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Benzodiazepine Poisoning
Benzodiazepine poisoning
Mechanism of toxicity
Toxic Dose
Symptoms and signs of poisoning
Special investigations
Management
Mechanism of toxicity
Potentiates the activity of the major CNS inhibitory neurotransmitter GABA.
Toxic dose
Toxic-to-therapeutic ratio very high requiring high doses to cause toxicity.
Symptoms and signs of poisoning
- Central nervous system: Confusion, drowsiness, paradoxical agitation, hallucinations, slurred speech, ataxia, coma
- Cardiovascular: hypotension
- Respiratory: depression
Special investigations
- No specific investigations required in patients with mild toxicity
- Qualitative (reported as negative or positive) urine benzodiazepine to confirm diagnosis
Management
| Intervention | Not effective | Consider | Indicated |
| Gastric lavage | |||
| Early post-ingestion activated charcoal | |||
| Multiple dose activated charcoal | |||
| Dialysis | |||
| Charcoal haemoperfusion |
Antidote: flumazenil
- Indications: Reversal of respiratory depression
- Contraindications: mixed overdose with CNS and CVS toxic drugs such as tricyclic antidepressants (precipitate seizures and arrhythmias), benzodiazepine dependant patients (precipitate withdrawal)
- Dosing: 0.2 mg IV over 15 seconds; if no response is achieved in 60 seconds 0.1 mg IV may be repeated at 60 second intervals as required to a maximal dose of 1–2 mg
Symptomatic and supportive:
- Support of airway (including intubation if respiratory depression or coma), breathing and circulation is the mainstay of treatment.