Acute phenobarbital poisoning in a resource-limited setting: A case report of successful management through high index of suspicion and immediate care

Abstract

A 33-year-old known epileptic female patient, who has been on phenobarbital 100 mg orally once daily for the past 6 years, presented to our emergency room after she was found unconscious. On presentation, she was unable to protect her airway and had significant oral secretions upon airway examination. Glasgow Coma Scale was 3/15 with severe respiratory compromise, necessitating immediate intubation and mechanical ventilation. Due to the high index of suspicion given the clinical presentation, serum phenobarbital level was determined and had shown to be markedly elevated. Hence, the diagnosis of phenobarbital poisoning was confirmed. Following this, the patient was promptly managed with two cycles of hemodialysis. After that, the patient regained consciousness. This case led us to conclude that clinicians need to have a high index of suspicion of medication overdose in epileptic patients and, therefore, should take a thorough medication history.