call an ambulance or anybody else did that hence we cannot say was it a safe or her own decision. Just keep in mind, if you don't have enough time, don't try to CTB.
The woman presented to hospital... It is not written did she call an ambulance or anybody else did that hence we cannot say was it a safe or her own decision. Just keep in mind, if you don't have enough time, don't try to CTB.
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