Benzodiazepine Toxicity Treatment & Management
- Author: Robin Mantooth, MD, FACEP; Chief Editor: Asim Tarabar, MD more...
Prehospital Care
- Cardiac monitoring
- Supplemental oxygen and airway support
- Intravenous access
- Rapid glucose determination (finger stick) and administration of D50 if necessary
- Naloxone can be administered at a very low dose (0.05 mg with gradual increase in dose if needed), if the diagnosis is unclear and an opiate co-ingestion is suspected (eg, evidence of severe respiratory depression).
- CAVEAT: Administration of 0.4 mg of naloxone will reverse respiratory depression in most opioid overdoses; however, it will also result in severe withdrawal symptoms (nausea, vomiting) in opioid-dependent individuals. This can be detrimental in patients who are still unable to protect their airway due to BZD effect (sedation) and can suffer from aspiration of gastric contents.
Emergency Department Care
Continue supportive care and monitoring (eg, cardiac monitoring, IV, oximetry, vital signs).
- Decontamination
- Ipecac syrup is contraindicated for prehospital or hospital use because of the risk for CNS depression and subsequent aspiration with emesis.
- Gastric lavage is not recommended 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 GI decontamination in patients with protected airway who present within 4 hours of ingestion. It is important to remember that isolated oral BZD overdose is relatively benign exposure (eg, prolonged sedation), and aspiration of activated charcoal can significantly worsen clinical outcome, sometimes resulting even in death.
- Respiratory depression may be treated with assisted ventilation.
- Flumazenil
- Flumazenil is a competitive BZD receptor antagonist and should be used cautiously because it has potential to precipitate BZD withdrawal in chronic users, resulting in seizures.
- Flumazenil administration is contraindicated in mixed overdoses (eg, TCAs) because BZD reversal can precipitate seizures and cardiac arrhythmias.
- Ideal indication for flumazenil use is isolated BZD overdose in BZD-naive patients, particularly if overdose is iatrogenic in nature (eg, during conscious sedation on BZD-naive patient).
- The American Psychiatric Association and the National Institute of Clinical Excellence have treatment and diagnostic guidelines available for cases of substance abuse and self-harm.[3, 4]
Consultations
- Toxicologist or a poison control center
- Intensive care specialist
- Psychiatrist, if suicide attempt
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