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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home First Aid and Emergency Benzodiazepines Poisoning

Benzodiazepines Poisoning

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Benzodiazepines are sedative-hypnotic agents, commonly used for seizure control, anxiety, alcohol withdrawal, insomnia, and as muscle relaxants. Most cases are suicidal but some occur through error and ungraded exploration in children.

 

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.

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