Benzodiazepine Toxicity Workup

Updated: Jan 03, 2018
  • 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 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

  • Glucose

  • blood urea nitrogen (BUN)

  • Creatinine clearance

  • Ethanol

  • Acetaminophen level