Signs and symptoms

• Dizziness
• Confusion
• Drowsiness
• Blurred vision
• Unresponsiveness
• Anxiety
• Agitation
• Nystagmus
• Hallucinations
• Slurred speech
• Ataxia
• Coma
• Hypotonia
• Weakness
• Altered mental status, impairment of cognition
• Amnesia
• Paradoxical agitation
• Respiratory depression
• Hypotension

Tests and diagnosis

• Qualitative screening of urine or blood can be performed but rarely influences treatment decisions. Immunoassay screening techniques are performed most commonly.
• Blood glucose
• Arterial blood gas analysis
• Serum electrolytes
• Renal function test- BUN and creatine clearance
• Chest X-ray
• ECG
• Pregnancy test in women of childbearing age

Complications

• Aspiration pneumonia
• Rhabdomyolysis
• Fatality (rare)

Management of Benzodiazepine Poisoning

Cardio respiratory support

• Supplemental oxygen, intravenous access, and rapid glucose determination\
• Clean the air ways by thorough suctioning and insertion of oral airways
• If the patient is comatose, prompt intubation is strongly advocated because of worsening of respiratory failure.
• Correction of dehydration by CVP guided fluid therapy depending on the serum electrolytes.

Emergency department care

• Gastric lavage is not recommended routinely but may be considered if the presence of a lethal co-ingestant is suspected and the patient presents within 1 hour of ingestion.
• Single dose activated charcoal is recommended for decontamination if the patients presents with in 4 hrs
• Antagonist or Antidote – Flumazenil
• Flumazenil is the drug of choice to reverse the effects of benzodiazepines by selectively inhibiting GABA/BZD receptor complex.