Benzodiazepine Toxicity Workup

Updated: Jan 23, 2020
  • Author: Chip Gresham, MD, FACEM; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Workup

Approach Considerations

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 to obtain depend on the presentation, as follows:

  • Arterial blood gas (ABG) assay, if respiratory depression is present
  • ECG, to evaluate for co-ingestants, particularly cyclic antidepressants
  • Chest radiograph, if respiratory compromise is present
  • Pregnancy test, in women of childbearing age

In cases of intentional overdose, measure the following:

  • Serum electrolytes
  • Glucose
  • BUN
  • Creatinine clearance
  • Ethanol level
  • Acetaminophen level