Sedative-Hypnotic Toxicity Workup

  • Author: Jeffrey S Cooper, MD, FAAEM, FACEP; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Apr 12, 2011
 

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.
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Imaging Studies

  • Obtain an abdominal radiograph. Chloral hydrate is radiopaque.
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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.
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Contributor Information and Disclosures
Author

Jeffrey S Cooper, MD, FAAEM, FACEP  Attending Physician, Department of Emergency Medicine, St Joseph Medical Center, Tacoma

Jeffrey S Cooper, MD, FAAEM, FACEP 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.

Specialty Editor Board

Lance W Kreplick, MD, FAAEM, MMM  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, FAAEM, MMM, is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physician Executives

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and 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.

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.

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.

References

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  2. Barnett R, Grace M, Boothe P, et al. Flumazenil in drug overdose: randomized, placebo-controlled study to assess cost effectiveness. Crit Care Med. Jan 1999;27(1):78-81. [Medline].

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  9. Hamad A, Sharma N. Acute zolpidem overdose leading to coma and respiratory failure. Intensive Care Med. Jul 2001;27(7):1239. [Medline].

  10. Hojer J, Salmonson H, Sundin P. Zaleplon-induced coma and bluish-green urine: possible antidotal effect by flumazenil. J Toxicol Clin Toxicol. 2002;40(5):571-2. [Medline].

  11. Isbister GK, O'Regan L, Sibbritt D, Whyte IM. Alprazolam is relatively more toxic than other benzodiazepines in overdose. Br J Clin Pharmacol. Jul 2004;58(1):88-95. [Medline].

  12. Liskow B, Pikalov A. Zaleplon overdose associated with sleepwalking and complex behavior. J Am Acad Child Adolesc Psychiatry. Aug 2004;43(8):927-8. [Medline].

  13. Lovett B, Watts D, Grossman M. Prolonged coma after eszopiclone overdose. Am J Emerg Med. Jul 2007;25(6):735.e5-6. [Medline].

  14. Meyer S, Kleinschmidt S, Gottschling S, Gortner L, Strittmatter M. [Gamma-hydroxy butyric acid: neurotransmitter, sedative and party drug]. Wien Med Wochenschr. Jul 2005;155(13-14):315-22. [Medline].

  15. Riegel W. Use of continuous renal replacement therapy for detoxification?. Int J Artif Organs. Feb 1996;19(2):111-2. [Medline].

  16. Rossman PG, Knesper DJ. The early phase of hospital treatment for disruptive adolescents! The integration of behavioral and dynamic techniques. J Am Acad Child Psychiatry. 1976;15(4):693-708. [Medline].

  17. Worthley LI. Clinical toxicology: part I. Diagnosis and management of common drug overdosage. Crit Care Resusc. Sep 2002;4(3):192-215. [Medline].

 
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