Sedative-Hypnotic Toxicity Workup

Updated: Oct 11, 2019
  • Author: Jeffrey S Cooper, MD, FAAEM, FACEP; Chief Editor: Asim Tarabar, MD  more...
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Workup

Laboratory Studies

Obtain a complete blood count (CBC), arterial blood gas (ABG) sampling, 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. Significant results for specific agents include the following:

  • 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.

On urinalysis, blue-green urine has been reported with zaleplon (Sonata) overdose.

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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).

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