Pentobarbital Toxicity after Self-Administration of Euthasol Veterinary Euthanasia Medication

Abstract

Suicide attempt via sodium pentobarbital is uncommon. A 48-year-old woman with a history of depression and prior suicide attempt was found unresponsive by her veterinarian spouse near a syringe containing pink solution. Upon EMS' arrival, the patient was experiencing apnea, hypoxemia, and miotic pupils; her blood glucose level measured 73 mg/dL. She was bradycardic and administered atropine with transient improvement in heart rate and transported to an emergency department; 2 mg of intravenous naloxone was administered without effect. She was endotracheally intubated via rapid sequence intubation. Rapid urine drug screening detected both benzodiazepines and barbiturates. The patient was transferred to an intensive care unit where she demonstrated a nearly absent radial pulse. Emergent fasciotomy to the left forearm and carpal tunnel was performed for acute compartment syndrome; “Euthasol” had been self-administered into the antecubital fossa. Expanded toxicological analysis via liquid chromatography/mass spectroscopy detected caffeine, atropine, 7-aminoclonazepam, phenytoin, citalopram, and naproxen. The patient's coma resolved over 48 hours and she was successfully extubated without complication. Emergency physicians must closely monitor patients exposed to veterinary euthanasia agents who develop central nervous system and respiratory depression, hypothermia, bradycardia, hypotension, or skin injury. Consultation with a regional poison center and medical toxicologist is recommended.

Suicide by Fatal Pentobarbital Intoxication in Ontario, Canada, from 2012 to 2015

“…Fatalities due to pentobarbital have been reported at postmortem blood concentrations of 10 mg/L and higher . A recent suicide attempt with intravenous pentobarbital was reported in which the admission serum pentobarbital concentration was 12.6 mg/L .…”

Recurrent Admissions for Hypothermia From Concomitant Topiramate and Phenobarbital: A Case Report

“…6 Since then, multiple other case reports have been reported in the literature. 2,7 –9 While toxic concentrations of barbiturates have been correlated to cause hypothermia, this was not the case in this patient as she was always found to have therapeutic phenobarbital levels. However, one of the limitations includes a lack of documented medication administration in regard to timing of drug levels to validate the appropriateness of the drug levels.…”

“…Numerous case reports have described hypothermia with barbiturates, usually in the setting of overdose. 2,[5][6][7][8][9] Lee and Ames first documented an incidence of hypothermia in *50% of barbiturate overdoses in a 1965 case series that was mostly associated with short-acting barbiturates. 5 In 1966, another case reported noted severe hypothermia of 23 C with an overdose of 50 capsules of sodium amylobarbitone.…”

Old and Cold: A Novel Case of Combined Secobarbital and Pentobarbital Poisoning in an Elderly Woman

“…Commonly prescribed barbiturates include phenobarbital, which is used for epilepsy and alcohol withdrawal, and butalbital, which is used for epilepsy and headache [ 1 ]. Additionally, pentobarbital is used as a general anaesthetic in both humans and animals [ 2 ]. Secobarbital is prescribed only as a primary euthanasia agent where physician-assisted suicide has been legalized [ 2 ].…”

“…Additionally, pentobarbital is used as a general anaesthetic in both humans and animals [ 2 ]. Secobarbital is prescribed only as a primary euthanasia agent where physician-assisted suicide has been legalized [ 2 ]. Though diagnosing barbiturate toxicity can be difficult, it is essential to recognize some of its potential effects such as severely depressed mental status and hypothermia.…”