What is the primary treatment for severe barbiturate toxicity?

In severe barbiturate toxicity, the primary treatment is supportive care. This approach focuses on maintaining vital functions, ensuring airway protection, providing supplemental oxygen, and monitoring the patient closely for any life-threatening complications. Barbiturates can cause significant central nervous system depression, leading to decreased respiratory drive, altered mental status, and potential cardiovascular instability. Supportive care may include intubation and mechanical ventilation if respiratory failure is present, as well as intravenous fluids and medications to support blood pressure if hypotension occurs.

While hemodialysis can be helpful in certain cases of barbiturate toxicity, it is not always the first or primary treatment. It may be considered in severe cases where the ingested dose is life-threatening and the patient is not responding to supportive measures, but the mainstay of initial management remains supportive care. Other options such as activated charcoal may be utilized if the patient presents shortly after ingestion and is alert enough for oral administration, but it will not address the severe symptoms of toxicity. Flumazenil, on the other hand, is contraindicated in barbiturate overdose because it can precipitate seizures and worsen the patient's condition. Therefore, the focus in severe barbiturate toxicity should be on comprehensive supportive care.