eMedicine Specialties > Emergency Medicine > Toxicology

Toxicity, Sedative-Hypnotics: Follow-up

Author: Jeffrey S Cooper, MD, Clinical Assistant Professor, Department of Surgery, The University of Toledo College of Medicine; Consulting Staff, Department of Emergency Medicine, Mercy Children's Hospital
Contributor Information and Disclosures

Updated: Dec 15, 2009

Follow-up

Further Inpatient Care

  • Assess for suicide risk.
  • With barbiturate toxicity, patients may be discharged after 6 hours of observation, provided that they are asymptomatic or minimally symptomatic.
  • Observe patients with benzodiazepine toxicity for at least 2 hours after recovery from flumazenil for late respiratory depression or resedation.
  • Patients with glutethimide (Doriden) toxicity require 24 hours of observation in the hospital.

Complications

  • Some sedative-hypnotics may have teratogenic or mutagenic effects.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • The use of flumazenil can be dangerous because of the potential to elicit withdrawal agitation or seizure. Its role in acute overdose is marginal because benzodiazepine overdose resulting in airway compromise can be adequately treated in an emergency setting without the dangers of flumazenil use. Recall that flumazenil's effect is likely to be shorter than that of many of the benzodiazepines.
  • Identification of the sedative or sedatives involved is important because some drug-specific treatments are available. Do not assume that addressing the ABCs is sufficient in a sedative overdose.
  • However, managing the ABCs is paramount. In particular, the airway should be protected if giving activated charcoal to a patient with declining mental status or obtundation. 
  • Be sure to consider co-ingestions. Sedatives are often abused in order to offset the effects of other drugs of abuse.
 


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
References
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References

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Further Reading

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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

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Contributor Information and Disclosures

Author

Jeffrey S Cooper, MD, Clinical Assistant Professor, Department of Surgery, The University of Toledo College of Medicine; Consulting Staff, Department of Emergency Medicine, Mercy Children's Hospital
Jeffrey S Cooper, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

Lance W Kreplick, MD, MMM, FAAEM, FACEP, Medical Director of Hyperbaric Medicine, Fawcett Wound Management and Hyperbaric Medicine; Consulting Staff in Occupational Health and Rehabilitation, Company Care Occupational Health Services; President and Chief Executive Officer, QED Medical Solutions, LLC
Lance W Kreplick, MD, MMM, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physician Executives
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals
John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

Michael J Burns, MD, Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center
Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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