Sedative Hypnotic Poisoning

Benzodiazepine poisoning

Lithium poisoning

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BENZODIAZEPINE POISONING

T42.4 + (X41.99/X61.99/Y11.99)

DESCRIPTION

Patients present with depressed levels of consciousness, confusion, ataxia, and dysarthria. Benzodiazepines are unlikely to cause significant respiratory depression unless co-ingested with alcohol or other CNS depressants. However, there is a risk of respiratory depression due to overdose in the elderly.

GENERAL MEASURES
Management is supportive, and ventilation may be required.

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Note:
The use of flumazenil is not recommended in any patient with possible benzodiazepine poisoning as it increases the risk of convulsions and dysrhythmias.

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LITHIUM POISONING

T43.8 + (X41.99/X61.99/Y11.99)

DESCRIPTION

Lithium toxicity mostly occurs with chronic therapy and may be precipitated by decreased excretion due to renal dysfunction, diuresis, dehydration, hyponatraemia, or drug-drug interactions (e.g. NSAIDs, diuretics, ACE-inhibitors, and ARBs).

Signs and symptoms include:

• nausea, vomiting, and diarrhoea
• nystagmus
• CNS symptoms: tremor, hyperreflexia, choreoathetoid movements, fasciculations, ataxia, agitation, confusion and lethargy

In severe toxicity:

• Coma
• Seizures
• Dysrhythmias
• Hypotension

GENERAL MEASURES

Monitor:

• Vitals signs, mental status, and urine output.
• If available, do serial lithium levels 6 hourly until peaked and declining.
• Electrolytes and renal function.
• Cardiac function and treat dysrhythmias (see: Cardiovascular dysrhythmias).
• Thyroid function, in chronic toxicity.

MEDICINE TREATMENT

If ingested dose is potentially toxic or modified-release products were ingested, consider WBI.

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• Hydration: administer sodium chloride, 0.9 % to maintain urine flow of 1 to 2 mL/kg/hour while preventing hypernatremia.
• Correct electrolyte abnormalities: see: Major electrolyte abnormalities.
• For seizures: Treat with benzodiazepines – see: Status epilepticus 

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Note:
Phenytoin should be avoided (due to potential cardiotoxicity).

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REFERRAL

Early referral for haemodialysis is indicated in severe lithium poisoning and in patients with renal impairment. Discuss with a specialist.

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Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 2.0_27 March 2025

Chapter 19 Poisoning_19.9 Sedative Hypnotic Poisoning