Wednesday, June 29, 2011

Phenobarbiturates overdose

I was reviewing some interesting cases with the residents this morning. A case caught our attention. This was a gentleman who came in the emergency room for phenobarbiturates overdose. We also found that this patient has a recurrent history of phenobarbiturates overdose. He usually comes in and gets admitted for a few days after he is stable, but this happens again and again. What happened here?

Phenobarbituates are a class of drugs used in epilepsy or in bipolar disorder. Its effect is to be used as a sedative to depress the central and peripheral nervous system, which means it will slow down our body's basic function, such as maintaining our body temperature, breathing and consciousness. If severe, it can lead to coma and death. Therefore, taking too much than instructed can be dangerous. 

Luckily, there is a solution clinically. The key is to get the drug out of the body as soon as possible. Phenobarbiturates are highly protein-bound, which makes it harder to eliminate from the kidney. If patient is loaded with bicarbonate, which will alkalize the body's pH, causing proteins to become more negatively charged. This will lead to phenobarbiturates dissociate from proteins and makes it easier to eliminate from the kidneys.

However, this patient purposely and recurrently puts himself in a phenobarbituates overdose state. Why would he do that?

He has a long history of epilepsy and is prescribed with phenobarbiturates. He is living in a supported housing program now. The reason he purposely overdosed himself is because he wanted attention. He feels that the staff members in the hospital take very good care of him, making him feel warm, cared and loved. So he created a reason for him to keep coming back to the hospital. Every time he "misses" the hospital, he would overdose himself. And when he was just about to pass out, he would call 911, so someone would come and bring him to the hospital. 

My point here is ***NOT*** blaming how this patient wastes medical resources. I want to point out the importance of love. Everyone needs love, even animals or plants need love. The definition of love is in the Bible, 1 Corinthians Chapter 13 vv. 4-7. Love is kind... It covers all things, believes all things, hopes all things, endures all things. Love never falls away. 

As an ordinary human being, I may not have great love like the Saints, but I can start from the people that are close to me. I love them, and I will make sure they know that I love them. Love is not hard to do. Love can be in a very simple gesture, a hug, a kiss or one look in the eyes. Love yourself first, otherwise it's hard to love others. Have you ever get a smile from a stranger on the street? Did that make you feel happy? If yes, smile at a stranger today, be more gentle when you drive, and things will feel so different today, everyday.

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