Benzodiazepine Toxicity Workup
- Author: Chip Gresham, MD, FACEM; Chief Editor: Asim Tarabar, MD more...
Overall, the laboratory detection of benzodiazepines (BZDs) depends upon the screening method used. Immunoassay screening techniques are performed most commonly and typically detect BZDs that are metabolized to desmethyldiazepam or oxazepam; thus, a negative screening result does not rule out the presence of a BZD. Qualitative screening of urine or blood may be performed but rarely influences treatment decisions and has no impact on immediate clinical care.
Tests and procedures depend on the presentation, as follows:
- Obtain a blood glucose level immediately if the patient has an altered mental status
- Obtain an arterial blood gas (ABG) if respiratory depression is present
- Obtain an electrocardiogram (ECG) to evaluate for co-ingestants, particularly cyclic antidepressants
- Obtain a chest radiograph if respiratory compromise is present
- Obtain a pregnancy test in women of childbearing age
In patients with an intentional overdose, measure the following:
- Serum electrolytes
- blood urea nitrogen (BUN)
- Creatinine clearance
- Acetaminophen level
Chyka PA, Seger D, Krenzelok EP, Vale JA. Position paper: Single-dose activated charcoal. Clin Toxicol (Phila). 2005. 43(2):61-87. [Medline].
Marraffa JM, Cohen V, Howland MA. Antidotes for toxicological emergencies: a practical review. Am J Health Syst Pharm. 2012 Feb 1. 69(3):199-212. [Medline].
Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. Substance Abuse and Mental Health Services Administration. Available at http://www.samhsa.gov/data/2k13/DAWN2k11ED/DAWN2k11ED.htm. Accessed: September 29, 2014.
Substance Abuse and Mental Health Services Administration. Emergency Department Data. SAMHSA. Available at http://www.samhsa.gov/data/emergency-department-data-dawn. April 4, 2016; Accessed: April 29, 2016.
Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol (Phila). 2015. 53 (10):962-1147. [Medline]. [Full Text].
Shah NA, Abate MA, Smith MJ, Kaplan JA, Kraner JC, Clay DJ. Characteristics of alprazolam-related deaths compiled by a centralized state medical examiner. Am J Addict. 2012 Nov. 21 Suppl 1:S27-34. [Medline].
Jann M, Kennedy WK, Lopez G. Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics. J Pharm Pract. 2014 Feb. 27(1):5-16. [Medline].
Darke S, Torok M, Duflou J. Circumstances and toxicology of sudden or unnatural deaths involving alprazolam. Drug Alcohol Depend. 2014 May 1. 138:61-6. [Medline].
[Guideline] Kleber HD, Weiss RD, Anton RF, et al. Treatment of patients with substance use disorders, second edition. American Psychiatric Association. Am J Psychiatry. 2006 Aug. 163(8 Suppl):5-82. [Medline]. [Full Text].
[Guideline] National Collaborating Centre for Mental Health. Self-harm: the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. London (UK): National Institute for Clinical Excellence (NICE). 2004. 199. [Full Text].
Penninga EI, Graudal N, Ladekarl MB, Jürgens G. Adverse Events Associated with Flumazenil Treatment for the Management of Suspected Benzodiazepine Intoxication - A Systematic Review with Meta-Analyses of Randomised Trials. Basic Clin Pharmacol Toxicol. 2016 Jan. 118 (1):37-44. [Medline].
The Flumazenil in Benzodiazepine Intoxication Multicenter Study Group. Treatment of benzodiazepine overdose with flumazenil. Clin Ther. 1992 Nov-Dec. 14(6):978-95. [Medline].
Seger DL. Flumazenil--treatment or toxin. J Toxicol Clin Toxicol. 2004. 42(2):209-16. [Medline].