Benzodiazepine toxicity: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Somnolence, slurred speech, ataxia (similar to ETOH intoxication) | *Somnolence, slurred speech, ataxia (similar to [[ETOH intoxication]]) | ||
*Paradoxical reaction (more common in hyperactive children, psychiatric patients) | *Paradoxical reaction (more common in hyperactive children, psychiatric patients) | ||
*Hypotension | *[[Hypotension]] | ||
*Respiratory depression | *Respiratory depression | ||
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==Management== | ==Management== | ||
*GI decontamination | *[[GI decontamination]] | ||
**[[Activated Charcoal]] x1 | **[[Activated Charcoal]] x1 | ||
*Mechanical ventilation if necessary | *[[Mechanical ventilation]] if necessary | ||
*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 | ||
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==Disposition== | ==Disposition== | ||
*Consider discharge after 6hr | *Consider discharge after 6hr observation | ||
==See Also== | ==See Also== | ||
Revision as of 04:49, 12 March 2017
Background
- Isolated benzodiazepine overdose has low morbidity/mortality
- Coingestion or parenteral administration accounts for vast majority of deaths
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
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
- Controversial
- Withdrawal
- High risk - GABA activity withdrawn
- CNS excitation:agitation, tremor, hallucinations, seizures
- Autonomic Instability: tachycardia, hypertension, hyperthermia, diaphoresis
- High risk - GABA activity withdrawn
Disposition
- Consider discharge after 6hr observation