Benzodiazepine toxicity: Difference between revisions
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*Isolated [[benzodiazepine]] overdose has low morbidity/mortality | *Isolated [[benzodiazepine]] overdose has low morbidity/mortality | ||
**Coingestion or parenteral administration accounts for vast majority of deaths | **Coingestion or parenteral administration accounts for vast majority of deaths | ||
**Respiratory depression rare with overdose of oral agents | |||
==Clinical Features== | ==Clinical Features== | ||
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===[[Flumazenil]]=== | ===[[Flumazenil]]=== | ||
*Controversial | *Controversial | ||
**May prevent need for mechanical ventilation; may precipitate benzo-withdrawal seizure | **May prevent need for [[mechanical ventilation]]; may precipitate benzo-withdrawal [[seizure]] | ||
*Indication: | *Indication: | ||
**Consider (though controversial) for coma reversal | **Consider (though controversial) for coma reversal | ||
| Line 37: | Line 38: | ||
**0.2mg IV; may repeat q1min (max dose 3mg) | **0.2mg IV; may repeat q1min (max dose 3mg) | ||
*Flumazenil-Induced Seizure | *Flumazenil-Induced Seizure | ||
**Treat with phenobarbital or propofol; benzodiazepines will not work | **Treat with [[phenobarbital]] or [[propofol]]; benzodiazepines will not work | ||
==Disposition== | ==Disposition== | ||
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*[[Sedative/Hypnotic]] | *[[Sedative/Hypnotic]] | ||
*[[Benzodiazepines]] | *[[Benzodiazepines]] | ||
*[[Benzodiazepine withdrawal]] | |||
==References== | ==References== | ||
Latest revision as of 05:55, 28 January 2021
Background
- Isolated benzodiazepine overdose has low morbidity/mortality
- Coingestion or parenteral administration accounts for vast majority of deaths
- Respiratory depression rare with overdose of oral agents
Clinical Features
- Somnolence, slurred speech, ataxia (similar to ETOH intoxication)
- Paradoxical reaction (more common in hyperactive children, psychiatric patients)
- Hypotension
- Respiratory depression
Differential Diagnosis
Sedative/hypnotic toxicity
- Absinthe
- Barbiturates
- Benzodiazepines
- Chloral hydrate
- Gamma hydroxybutyrate (GHB)
- Baclofen toxicity
- Opioids
- Toxic alcohols
- Xylazine toxicity
Evaluation
- Urine toxicology screen
- Most benzodiazepine screens look for oxazepam, which is a metabolite of diazepam and chlordiazepoxide. Therefore, lorazepam, alprazolam, and clonazepam are commonly missed.
- True positives: Oxazepam, temazepam, diazepam, alprazolam, triazolam
- False negatives: Lorazepam, clonazepam, midazolam
Management
- GI decontamination
- Mechanical ventilation if necessary
Flumazenil
- Controversial
- May prevent need for mechanical ventilation; may precipitate benzo-withdrawal seizure
- Indication:
- Consider (though controversial) for coma reversal
- Contraindications:
- Suspected or known physical dependence on benzodiazepines
- Suspected TCA overdose
- Co-ingestion of seizure-inducing agents
- Known seizure disorder
- Suspected increased intracranial pressure
- Dosing
- 0.2mg IV; may repeat q1min (max dose 3mg)
- Flumazenil-Induced Seizure
- Treat with phenobarbital or propofol; benzodiazepines will not work
Disposition
- Consider discharge after 6hr observation