Sedative/hypnotic toxicity
Background
Clinical Features
Differential Diagnosis
Sedative/hypnotic toxicity
- Absinthe
- Barbiturates
- Benzodiazepines
- Chloral hydrate
- Gamma hydroxybutyrate (GHB)
- Baclofen toxicity
- Opioids
- Toxic alcohols
- Xylazine toxicity
Evaluation
Toxic Alcohols Anion/Osmolar Gaps
Osmolar gap | Metabolic acidosis | Osmolar gap | Anion gap | Ketones | Ca Oxolate stones | Reduced vision | Management |
---|---|---|---|---|---|---|---|
Ethanol | + | + | + (if ketoacidosis) | + | - | Mainly supportive | |
Ethylene glycol | + | + | + | - | + | - | Fomepizole, Thiamine, Pyridoxine, +/- Dialysis |
Methanol | + | + (early on, then disappears) | + | - | - | + | Fomepizole or ethanol, Folinic acid, +/- Dialysis |
Isopropyl alcohol | - | + | - | + | - | + | Mainly supportive |
Propylene gylcol | + | + (initially) | + (converted to lactate) | - | - | - |
Toxidrome Chart
Finding | Cholinergic | Anticholinergic | Sympathomimetic | Sympatholytic^ | Sedative/Hypnotic |
Example | Organophosphates | TCAs | Cocaine | Clonidine | ETOH |
Temp | Nl | Nl / ↑ | Nl / ↑ | Nl / ↓ | Nl / ↓ |
RR | Variable | Nl / ↓ | Variable | Nl / ↓ | Nl / ↓ |
HR | Variable | ↑ | ↑ (sig) | Nl / ↓ | Nl / ↓ |
BP | ↑ | ↑ | ↑ | Nl / ↓ | Nl / ↓ |
LOC | Nl / Lethargic | Nl, agitated, psychotic, comatose | Nl, agitated, psychotic | Nl, Lethargic, or Comatose | Nl, Lethargic, or Comatose |
Pupils | Variable | Mydriatic | Mydriatic | Nl / Miotic | |
Motor | Fasciculations, Flacid Paralysis | Nl | Nl / Agitated | Nl | |
Skin | Sweating (sig) | Hot, dry | Sweating | Dry | |
Lungs | Bronchospasm / rhinorrhea | Nl | Nl | Nl | |
Bowel Sounds | Hyperactive (SLUDGE) | ↓ / Absent | Nl / ↓ | Nl / ↓ |
- ^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan
- Withdrawal from substances have the opposite effect