ABSTRACT
Lab and X-Ray Findings ◾ Labs: To rule out other causes of stupor and coma (especially metabolic and neuro-
logic causes): Electrolytes, BUN, creatinine, glucose, serum alcohol and phenobarbital, LFTs, ABGs
Pathognomonic Signs ◾ Breath odor: Chloral hydrate and paraldehyde = pear-like; ethchlorvynol (Placidyl®) =
hands, buttocks, knees; (2) bromoderma = bromide acne = ulcerating acneiform eruption starts on face and spreads over body
◾ Airway protection: Endotracheal tube (ETT) inserted for airway maintenance and aspiration protection
especially for phenobarbital, meprobamate, and glutethimide ◾ WBI (whole-bowel irrigation)-polyethylene glycol/electrolyte solution (PEG/ELS):
For gastrointestinal concretions on x-ray (meprobamate) and overdoses with sustainedrelease SHs (diazepam and/or barbiturates)
Enhanced Elimination ◾ Acid-base manipulation: Urinary alkalinization only for phenobarbital (pKa = 7.21),
NaHCO3 1-2 mEq/kg IV bolus, then 150 mEq/L D5W to keep arterial pH 7.45-7.50 and urine pH 7.5-8.0; replace K losses.
