{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T12:56:28Z","timestamp":1781873788127,"version":"3.54.5"},"reference-count":12,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,5,21]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>Pentobarbitone is a short-acting barbiturate central nervous system depressant used primarily for veterinary anaesthesia and euthanasia. Pentobarbitone has recognised clinical uses, including in anaesthesia and management of refractory seizures but may also be encountered in cases of intentional overdose. This report presents the case of a patient who ingested pentobarbitone and required mechanical ventilation for 6\u2009days. Pentobarbitone and a barbiturate test kit were later found in the patient\u2019s home. Blood analysis revealed pentobarbitone concentrations of 91, 56 and 19\u2009mg\/L at 11, 59 and 107 hours post-ingestion, respectively. Following intensive supportive care, the patient made a full recovery. The case describes coma, respiratory failure and barbiturate-associated skin and vascular complications, with diagnosis delayed due to the agent\u2019s absence from standard hospital drug screens. As pentobarbitone may not cross-react with common phenobarbitone assays, rapid access to comprehensive toxicological analysis is critical for identifying uncommon toxicities and guiding timely clinical and public health responses. This case highlights that pentobarbitone toxicity may mimic severe neurological injury and may not be detected on routine hospital toxicology screening.<\/jats:p>","DOI":"10.1136\/bcr-2026-272273","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T12:40:30Z","timestamp":1781872830000},"page":"e272273","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Self-administered pentobarbitone overdose with prolonged coma and delayed toxicological diagnosis"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3912-9293","authenticated-orcid":false,"given":"William","family":"Li","sequence":"first","affiliation":[{"name":"Medicine, The University of Sydney - Camperdown and Darlington Campus, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasia","family":"Vardakis","sequence":"additional","affiliation":[{"name":"Medicine, The University of Sydney - Camperdown and Darlington Campus, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"2026061905402685000_19.6.e272273.1","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1080\/15563650.2020.1789653","article-title":"Trends and characteristics in barbiturate deaths Australia 2000\u20132019: a national retrospective study","volume":"59","author":"Campbell","year":"2021","journal-title":"Clin Toxicol"},{"key":"2026061905402685000_19.6.e272273.2","doi-asserted-by":"publisher","DOI":"10.1111\/1556-4029.13828"},{"key":"2026061905402685000_19.6.e272273.3","doi-asserted-by":"crossref","first-page":"849","DOI":"10.3109\/15563650.2010.512562","article-title":"Death on the doorstep of a border community - intentional self-poisoning with veterinary pentobarbital","volume":"48","author":"Cantrell","year":"2010","journal-title":"Clin Toxicol (Phila)"},{"key":"2026061905402685000_19.6.e272273.4","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s13181-018-0675-3","article-title":"Deliberate Self-poisoning with a Lethal Dose of Pentobarbital with Confirmatory Serum Drug Concentrations: Survival After Cardiac Arrest with Supportive Care","volume":"15","author":"Druda","year":"2019","journal-title":"J Med Toxicol"},{"key":"2026061905402685000_19.6.e272273.5","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.forsciint.2016.11.042","article-title":"Pentobarbital in the context of possible suicides: Analysis of a Case","volume":"274","author":"Melo","year":"2017","journal-title":"Forensic Sci Int"},{"key":"2026061905402685000_19.6.e272273.6","article-title":"Pentobarbital Toxicity after Self-Administration of Euthasol Veterinary Euthanasia Medication","volume":"2016","author":"Crellin","year":"2016","journal-title":"Case Rep Emerg Med"},{"key":"2026061905402685000_19.6.e272273.7","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1093\/jat\/bkw118","article-title":"Simultaneous Screening and Quantification of Basic, Neutral and Acidic Drugs in Blood Using UPLC-QTOF-MS","volume":"41","author":"Bidny","year":"2017","journal-title":"J Anal Toxicol"},{"key":"2026061905402685000_19.6.e272273.8","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1002\/dta.292","article-title":"Acute toxicity and withdrawal syndromes related to gamma\u2010hydroxybutyrate (GHB) and its analogues gamma\u2010butyrolactone (GBL) and 1,4\u2010butanediol (1,4\u2010BD)","volume":"3","author":"Wood","year":"2011","journal-title":"Drug Test Anal"},{"key":"2026061905402685000_19.6.e272273.9","doi-asserted-by":"crossref","unstructured":"Koizumi Y , Higashitani M , Fukui S , et al . n.d. A Case of Barbiturate Poisoning From Pentobarbital in a Young Japanese Patient. Cureus 15:2. doi:10.7759\/cureus.36498","DOI":"10.7759\/cureus.36498"},{"key":"2026061905402685000_19.6.e272273.10","doi-asserted-by":"crossref","first-page":"46","DOI":"10.18700\/jnc.230019","article-title":"Unexpected epileptogenic effect of lethal doses of pentobarbital: a case report","volume":"16","author":"Giudicelli-Bailly","year":"2023","journal-title":"J Neurocrit Care"},{"key":"2026061905402685000_19.6.e272273.11","unstructured":"TGA . Therapeutic goods administration: notice of interim decisions on proposed amendments to the poisons standard - ACMS\/ACCS\/joint ACMS-ACCS meet- ings, March 2020.: Therapeutic Goods Administration (TGA). 2022. 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