eMedicine Specialties > Emergency Medicine > Toxicology
Toxicity, Sedative-Hypnotics: Differential Diagnoses & Workup
Updated: Dec 10, 2007
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Workup
Laboratory Studies
- Obtain a complete blood count (CBC), arterial blood gas (ABG), glucose, chemistry, and toxicology screen. Screen for alcohol, salicylate, and acetaminophen with all intentional exposures.
- Quantitative serum drug concentrations are recommended for patients with serious toxicity
- Barbiturates: For short-acting drugs, the lethal dose is 3 g or a serum concentration higher than 3.5 mg/dL. For long-acting drugs, the lethal dose is 5-10 g or a concentration higher than 8 mg/dL.
- Methaqualone: A serum concentration higher than 8 mg/L is life threatening.
- Glutethimide: Consider hemodialysis if the serum concentration is higher than 3 mg/dL.
- Methyprylon: A serum concentration higher than 3 mg/dL is associated with severe toxicity and concentration higher than 6 mg/dL is typically fatal.
- Ethchlorvynol: Perform charcoal hemoperfusion for an ingestion more than 100 mg/kg or a serum concentration higher than 10 mg/dL.
- Chloral hydrate: The lethal dose is 10 g and a concentration higher than 100 mcg/mL is toxic.
- Meprobamate: Coma occurs at 6-20 mg/dL. The drug is fatal at serum concentrations higher than 20 mg/dL.
Imaging Studies
- Obtain an abdominal radiograph. Chloral hydrate is radiopaque.
Other Tests
- Obtain an electrocardiogram (ECG); co-ingested drugs may have direct cardiac effects (eg, tricyclic antidepressants).
- On urinalysis, blue-green urine has been reported with zaleplon (Sonata) overdose.
More on Toxicity, Sedative-Hypnotics |
| Overview: Toxicity, Sedative-Hypnotics |
 Differential Diagnoses & Workup: Toxicity, Sedative-Hypnotics |
| Treatment & Medication: Toxicity, Sedative-Hypnotics |
| Follow-up: Toxicity, Sedative-Hypnotics |
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References
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Further Reading
Keywords
sedative-hypnotic exposure, sedative-hypnotic toxicity, sedative-hypnotic poisoning, sedative-hypnotic overdose, CNS depression, benzodiazepines, barbiturates, nonbarbiturate nonbenzodiazepine sedative hypnotics, buspirone, zolpidem, ethchlorvynol, glutethimide, chloral hydrate, meprobamate, methaqualone, methyprylon, carisoprodol, gamma-hydroxybutyrate, GHB, gamma-butyrolactone, GBL, GABA, flumazenil, Quaalude, methohexital, Brevital, thiopental, Pentothal, amobarbital, Amytal, pentobarbital, Nembutal, secobarbital, Seconal, butalbital, Fioricet, Fiorinal, carbamates, meprobamate, Miltown, chloral derivatives, Noctec, ethchlorvynol, Placidyl, piperidines, glutethimide, Doriden, methyprylon, Noludar, quinazolinone, methaqualone, imidazopyridine, zolpidem, Ambien, alpidem, diphenhydramine, doxylamine
