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November 23, 1970

Barbiturate Coma Bullae

Author Affiliations

London, Ontario

JAMA. 1970;214(8):1564. doi:10.1001/jama.1970.03180080144033

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To the Editor.—  I would like to describe briefly a case quite similar to those reported by Drs. Mandy and Ackerman (213:253, 1970).On Jan 31, 1969, a 42-year-old man was found unconscious in his car after taking 24 tablets of a secobarbital-butabarbital mixture together with much alcohol. He regained consciousness the next day, saying that he had wanted to commit suicide. Twenty-four hours after admission, "blisters" developed on heels, buttocks, and fingers. These were first described as "pressure sores" with an erythematous base, but they rapidly changed into large tense vesicles and bullae. The subsequent course was uneventful except for a pneumonia which subsided on antibiotic treatment. The skin lesions had healed by the time of discharge on Feb 13.We were impressed by the rapidity of development and peculiar distribution of the skin lesions. The body position while he was unconscious in the automobile, we learned later,