Bullous lesions in acute barbiturate poisoning

To the Editor.— We had the opportunity to observe a case of extremely severe barbiturate poisoning characterized by the early appearance of multiple bullous lesions on the ocular conjunctiva and skin. We were not able to find a previous report of bullous lesions on the ocular conjunctiva. The patient was a 23-year-old man. Ten hours after taking 17.5 gm of phenobarbital he was in profound coma with shallow respiration and cyanosis, with a temperature of 37.8 C; pulse rate, 120 beats per minute; and blood pressure, 100/80 mm Hg. Corneal, tendon reflexes, and reaction of the pupils to light were absent. There was no response to painful stimuli and no bowel sounds were heard. The eyelids were swollen. There were bullae of considerable size on the ocular conjunctiva (Figure). Similar lesions developed on the skin of the heels four to eight hours later. Details of treatment, clinical course, and laboratory