Benzodiazepine toxicity

Background

• Isolated benzo overdose has low morbidity/mortality
  • Coingestion or parenteral administration accounts for vast majority of deaths

Clinical Features

1. Somnolence, slurred speech, ataxia (similar to ETOH intoxication)
2. Paradoxical reaction (more common in hyperactive children, psychiatric pts)
3. Hypotension
4. Respiratory depression

Treatment

1. GI decontamination
   1. Activated charcoal x1
2. Mechanical ventilation if necessary
3. Flumazenil
   1. Controversial
      1. May prevent need for mechanical ventilation; may precipitate benzo-withdrawal seizure
   2. Indication:
      1. Consider (though controversial) for coma reversal
   3. Contraindications:
      1. Suspected or known physical dependence on benzodiazepines
      2. Suspected TCA overdose
      3. Coingestion of seizure-inducing agents
      4. Known seizure disorder
      5. Suspected increased intracranial pressure
   4. Dosing
      1. 0.2mg IV; may repeat q1min (max dose 3mg)
   5. Flumazenil-Induced Seizure
      1. Treat with phenobarbital or propofol; benzos will not work

Disposition

• Consider d/c after 6hr obs

Source

• Tintinalli