Benzodiazepine toxicity
Revision as of 11:15, 24 July 2016 by Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==")
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; benzos 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- High risk - GABA activity withdrawn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- High risk - GABA activity withdrawn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 obs