Benzodiazepine toxicity: Difference between revisions
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==Background== | ==Background== | ||
*Isolated | *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== | ||
*Somnolence, slurred speech, ataxia (similar to [[ETOH intoxication]]) | |||
*Paradoxical reaction (more common in hyperactive children, psychiatric patients) | |||
*[[Hypotension]] | |||
*Respiratory depression | |||
== | ==Differential Diagnosis== | ||
{{Sedatve/hypnotic toxicity types}} | |||
==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]] | |||
**[[Activated Charcoal]] x1 | |||
*[[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== | ==Disposition== | ||
*Consider | *Consider discharge after 6hr observation | ||
==See Also== | ==See Also== | ||
*[[ | *[[Sedative/Hypnotic]] | ||
*[[Benzodiazepines]] | |||
*[[Benzodiazepine withdrawal]] | |||
==References== | |||
<references/> | |||
[[Category: | [[Category:Toxicology]] | ||
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