Review Question - QID 106921

This patient's clinical presentation is consistent with barbiturate addiction. Cardiovascular collapse is one of the most deadly complications (another is seizures) of barbiturate withdrawal.

Symptoms of barbiturate withdrawal are similar to those of alcohol withdrawal and include restlessness, weakness, nausea, dizziness, sweating, tachycardia, and hypertension. More serious complications include seizures and psychosis, as well as severe hyperthermia and life-threatening cardiovascular collapse. Symptoms of withdrawal usually appear within 8-16 hours of the last usage. Similar to alcohol withdrawal, treatment of barbiturate withdrawal consists of benzodiazepines with a taper.

Miller and Gold discuss treatment of barbiturate withdrawal. They note that long-acting benzodiazepines are more effective than short-acting benzodiazepines for suppressing symptoms of withdrawal. They also note that protocols for treatment of barbiturate withdrawal can also be used for treatment of benzodiazepine withdrawal.

Bidlack and Morris discuss the timeline of phenobarbital withdrawal, noting that patients can experience withdrawal seizures even with drug tapers that last several months. They suggest that withdrawal occurs because long-term treatment with barbiturates leads to downregulation of GABA receptors. When the sedative is withdrawn, the patient lacks enough GABA receptors to carry inhibitory stimuli, which allows seizures to occur.

Illustration A is a chart showing symptoms of drug intoxication, withdrawal, and chronic use.

Incorrect Answers:
Answer 1: This is not a complication of barbiturate use or withdrawal.
Answer 2: Respiratory depression is a complication of barbiturate intoxication, not withdrawal.
Answer 3: HypERthermia, not hypOthermia is a complication of barbiturate withdrawal.
Answer 5: Although patients experiencing barbiturate withdrawal may become aggressive with caretakers, self-inflicted violence is not a common cause of death in these patients.