Benzodiazepine toxicity: Difference between revisions

Line 25: Line 25:
===[[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 37:
**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==

Revision as of 05:11, 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

Evaluation

Management

Flumazenil

  • Controversial
  • 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

Disposition

  • Consider discharge after 6hr observation

See Also

References