Benzodiazepine toxicity

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